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Feeding dysfunction is associated with poor growth and health status in children with cerebral palsy
Ellen B Fung1, Lisa Samson-Fang, Virginia A Stallings
1Department of Gastroenterology and Nutrition, Children's Hospital Oakland, CA 94609, USA.
Insights
Parent-reported feeding dysfunction in children with cerebral palsy is linked to poor health and nutrition. Early identification of mild feeding issues is crucial for nutritional risk screening.
Area of Science:
- Pediatric Nutrition
- Cerebral Palsy Research
- Clinical Dietetics
Background:
- Feeding dysfunction is a significant concern in children with cerebral palsy (CP).
- Understanding the link between feeding issues and health outcomes is vital for this population.
Purpose of the Study:
- To investigate parent-reported feeding dysfunction in children with moderate to severe CP.
- To determine the association between feeding dysfunction severity and health/nutritional status.
Main Methods:
- 230 children with moderate to severe CP were assessed.
- Anthropometry (weight, height, body fat) and health status (Child Health Questionnaire) were measured.
- Feeding dysfunction was categorized using a scale from none to severe.
Main Results:
- Feeding dysfunction severity strongly correlated with poorer nutritional indicators (weight, height, body fat z-scores).
- Children with mild feeding dysfunction showed reduced body fat compared to those without.
- Tube-fed children had better anthropometric measures than orally-fed children with similar motor impairments.
Conclusions:
- Feeding dysfunction is common in children with CP and impacts health and nutrition.
- Even mild feeding dysfunction poses nutritional risks.
- Parental reporting via questionnaires can aid in screening for nutritional risk.
Objective:
To describe parent-reported feeding dysfunction and its association with health and nutritional status in children with cerebral palsy.
Design:
Anthropometry was measured and z scores calculated. The Child Health Questionnaire was used to assess health status, and a categorical scale (none to severe) was used to classify subjects according to severity of feeding dysfunction.
Subjects:
230 children (9.7+/-4.6 years; 59% boys) with moderate to severe cerebral palsy were recruited from 6 centers in the United States and Canada.
Statistical Analyses:
Descriptive statistics, the Kruskal-Wallis and Pearson chi2 tests.
Results:
Severity of feeding dysfunction was strongly associated with indicators of poor health and nutritional status. The mean weight z scores were -1.7, -2.5, -3.3, and -1.8 among children with none, mild, moderate, or severe (largely tube-fed) feeding dysfunction, respectively (P= .003). Similar results were observed for height z score (P=.008), triceps z score (P=.03), and poor Global Health score (part of the Child Health Questionnaire) (P<.001). Subjects who were tube fed were taller (P=.014) and had greater body fat stores (triceps z score, P=.001) than orally fed subjects with similar motor impairment. For subjects exclusively fed by mouth, a dose-response relationship was observed between feeding dysfunction severity and poor nutritional status. Subjects with only mild feeding dysfunction had reduced triceps z score (-0.9) compared with those with no feeding problems (-0.3).
Conclusion:
For children with moderate to severe cerebral palsy, feeding dysfunction is a common problem associated with poor health and nutritional status. Even children with only mild feeding dysfunction, requiring chopped or mashed foods, may be at risk for poor nutritional status. Parental report of feeding dysfunction with a structured questionnaire may be useful in screening children for nutritional risk.