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Growth in children with cerebral palsy fed via gastrostomy
G R Rempel1, S O Colwell, R P Nelson
1Cerebral Palsy Service, Gillette Children's Hospital, St Paul.
Insights
Gastrostomy feeding improves weight in children with cerebral palsy but does not eliminate growth retardation. Early gastrostomy placement may enhance height and weight outcomes for these children.
Area of Science:
- Pediatrics
- Neurology
- Clinical Nutrition
Background:
- Children with severe cerebral palsy often experience significant growth retardation.
- Poor nutritional status is a primary suspected contributor to growth issues in this population.
- Feeding gastrostomies are utilized to improve nutritional intake in affected children.
Purpose of the Study:
- To evaluate the growth characteristics of children with cerebral palsy who have feeding gastrostomies.
- To assess the impact of gastrostomy feeding on height and weight percentiles.
- To identify factors influencing growth outcomes in this cohort.
Main Methods:
- Retrospective evaluation of growth data for 57 children with cerebral palsy and feeding gastrostomies.
- Analysis of height and weight percentiles before and after gastrostomy tube placement.
- Comparison of growth outcomes based on age at gastrostomy insertion.
Main Results:
- Over 90% of children were below the fifth percentile for height and weight pre-gastrostomy.
- Post-gastrostomy, 33% remained underweight and 21% became overweight for height.
- Weight improvement was more common than linear growth improvement; most children remained below the fifth percentile.
- Gastrostomies placed within the first year of life were associated with better height and weight percentile outcomes.
Conclusions:
- Gastrostomy feeding can improve nutritional status in children with severe cerebral palsy but does not fully resolve growth retardation.
- Linear growth remains a significant challenge despite nutritional support.
- Further research is needed to understand the long-term impact of growth and nutrition on morbidity in children with severe neuromotor impairments.
Abstract:
Growth characteristics of 57 children with feeding gastrostomies attending the cerebral palsy clinic at a regional medical facility were evaluated. All children had severe neuromotor and orofacial involvement and mental retardation. More than 90% of the patients were less than fifth percentile for height and weight, and 80% were underweight for height before gastrostomy tube placement. Following gastrostomy, 33% remained underweight for height and 21% became overweight for height. The majority of children remained at less than the fifth percentile for height and weight. Improvement in linear growth was much less common than improvement in weight. Children with gastrostomies placed in the first year of life were most likely to exceed the fifth percentile for height and weight. The mechanisms of growth retardation in children severely affected by cerebral palsy are not known, but poor nutrition is thought to be the major contributor. Gastrostomy feeding in children severely affected by cerebral palsy can improve nutritional status but does not eliminate growth retardation. The importance of growth and adequate nutrition in reducing morbidity in children with severe neuromotor involvement remains to be established.