Nutritional management of children with cerebral palsy

Abstract

Children with severe cerebral palsy and particularly those with oropharyngeal dysfunction are at risk of poor nutritional status. Determining the need and the mode of nutritional intervention is multifactorial and requires multiple methodologies. First-line treatment typically involves oral nutritional support for those children who are safe to consume an oral diet. Enteral tube feeding may need to be considered in children with undernutrition where poor weight gain continues despite oral nutritional support, or in those with oropharyngeal dysphagia and an unsafe swallow. Estimates for energy and protein requirements provide a starting point only, and ongoing assessment and monitoring is essential to ensure nutritional needs are being met, that complications are adequately managed and to avoid over or under feeding.

Common Complications of Pediatric Neuromuscular Disorders

“…14 The resting energy expenditure (REE) in pNMDs has been measured in several studies. [15][16][17][18][19][20][21] The development of obesity in children with DMD is not primarily because of a low REE but because of other causes, such as a reduction in physical activity and/ or overfeeding. Similar trends have been observed in CP.…”

“…Nonambulant children with CP have significantly lower total energy expenditures, which is largely due to decreased activity levels. [19][20][21] Interventions are required for unintentional weight gain or loss. Metformin has been used for weight management in obese patients with pNMDs, and has shown positive effects on weight management and reduced metabolic syndrome.…”

Clinical management of Krabbe disease

“…Vomiting and reflux Keep the child in an upright position both during and after feeding Arvedson, 2008;Bell and Samson-Fang, 2013 Proton pump inhibitors such as omeprazole and lansoprazole are useful for controlling reflux in children over the age of 1 year Gold and Freston, 2002;Samson-Fang et al, 2003 Nissen fundoplication is useful for preventing reflux in untransplanted children and is often performed with gastrostomy tube placement Gold and Freston, 2002 Dysphagia Modifying the texture and thickness of foods can help with swallowing difficulties; commercial thickening agents containing xanthan gum or starch can be added to liquids but are not appropriate for premature infants Bell and Samson-Fang, 2013 For nonoral feeders, swallowing ability can be improved by providing tiny tastes of food or juice several times per day Arvedson, 2013 A gastrostomy tube will eventually be required for untransplanted children; transplanted children at risk of undernutrition may also benefit from gastrostomy tube placement Bell and Samson-Fang, 2013 Constipation Ensure that fluid intake is sufficient; polyethylene glycol 3350 can prevent constipation, but lactulose or stimulant medication may eventually be required Martin et al, 2006;Kurtzberg et al, 2008 upper motor neuron damage in KD, so, after transplantation, KD becomes almost identical to cerebral palsy. Just as in cerebral palsy, the complex challenges of KD require an ongoing team approach.…”

Hubungan Pengetahuan Pengasuh Tentang Posisi Pemberian Makan Dengan Asupan Energi Dan Protein Anak Cerebral Palsy Di Ypac Malang

“…Saat ini tidak ada bukti yang menunjukkan perbedaan kebutuhan protein pada anak atau remaja cerebral palsy dengan anak pada umumnya sehingga rekomendasi asupan protein pada cerebral palsy bisa digunakan. 23 Gangguan medis yang terjadi pada anak dengan gangguan neurologis dapat mempengaruhi proses makan. Masalah tersebut dapat mengganggu proses pembelajaran makan yang tepat untuk perkembangannya.…”

“…24 Pemberian makan secara oral atau enteral bagi pengasuh harusnya memiliki pengetahuan tentang posisi pemberian makan, modifikasi, jenis makanan, prilaku pengasuh, tingkat stres pengasuh. 23 …”