"Cerebral palsy" refers to a number of neurological disorders that affect muscle coordination and body movement. These appear in infancy or early childhood and, while permanent, don't worsen over time. Cerebral palsy makes it difficult to maintain balance and move; in some, the disorder makes it tough to eat. In fact, about one-third of children who suffer from this disorder don't get enough nutrients, according to "Lovell and Winter's Pediatric Orthopaedics." When eating difficulties caused by cerebral palsy affect nutrition status, doctors and caregivers need to consider external, or tube feeding, to meet a person's nutritional needs.
Nutrient Deficiencies
People with cerebral palsy often suffer nutritional deficiencies because they lack motor skills and have impaired muscle movement, which makes it hard to eat and thus gain adequate calories. Issues with food texture caused by mouth sensitivity add to the problem. Even when a person is able to consume enough calories, many medications used with cerebral palsy decrease a person's levels of vitamins K, D, B6, B12, C and folate. The medicines also diminish magnesium and calcium levels.
Considerations
A person with cerebral palsy may need tube feeding if she is unable to take in about 80 percent of her calorie needs by mouth, suffers weight loss or is a child who does not gain any weight for three months or is at or below the 5th percentile for her weight for height category, according to registered dietician Annette Pederson, author of guidelines used by the State of Washington Office of Children with Special Health Care Needs. The guidelines recommend that a team of caregivers work together to determine if tube feeding is the best option for the person, as problems such as gastroesophageal reflux may cause complications. The team usually consists of a person's primary caregiver, primary physician and a nutritionist. An occupational therapist on the team is appropriate in some cases, such as when a person has a swallowing disorder.
Nutritional Decisions
The nutritionist on the feeding team determines what goes into the feeding tube after assessing a person's nutritional status and factors like his weight, height and age. The nutritionist determines how many overall calories the person needs to grow or regain strength, along with how much protein and other nutrients the person needs.
Effect
Debate over whether tube feeding is the absolute best option to shore up nutritional deficiencies for people with cerebral palsy exists, according to Peter B. Sullivan, lead author for a study published in "Developmental Medicine and Child Neurology." However, the 2005 study led by Sullivan found that tube feeding significantly improves nutritional status when it is used. The study does note that complications in this method of feeding are described in up to 26 percent of cases. Possible complications include making gastroesophageal reflux worse, inhaling the feeding solution into the lungs, bacterial contamination of the formula or feeding device, vomiting, nausea, intestinal discomfort and diarrhea.
References
- Cambridge Journals; "Developmental Medicine and Child Neurology"; Gastrostomy Tube Feeding in Children with Cerebral Palsy; Peter B. Sullivan et al.; 2005
- RD411: Cerebral Palsy -- Meeting Patients' Nutritional Needs
- State of Washington Office of Children with Special Health Care Needs: Enteral Feeding (Tube Feeding)
- "Nutrition in the Prevention of Treatment and Disease"; Ann M. Coulston and Carol Boushey; 2008
- Medline Plus: Cerebral Palsy
- National Institute of Neurological Disorders and Stroke: Cerebral Palsy
