Children with cerebral palsy may be at risk for malnutrition or being undernourished. This is because the neurological condition affects motor skills and that may include the muscles and movements involved in chewing and swallowing or eating independently. These children may also have gastrointestinal complications that affect what they eat and how they absorb nutrients.
To manage 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 having dysphagia as a complication of the condition. Also known as oral motor dysfunction, dysphagia refers to an inability to swallow normally. 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 motor dysfunctions, these may be affected and swallowing, talking, and breathing may be impaired. Dysphagia may occur in the muscles of the oral cavity, in the pharynx and in the sphincter of the esophagus. This is called oropharyngeal dysphagia. Esophageal dysphagia affects the lower part of the esophagus.
Strategies for eating and swallowing with dysphagia include changing the consistency of a food, making it more liquid or more solid, chewing more thoroughly, and eating smaller portions of food, multiple times a day. Muscle exercises guided by a physical therapist or speech and language pathologist can also help a child swallow more easily. In severe cases, feeding tubes or surgery on the esophagus can be used.
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 longer 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. Acid reflux and gastroesophageal reflux disorder are not uncommon with cerebral palsy and cause 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 can help.
Consequences of Poor Nutrition
If a child is not eating enough or is not getting enough macro and micronutrients because of food choices, the results can be long-lasting. Poor nutritional status may cause specific vitamin deficiencies, constipation, tooth decay, osteopenia or osteoporosis, poor growth 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 malnourished or undernourished.
Some of the common specific deficiencies that children with cerebral palsy experience are 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 eating 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. With cerebral palsy, though, there are more concerns and more difficulties.
A child with this condition may struggle just to swallow anything and may end up with malnutrition and undernourishment as result. The consequences over the long-term can be devastating, but by treating the underlying causes and by developing a complete diet, a child can recover from malnutrition and begin to thrive again.