Evaluation and Treatment of Malnutrition and Associated Gastrointestinal Complications in Children with Cerebral Palsy

Overview

Journal Pediatr Gastroenterol Hepatol Nutr

Date 2019 Mar 23

PMID 30899688

Citations 10

Authors

Ivana Trivic

Iva Hojsak

Affiliations

Soon will be listed here.

Abstract

The majority of children with cerebral palsy (CP) have feeding difficulties and are especially prone to malnutrition. The early involvement of a multidisciplinary team should aim to prevent malnutrition and provide adequate nutritional support. Thorough nutritional assessment, including body composition, should be a prerequisite for the nutritional intervention. As in typically-developed children nutritional support should start with dietary advice and the modification of oral feeding, if safe and acceptable. However, for prolonged feeding, in the presence of unsafe swallowing and inadequate oral intake, enteral nutrition should be promptly initiated and early gastrostomy placement should be evaluated and discussed with parents/caregivers. Gastrointestinal problems (oropharyngeal dysfunction, gastroesophageal disease, and constipation) in children with CP are frequent and should be actively detected and adequately treated as they can further worsen the feeding process and nutritional status.

Citing Articles

Development and Validation of a Questionnaire to Measure Feeding Challenges and Nutritional Problems Associated With Long-Term Enteral Nutrition Among Children With Disabilities.

Zaher S, Ajabnoor S Risk Manag Healthc Policy. 2025; 18:747-757.

PMID: 40060115 PMC: 11887491. DOI: 10.2147/RMHP.S502223.

Use of a specialized peptide-based enteral formula containing medium-chain triglycerides for enteral tube feeding in children with cerebral palsy and previous tube feeding intolerance on standard enteral formula: a prospective observational TolerUP....

Kansu A, Kutluk G, Caltepe G, Arikan C, Urganci N, Tumgor G Front Pediatr. 2025; 13:1448507.

PMID: 40013110 PMC: 11861557. DOI: 10.3389/fped.2025.1448507.

Initial observations of medically complex young adults transitioning to adult care: Revealing data regarding mental health, nutrition, and transition preparedness.

Hooker E, Eckenrode M, Hopson B, Somerville C Health Care Transit. 2024; 1:100005.

PMID: 39712994 PMC: 11657854. DOI: 10.1016/j.hctj.2023.100005.

Markers of Intestinal Permeability and Inflammation in Enterally Fed Children with Cerebral Palsy.

Mickiewicz-Gora D, Sznurkowska K, Skonieczna-Zydecka K, Drozd A, Borkowska A, Zagierski M Nutrients. 2024; 16(15).

PMID: 39125328 PMC: 11314602. DOI: 10.3390/nu16152447.

Is Chewing Performance Related to Dietary Intake in Children with Cerebral Palsy?.

Ozder F, Ilgaz F, Serel Arslan S Dysphagia. 2023; 39(2):299-309.

PMID: 37566107 DOI: 10.1007/s00455-023-10612-y.

References

Sullivan P, Lambert B, Rose M, Ford-Adams M, Johnson A, Griffiths P . Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study. Dev Med Child Neurol. 2000; 42(10):674-80. DOI: 10.1017/s0012162200001249. View

Pashankar D, Bishop W . Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Pediatr. 2001; 139(3):428-32. DOI: 10.1067/mpd.2001.117002. View

Elawad M, Sullivan P . Management of constipation in children with disabilities. Dev Med Child Neurol. 2002; 43(12):829-32. DOI: 10.1017/s0012162201001505. View

Fung E, Samson-Fang L, Stallings V, Conaway M, Liptak G, Henderson R . Feeding dysfunction is associated with poor growth and health status in children with cerebral palsy. J Am Diet Assoc. 2002; 102(3):361-73. DOI: 10.1016/s0002-8223(02)90084-2. View

Razeghi S, Lang T, Behrens R . Influence of percutaneous endoscopic gastrostomy on gastroesophageal reflux: a prospective study in 68 children. J Pediatr Gastroenterol Nutr. 2002; 35(1):27-30. DOI: 10.1097/00005176-200207000-00007. View

Dormann A, Huchzermeyer H . Endoscopic techniques for enteral nutrition: standards and innovations. Dig Dis. 2003; 20(2):145-53. DOI: 10.1159/000067486. View

Samson-Fang L, Butler C, ODonnell M . Effects of gastrostomy feeding in children with cerebral palsy: an AACPDM evidence report. Dev Med Child Neurol. 2003; 45(6):415-26. DOI: 10.1017/s001216220300077x. View

Sanchez-Lastres J, Eiris-Punal J, Otero-Cepeda J, Pavon-Belinchon P, Castro-Gago M . Nutritional status of mentally retarded children in northwest spain: II. Biochemical indicators. Acta Paediatr. 2003; 92(8):928-34. View

Park E, Park C, Cho S, Na S, Cho Y . Colonic transit time and constipation in children with spastic cerebral palsy. Arch Phys Med Rehabil. 2004; 85(3):453-6. DOI: 10.1016/s0003-9993(03)00479-9. View

10.

Liu L, Roberts R, Moyer-Mileur L, Samson-Fang L . Determination of body composition in children with cerebral palsy: bioelectrical impedance analysis and anthropometry vs dual-energy x-ray absorptiometry. J Am Diet Assoc. 2005; 105(5):794-7. DOI: 10.1016/j.jada.2005.02.006. View

11.

Marchand V, Motil K . Nutrition support for neurologically impaired children: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2006; 43(1):123-35. DOI: 10.1097/01.mpg.0000228124.93841.ea. View

12.

Stevenson R, Conaway M, Chumlea W, Rosenbaum P, Fung E, Henderson R . Growth and health in children with moderate-to-severe cerebral palsy. Pediatrics. 2006; 118(3):1010-8. DOI: 10.1542/peds.2006-0298. View

13.

Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D . A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007; 109:8-14. View

14.

Gurka M, Kuperminc M, Busby M, Bennis J, Grossberg R, Houlihan C . Assessment and correction of skinfold thickness equations in estimating body fat in children with cerebral palsy. Dev Med Child Neurol. 2009; 52(2):e35-41. PMC: 2859115. DOI: 10.1111/j.1469-8749.2009.03474.x. View

15.

Bandini L, Schoeller D, Fukagawa N, Wykes L, Dietz W . Body composition and energy expenditure in adolescents with cerebral palsy or myelodysplasia. Pediatr Res. 1991; 29(1):70-7. DOI: 10.1203/00006450-199101000-00014. View

16.

Braegger C, Decsi T, Amil Dias J, Hartman C, Kolacek S, Koletzko B . Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2010; 51(1):110-22. DOI: 10.1097/MPG.0b013e3181d336d2. View

17.

Rodriguez L, Flores A, Gilchrist B, Goldstein A . Laparoscopic-assisted percutaneous endoscopic cecostomy in children with defecation disorders (with video). Gastrointest Endosc. 2010; 73(1):98-102. DOI: 10.1016/j.gie.2010.09.011. View

18.

Jahromi S, Togha M, Fesharaki S, Najafi M, Beladi Moghadam N, Kheradmand J . Gastrointestinal adverse effects of antiepileptic drugs in intractable epileptic patients. Seizure. 2011; 20(4):343-6. DOI: 10.1016/j.seizure.2010.12.011. View

19.

Thomson M, Rao P, Rawat D, Wenzl T . Percutaneous endoscopic gastrostomy and gastro-oesophageal reflux in neurologically impaired children. World J Gastroenterol. 2011; 17(2):191-6. PMC: 3020372. DOI: 10.3748/wjg.v17.i2.191. View

20.

Pentiuk S, OFlaherty T, Santoro K, Willging P, Kaul A . Pureed by gastrostomy tube diet improves gagging and retching in children with fundoplication. JPEN J Parenter Enteral Nutr. 2011; 35(3):375-9. DOI: 10.1177/0148607110377797. View