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Nutrition Interventions for Children with Cerebral Palsy in Low- and Middle-Income Countries: A Scoping Review
Israt Jahan1,2,3, Risad Sultana1,2, Mohammad Muhit1,2
1CSF Global, Dhaka 1213, Bangladesh.
Insights
Malnutrition is common in children with cerebral palsy (CP) in low- and middle-income countries (LMICs). Interventions directly impacting feeding and growth show better nutritional outcomes than behavioral approaches for these children.
Area of Science:
- Pediatric Nutrition
- Cerebral Palsy Management
- Global Health Interventions
Background:
- Malnutrition rates are significantly higher in children with cerebral palsy (CP) in low- and middle-income countries (LMICs) compared to the general population.
- Access to appropriate nutritional interventions is critical for improving the health and well-being of children with CP in LMICs.
- A significant knowledge gap exists regarding effective nutrition interventions for this vulnerable group.
Purpose of the Study:
- To systematically review the existing evidence on nutrition interventions for children with CP in LMICs.
- To identify the types of interventions and their effectiveness in improving nutritional outcomes.
- To inform the development of best practice guidelines for nutritional management in these settings.
Main Methods:
- A comprehensive literature search was conducted in PubMed, Scopus, and Google Scholar up to January 10, 2022.
- Peer-reviewed articles focusing on LMIC-based nutritional management guidelines and interventions for children with CP were identified.
- Data on study characteristics, intervention types, and outcomes were extracted and descriptively analyzed.
Main Results:
- Eight studies published between 2008 and 2019, involving 252 children with CP (aged 1-18 years), were included.
- Interventions included parental/caregiver training, surgical procedures (gastrostomy), neurodevelopmental therapy, and dietary modifications.
- Dietary modification interventions demonstrated better outcomes compared to feeding skills or behavioral modifications; surgical interventions also showed positive results.
Conclusions:
- A substantial knowledge gap persists regarding nutrition interventions for children with CP in LMICs, hindering guideline development.
- Interventions directly targeting growth and feeding appear more effective than behavioral interventions for improving nutritional status.
- Future planning of nutrition-focused services for children with CP in LMICs should prioritize growth and feeding-related interventions.
Background:
Malnutrition is substantially higher among children with cerebral palsy (CP) in low- and middle-income countries (LMICs) when compared with the general population. Access to appropriate interventions is crucial for better management of malnutrition and nutritional outcomes of those children. We aimed to review the existing evidence on nutrition interventions for children with CP in LMICs.
Methods:
Online databases, i.e., PubMed and Scopus, and Google Scholar were searched up to 10 January 2022, to identify peer-reviewed publications/evidence on LMIC focused nutritional management guidelines/interventions. Following title screening and abstract review, full articles that met the inclusion/exclusion criteria were retained for data charting. Information about the study characteristics, nutrition interventions, and their effectiveness were extracted. Descriptive data were reported.
Results:
Eight articles published between 2008 and 2019 were included with data from a total of n = 252 children with CP (age range: 1 y 0 m-18 y 7 m, 42% female). Five studies followed experimental design; n = 6 were conducted in hospital/clinic/center-based settings. Four studies focused on parental/caregiver training; n = 2 studies had surgical interventions (i.e., gastrostomy) and n = 1 provided neurodevelopmental therapy feeding intervention. Dietary modification as an intervention (or component) was reported in n = 5 studies and had better effect on the nutritional outcomes of children with CP compared to interventions focused on feeding skills or other behavioral modifications. Surgical interventions improved nutritional outcomes in both studies; however, none documented any adverse consequences of the surgical interventions.
Conclusion:
There is a substantial knowledge gap on nutrition interventions for children with CP in LMICs. This hinders the development of best practice guidelines for the nutritional management of children with CP in those settings. Findings suggest interventions directly related to growth/feeding of children had a better outcome than behavioral interventions. This should be considered in planning of nutrition-focused intervention or comprehensive services for children with CP in LMICs.
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