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Nutrition
FEEDING DIFFICULTIES

feeding-difficulties

Emily S.
Emily will take you through the feeding difficulties and the nutritional needs of a child with CP:
“It is not easy, but you develop a routine...”

Cerebral palsy and feeding


You might already know that children with cerebral palsy (CP) often have feeding difficulties. This is because CP affects body movement and muscle control and the act of eating requires a large number of muscle groups working together (especially facial muscles).

“Ever since he was born he had trouble feeding; everything he did drink, it came back straight back up”
Emily S.

It is important to notify your healthcare team if your child is having any feeding difficulties, especially if it has been happening for some time. Your child might not be receiving enough nutrition, and this might affect his/her growth and development.


If this is the case, your team of healthcare professionals can help you create a nutritional plan.


It is important to remember that your child’s needs will change over time. Consult with your healthcare team before trying something new or making changes to your child’s diet.


Your healthcare professional may ask you a few questions to learn more about your child’s eating or mealtime behaviour. Possible questions are:


  • How long does it take to feed your child?
  • How would you describe mealtimes?
  • Is your child gaining weight as expected? 
  • How would you describe your child’s breathing during and after meal times? This includes being short of breath or coughing while eating and drinking.

Depending on the answers, your healthcare professional will guide you to the nutritional solution that will best support your child.

" Your child not eating can take you to places that you don´t want to go...I wasn´t eating because he couldn´t eat”

Miriam, Yehoshua’s mum

What is dysphagia?


Dysphagia, the medical term for swallowing difficulties, is the most common feeding difficulty in children with moderate to severe cases of cerebral palsy. Dysphagia may lead to your child being unable to eat and drink enough each day to reach their growth and development potential or put them at risk of malnutrition or dehydration.


In some children with dysphagia, foods or liquids may go down the wrong way, and into their airway. The medical term for this is “aspiration”, and it may lead to respiratory problems, such as pneumonia or chest infections.


If your child has trouble swallowing, he or she may show some of these signs while eating or drinking:1


Physical


  • Coughs and/or chokes during eating
  • Changes in facial colour while eating or drinking
  • Becomes tired during meals
  • Has difficulty retaining food in the mouth
  • Excessive food remains in mouth
  • Coughing that persists after eating
  • Does not gain weight
  • Sweats during meals

Behavioural


  • Change in eating or drinking habits, either gradual or sudden
  • Does not want to eat
  • Avoids certain foods and drinks
  • Takes a long time to eat or drink
  • Wants to eat alone

Talk to your healthcare professional if you notice any of these signs or if you have any other questions about your child’s swallowing.


Changing the textures of food and thickness of liquids your child eats and drinks may help your child swallow more safely and get the nutrition they need to grow.

Solid foods may need to be chopped, minced or pureed, and drinks and other liquids may need to be thickened so they are more easily managed in the mouth and during swallowing. The textures of food and thickness of liquids may vary according to your child’s needs. Your child’s healthcare professional may advise you on what texture is right for your child.

→Check out the section related to nutritional strategies


References:

  1. Arvedson JC. Feeding children with cerebral palsy and swallowing difficulties. Eur J Clin Nutr. 2013;67 Suppl 2:S9-12.

Understanding gastro-esophageal reflux disease (GERD).


Your child may also experience reflux, also called gastro-esophageal reflux disease (GERD). If you have GERD, it feels like your stomach contents are coming back up into your throat. This can be very uncomfortable and may cause a change in your child’s feelings about eating. GERD can be controlled through specific medications that can be prescribed by your healthcare professional.


Certain changes could also help, such as correct positioning of your child and refraining from laying your child down directly after meal times.

Be on the lookout for other conditions


Your child may also be experiencing associated conditions, such as:

Constipation

Constipation is also a frequent issue in children with CP. Up to 74% of children with severe disabilities have constipation.1 The factors that contribute to constipation are:1

  • Reduced liquids and fibre intake
  • Abnormal bowel movements
  • Prolonged periods without a bowel movement
  • Skeletal abnormalities
  • Decreased muscle tone (Generalised hypotonia)

If your child is experiencing constipation frequently, it can lead to chronic nausea, recurrent vomiting, abdominal pain and, ultimately, reduced food intake.1

A child with constipation might refuse to eat due to pain in his/her tummy and may not get the required nutrition for proper growth and development.1

Obesity

Children with limited mobility are at an increased risk of obesity.  Talk to your healthcare professional about an individualized diet plan that is right for your child.

References:

  1. Penagini F et al. Dietary Intakes and Nutritional Issues in Neurologically Impaired Children. Nutrients.2015;7(11):9400-15.