Cerebral palsy (CP) is a neuromuscular disorder that affects muscular coordination, movement and muscle tone. Amongst children, it can be difficult to deal if not handled correctly.
These children are frequently affected with malnutrition because of various reasons. The reasons can be as follows..
• Undernourishment or over nutrition, hormonal problems
• Frequent infections
• loss of appetite because of constipation or gastro esophageal reflex
• Dependency on others for feeding
• problems in feeding, eating, drinking etc.
• Weight of the child
However, with the administration of the right feeding and diet techniques, mealtime experiences can be enjoyed despite cerebral palsy in children.
• Estimate energy needs according to: age, activity level, growth rate and muscle tone More spasticity CP require more energy expenditure, Ambulatory spastic CP have medium energy expenditure while Wheel chair bound/non ambulatory have lower energy expenditure. Reduced physical activity leads to weight gain and Wt gain itself detrimental to person’s physical activity and it becomes vicious cycle.
• The solution is good balanced diet having all the kind of nutrients including vegetables and fruits.
• These children are more vulnerable to vitamin D deficiency because they are confined indoors. To prevent this regular exposure to sunlight is necessary.
• Assessment and treatment of any hormone related problem should be done promptly.
• Standing, walking, outdoor activity, regular physical therapy must be done. The key is to be mobile as much as possible.
Type of nutritional problems for CP children
Reasons of Nutrition related problems in cerebral palsy in children
1) Feeding, Eating, Drinking and Swallowing Difficulties (FEDS),
2) Oro-motor Difficulties
3) Sensory Difficultés
4) Self-Feeding
5) Gastro-esophageal Reflux
6) Constipation
7) Tooth Decay
FEDS (Feeding eating, drinking and swallowing) for this it is necessary to maintain posture of child and the body must be in one direction. You can use CP chair or corner chair if needed. The feeder must sit facing towards the child and try to develop coordination by supporting jaw and upper lip closure. The child must first learn to have liquids properly then semisolids and then solids. You must always give small bites and give second bite only after mouth is cleared of the first. Let the child take her own time. Encourage child to eat himself, use various assistive devices for this.
GOR: This can be potentially hazardous. If the child regurgitates the food and aspirates it into the lungs it can even be fatal. To prevent this always feed the child in propped up position and always give small but frequent meals. Avoid giving acidic food and prevent or treat constipation.
Digestive problems such as constipation and gastro esophageal reflux often make eating uncomfortable. These children are frequently constipated because of less mobility and faulty diet. Give them plenty of fibrous diet like green vegetables, fruits, whole grains etc. These children are also very much vulnerable for tooth decay which further hampers their nutrition. To prevent this regular cleaning with soft toothbrush is necessary especially at night before sleeping.
