Nutritional red flags in children with cerebral palsy

Area of Science:

• Pediatric Nutrition
• Cerebral Palsy Research
• Clinical Dietetics

Background:

• Children with cerebral palsy (CP) are at high risk for under-nutrition.
• European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines highlight anthropometric nutritional red flags for neurologically impaired children.
• These red flags include low weight-for-age z-scores (WFA), triceps skinfold (TSF), arm muscle area (AMA), and faltering weight.

Purpose of the Study:

• To evaluate the nutritional status of Flemish children and adolescents with CP using various anthropometric indicators.
• To determine the prevalence of identified nutritional red flags in this population.
• To identify risk factors associated with low anthropometric parameters in children with CP.

Main Methods:

• A prospective, longitudinal observational study was conducted over 12 months in 9 specialized Flemish centers.
• Participants included children and adolescents with CP aged 2-20 years (n=325 at baseline).
• Anthropometric measurements (WFA, TSF, subscapular skinfolds (SSF), arm muscle area (AMA)) were compared with reference data, and weight faltering was monitored.

Main Results:

• At baseline, 42.1% of children had at least one nutritional red flag, with prevalence remaining around 40% over 12 months.
• Higher Gross Motor Function Classification System (GMFCS) levels (GMFCS >2) and dysphagia were significantly associated with lower nutritional indices.
• Approximately 15-19% of children with initial red flags experienced further weight loss within 6 months, suggesting inadequate clinical intervention.

Conclusions:

• Underweight is prevalent, particularly in severe CP (GMFCS 5), with nearly three-quarters affected.
• Nutritional red flags are present in about 40% of Flemish CP children but appear inadequately addressed in clinical practice.
• GMFCS level and dysphagia are key factors influencing poor nutritional status in children with CP, necessitating targeted interventions.