Cerebral Palsy and Malnutrition
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People with cerebral palsy may be at risk for malnutrition or being undernourished. This is because the neurological condition may affect the muscles and movements involved in chewing, swallowing, and eating independently. These children may also have gastrointestinal complications that affect what they can eat and how they absorb nutrients.
Managing nutritional health in a child with cerebral palsy is important. There are various treatments, therapies, and simple eating strategies that can ensure a child gets enough nutrition and adequate nutrients in the proper ratios. To implement these strategies, though, it is first important to monitor a child to determine if there is a nutritional deficiency of any type.
Dysphagia – Oral Motor Dysfunction
One of the main reasons that a child with cerebral palsy is at risk of developing a nutritional problem is because of dysphagia, or difficulty swallowing. Not only does this make eating difficult, it also makes breathing difficult and may increase the risk of choking. Dysphagia is most common in children with moderate to severe cerebral palsy.
The muscles that are coordinated to move food from the mouth, down the esophagus, and into the stomach are complexly linked. In a child with cerebral palsy, these muscles are commonly affected and swallowing, talking, and breathing may be impaired. Dysphagia may be oropharyngeal, occurring in the muscles of the oral cavity and back of the throat, or esophageal, which affects the lower part of the esophagus and entry into the stomach.
Strategies to improve eating and swallowing with dysphagia include changing the consistency of a food to make it softer, thinner, or thicker as needed, chewing more thoroughly, and eating smaller portions of food, multiple times a day. Muscle exercises guided by a physical therapist or speech language pathologist can also help a child swallow more easily. In severe cases, feeding tubes may be necessary.
Other Causes of Malnutrition
Dysphagia is not the only complication of cerebral palsy that can cause problems with eating and nutrition. Other muscle and motor difficulties may make eating difficult, such as difficulty holding utensils. In these cases, meal times may be long and tiring and a child may give up before consuming adequate calories and nutrients. Making foods easier to eat, using adaptive equipment, and having smaller meals more frequently can all help.
Gastrointestinal health can also play a role in nutritional deficits. Gastroesophageal reflux is not uncommon with cerebral palsy and causes heartburn, ulcers, and pain. These symptoms make eating difficult and many children may refuse to eat because of the discomfort it causes. It is important to monitor gastrointestinal health in these children and to treat the acid reflux with medications and provide a diet that reduces reflux where indicated.
Consequences of Poor Nutrition
If a child is not eating enough or is not getting enough macro and micro nutrients because of food choices, the results can be long-lasting. Poor nutritional status may cause specific vitamin deficiencies, constipation, tooth decay, decreased bone density, poor or delayed growth, and failure to thrive in infants. A child may also experience urinary tract infections, incontinence, diarrhea, bowel obstruction, halitosis, and irritable bowel syndrome from being poor nutrition.
Some of the common specific deficiencies that children with cerebral palsy experience are in overall calories, protein, vitamin D, vitamin B12, iron, folic acid, zinc, calcium, magnesium, phosphorus, and copper. Each of these comes with its own consequences and symptoms and supplementing with the missing nutrient may be necessary.
A child with cerebral palsy may even suffer from being overweight or obese. This may result from poor food choices, eating foods that taste good and are easy to eat instead of considering nutrition, but also from the fact that many kids with cerebral palsy are unable to be very active. Many of the consequences of poor nutrition can be reversed, but when severe, the problems may persist for years.
Working with a Dietitian
Addressing and treating the underlying cause of malnutrition is an important first step, whether that means therapy to make swallowing easier or better utensils to make self-feeding easier. However, it is also important that a child with nutritional deficits get professional guidance in food choieces and maintaining a good balance of nutrients in the diet.
A registered dietitian can help parents and children develop a meal plan that will provide all the nutrients and calories a child needs. A dietitian will also create a meal plan that considers a child’s unique needs and difficulties, including the use of nutritional shakes and supplements. Supplementing with vitamin D and calcium may be especially important for strengthening bones. Because children with cerebral palsy are generally less active, they are at a greater risk for developing weak bones.
Nutrition is an important consideration when raising any child. All children are growing and developing and need the right nutrition and adequate calories in order to develop normally. This is equally important, though often much more challenging when considering the care of a child with cerebral palsy.
A child with this condition may struggle just to swallow anything and may end up with malnutrition and undernourishment as a result. The consequences over the long-term can be devastating, but by treating the underlying causes and by developing a well rounded diet, malnutrition can be avoided or corrected in order to help these children reach their best health outcomes.
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