The nutritional support in children with spastic forms of cerebral palsy

Background. The approaches to the managing of nutrition for healthy children are not always applicable to patients with neurological disorders, since their body composition, muscle tone, level of physical activity, and energy requirements significantly differ from healthy children and, therefore, must be personalized with the mandatory involvement of a nutritionist/dietitian.

The purpose is to assess nutrition in children with cerebral palsy (CP) depending on Gross Motor Function Classification System (GMFCS) level.

Materials and methods. Eighty-eight 2 to 16 years nine months CP children rehabilitated at the National Medical Research Center for Children’s Health from 2019 to 2021 were included in this study. Participants were divided into two groups. The main group was patients with GMFCS levels IV–V (48 children) and the comparison group — GMFCS levels I–III (40 children). The medical and dietary history of participants was analyzed. Anthropometric parameters using the WHO AnthroPlus (2009) software were assessed in all participants, the ability to eat and drink was determined by questioning the EDACS scale (Eating and Drinking Ability Classification System).

Results. The mean values of weight/age, height/age, BMI/age Z-scores were significantly below 0 (p = 0.01) in all patients (88): WAZ –1.54 ± 1.9, HAZ –1.03 ± 1.48, BAZ –1.5 [–3.11; –0.35]. Children of the main group had significantly lower Z-scores. As a result of the survey, patients of the main group were revealed to have indicators characterizing eating disorders significantly more often (p < 0.001) than the comparison group. EDACS survey revealed that children of the main group were significantly more likely (58% and 10%, respectively; p < 0.001) to have disorders corresponding to levels IV–V, characterized by significant safety restrictions. We have developed a nutritional assessment and management algorithm for children with cerebral palsy, admitted for rehabilitation at the neurological department.

Conclusion. Children with cerebral palsy need regular nutritional assessment and management for timely and adequate nutritional support, including enteral nutrition.

Acknowledgement. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: December 28, 2021
Accepted: February 17, 2022
Published: March 15, 2022

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