Optimisation of health and nutrition
To maximise the potential of a child with hemiplegia or cerebral palsy, and to ensure that the best possible gains are made through therapy and medical treatment, it is important that the general health and nutritional status of the child is maintained and, if necessary, improved.
Dietary management of children with cerebral palsy
Children with cerebral palsy are known to be a nutritionally vulnerable group, however, identification of nutritional problems often happens at a later rather than an earlier stage in life. Due to their multiple disabilities these children require a multidisciplinary approach if their feeding problems are to be assessed and managed effectively.
As the severity of the disorder varies between muscle groups and different parts of the body, the severity of the feeding problem also varies. An extensive list of potential reflexes and reactions and their effect on feeding is described by Chailey Heritage in Eating and drinking skills for children with cerebral palsy (1993). The major nutritional problems that stem from these effects in CP are:
- failure to thrive
- low body weight for height
- vitamin and mineral deficiencies
- dental caries
The cause of failure to thrive has to be assessed by a multidisciplinary team in order to determine the most appropriate methods to correct this problem. The dietitianis the sole professional trained to assess the child's nutritional intake and requirements. Nutrition plans should be developed to consider the assessments of other healthcare professionals with regard to texture, safety, taste and positioning plus consideration of the child's tolerance and parent's abilities.
The dietetic advice offered may involve the following:
- fortification or supplementation of the diet
- enteral or gastrostomy feeding - although many carers are initially against this option, the positive outcomes of weight gain, growth and improved bowel function make artificial feeding acceptable
Regular monitoring is essential to provide appropriate and effective nutritional support, working together with other professionals e.g. speech and language therapists, paediatricians and neurologists. This can be facilitated in a special 'feeding clinic'.