Nutritional Disorders

The assessment of growth and nutrition in children with CP can be difficult due to the lack of a reliable means of measuring stature in children with contrac­tures and scoliosis and the lack of appropriate reference data or growth curves specific to CP (49).

Poor oromotor skills, gastroesophageal reflux, and the inability to self-feed or communicate hunger can all increase the risk for malnutrition in children with CP. The North American Growth in Cerebral Palsy Project (NAGCPP) is a population-based study that identified the presence of feeding problems in 58% of children with moderate to severe CP. In addition, children with a pattern of severe feeding dysfunction were described as having the greatest risk for poor nutritional status and health, but even those with only mild feeding dys­function were identified as being at risk for poor nutri­tional status. Subjects who were enterally fed were taller and had greater body fat stores when compared to subjects with similar motor impairments who were exclusively fed by mouth (51). Data from the NAGCPP also revealed that children with the best growth had better health and social participation (52).

Although malnutrition is a primary concern, chil­dren with CP are also at risk for overfeeding and obe­sity. Children with more severe CP have a lower total energy expenditure and higher body fat content than age- and sex-matched children without disabilities, placing them at risk for overfeeding with energy-dense enteral feeds (53). A study of ambulatory children with CP showed an increase in the prevalence of obesity from 7.7% to 16.5% over a 10-year period, an increase similar to that seen in the general pediatric population in the United States (54).