Related Experiment Videos
Feeding problems in children with cerebral palsy
A Gangil1, A K Patwari, S Aneja
1Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Kalawati Saran Children s Hospital and Lady Hardinge Medical College, New Delhi 110 001, India.
Insights
Children with cerebral palsy (CP) experience significant feeding problems and poor nutritional status due to oral motor dysfunction. Early nutritional intervention is crucial for improving feeding, development, and overall quality of life in these children.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Clinical Nutrition
Background:
- Children with cerebral palsy (CP) often face complex feeding challenges impacting their nutritional status and development.
- Oral motor dysfunction (OMD) is a prevalent issue in CP, affecting a child's ability to eat and swallow.
- Parental perception of feeding problems and nutritional status in children with CP can be inaccurate, necessitating objective assessment.
Purpose of the Study:
- To quantify the prevalence and severity of feeding difficulties in children with CP.
- To evaluate the efficacy of nutritional interventions in addressing these feeding and nutritional issues.
- To identify factors contributing to feeding problems and poor nutritional status in this population.
Main Methods:
- A prospective hospital-based interventional study involving 100 children with CP.
- Assessment included feeding skills (Gisel and Patrick score), nutritional status (anthropometry, caloric intake), neurological type/severity, and developmental age (Gesell scale).
- Nutritional rehabilitation interventions were applied, with outcomes monitored over a 3-10 month follow-up period.
Main Results:
- All children with CP exhibited oral motor dysfunction (OMD); spastic quadriplegic CP and hypotonic types showed poorer feeding skills.
- Children with CP had significantly lower anthropometric indicators compared to controls, with OMD, spastic quadriparesis, and hypotonia negatively affecting nutritional status.
- Parental awareness of feeding problems was low, and 30% of parents were pessimistic about improvement, despite significant gains post-intervention.
Conclusions:
- Poor nutritional status in children with CP results from multiple interconnected factors, including OMD and neurological impairments.
- Comprehensive assessment of feeding problems and nutritional status is essential for initiating timely and effective nutritional rehabilitation.
- Nutritional rehabilitation significantly improves feeding abilities, nutritional status, and quality of life for children with CP.
Objective:
To determine the magnitude and extent of feeding problems in children with cerebral palsy (CP) and to evaluate the effectiveness of nutritional interventions.
Design:
Prospective hospital based interventional study.
Method:
Children with cerebral palsy of either sex were enrolled randomly and their parents were interviewed for their perception about feeding problems, nutritional status and for their views about the expected outcome of feeding problems. Each case was assessed for feeding problems based on Gisel and Patrick feeding skill score; for nutritional status by measurement of weight, skinfold thickness (at biceps, triceps, suprailiac and subscapular), mid arm circumference and caloric intake; neurologically for type and severity of cerebral palsy and for developmental age by Gasell s developmental scale. Equal number of age and sex matched controls were included for comparison of nutritional status and developmental quotient. Various rehabilitation procedures were applied and their response was observed in the followup ranging from 3-10 months.
Results:
One hundred children (76 boys and 24 girls) with cerebral palsy of mean age 2.5 years (range 1 to 9 years) and mean developmental age of 7.6 months (range 1 to 36 months) were included in the study. Oral motor dysfunction (OMD) was found in all cases and in each category. Spastic quadriplegic cerebral palsy (SQCP) and hypotonic patients had significantly poor feeding skill score (p < 0.001). Mean duration of feeding session was 31.5 minutes (range 10-60 minutes). Main food of children with cerebral palsy consisted of liquid and semisolid diet. Children with poor OMD were unable to take solid food. Cases with seizures had significantly more feeding problems than those without seizures (p < 0.001). Parental awareness about feeding problems of their children was significantly low and they overestimated the nutritional status of their children. Anthropometric indicators were significantly lower than controls (p < 0.001). Spastic quadreparesis, hypotonia and poor feeding skill score had negative effect on nutritional status. Thirty per cent parents of cerebral palsy patients were pessimistic about the possibility of any improvement in feeding problems. After nutritional rehabilitation, good improvement was seen in feeding problems, OMD and nutritional status.
Conclusion:
Nutritional status of children with cerebral palsy is poor due to summation of several factors. Therefore, they should be thoroughly assessed for feeding problems and nutritional status in order to start timely nutritional rehabilitation which can significantly improve their nutritional status and quality of life.