Feeding problems are common and often severe in individuals with cerebral palsy. According to a study performed by Elsevier titled, “Gastrointestinal manifestations in children with cerebral palsy,” ninety-two percent of those with cerebral palsy had one or more significant gastrointestinal symptoms, including difficulty swallowing, regurgitation, abdominal pain, chronic pulmonary aspiration, and chronic constipation. The majority of those who experienced swallowing difficulties had oral dysfunction.
In a study published March 3, 2000 in Developmental Medicine & Child Neurology compiled by the Department of Paediatrics at the University of Oxford in the United Kingdom, not only were gastrointestinal problems common and severe, a significant amount of those experiencing these problems did not receive a feeding or nutrition assessment.
Common and severe gastrointestinal problems include:
- Chronic pulmonary aspiration
- Chest infections
- Prolonged feeding times
Feeding difficulties may lead to less than ideal food intake causing a child to become malnourished. Failure to thrive, malnutrition, growth delay, and gastroenterological conditions can result. Feeding difficulties can lead to life threatening situations such as food aspiration and pneumonia.
Since cerebral palsy involves motor function impairment, facial muscles are commonly affected in a condition known as oral motor dysfunction. If a child is unable to properly control facial muscles, speech impairment, drooling, sucking, chewing and swallowing challenges can result.
Nutritional Assessments and Meal Planning
Those with cerebral palsy can greatly benefit from a feeding and nutrition assessment. The focus of the assessment is to prevent or treat in a manner that provides proper nourishment levels while improving the individual’s ability to consume and digest foods comfortably.
One or more of the following individuals may be necessary to assess, formulate, prescribe, manage, and monitor the child’s dietary intake:
- Clinical dietitians
- Feeding therapist (occupational therapist, speech/language pathologist or physiotherapy)
- Pediatric dentist
- Otorhinolaryngologist (ear, nose and throat specialist)
The type experts required and the service they offer depend on the severity of the child’s condition, problems experienced, and the discretion of the child’s primary care physician. Health insurance coverage can be a factor. Optimally, periodic home visits may be arranged to assess nutrition levels, educate on plan goals and actions steps, monitor progress, and modify.
Nutritional interventions may include increasing the quality of food, increasing fluid intake, and forming individualized meal plans with specified quantities and consistencies of food. High energy nutrition supplements may be required. Medications, such as prokinetic drugs, antacids and gastric enzyme inhibitors, may be prescribed. Therapy may improve head control, feeding skills, and speech. Surgeries and feeding tube options, including nasoeteric (Enteric), pecutaneous endoscopic gastrostomy (PEG), gastrojejunal (GJ tube) or enterostomy, may be considered. Instruction in feeding techniques, food preparation, and food choice may be shared by primary caregivers to improve feeding outcomes.
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Meal Time Assistance
Some individuals with cerebral palsy require mealtime assistance, such as preparing meals, getting into and maintaining eating positions, portion controls, and the use of adaptive equipment.
Individuals with associative conditions or co-mitigating factors of cerebral palsy, such as swallowing difficulties, reflux, or propensity towards seizures, may require a speech and language pathologist who is able to assist with exercises to enhance the mouth and facial muscle performance, head control, and feeding skills, particularly for those with oral motor dysfunction. Security and safety is important and can be life-enhancing during feeding.
Proper mealtime assistance helps reduce the risk of nutritional failure and respiratory infections from aspiration. Home visits by registered dietitians or nutritionists are periodically scheduled to assist the family in meeting nutritional and dietary guidelines of a child’s care plan.
Registered dieticians or nutritionists may consult with the child’s primary care physician on options like surgeries and feeding intubation (nasoeteric, pecutaneous gastrostomy, gastrojejunal or enterostomy), where appropriate.
Family Nutrition Guidance
Meal plans must take into consideration the family’s cultural preferences, food preparation capability, and accessibility of meal plan requirements. Sometimes health insurance limits coverage on nutrition sources. Food choices must be readily available, convenient and affordable at accessible food stores if the family is to be successful their child’s food program. Registered dieticians and nutritionists can help the family to find, afford, and prepare the meals necessary. Food selection, preparation, and portion control are often incorporated in information sessions to those responsible for food procurement and preparation. Food intake levels can be coordinated with exercise to provide healthy weight control measures.
Components of meal plans may include:
- Adaptive equipment
- Dietary requirements
- Eating positions
- Feeding techniques
- Fluid intake
- Food preparation
- Food quality
- Food texture and consistency
- Foods to avoid
- High energy nutrition supplements
- Individualized plans
- Label reading
- Meal timing
- Nutritional interventions
- Online procurement
- Portion controls
- Proper mouth care
- Shopping habits
- Specified quantities and consistencies
- Supplemental nutrition
- Tube feeding
- Weight management techniques