Effect of Nutritional Support in Children With Spastic Quadriplegia

Malnutrition is a common problem in patients with cerebral palsy. We evaluated the effect of nutritional support on clinical findings in children with spastic quadriplegia. Feeding history, numbers of lower respiratory tract infections, and gastrointestinal and neurologic findings were evaluated via questionnaire. Weight, height, head circumference, midarm circumference, and triceps skinfold thickness were measured. Height for age, weight for age, weight for height, body mass index, and weight and height z-scores were calculated. Clinical findings and anthropometric parameters were re-evaluated after nutritional support for 6 months. Forty-five patients were enrolled. No difference was evident between the first and the last height z-scores of 31 patients who completed the follow-up. Weight, height, weight z-scores, weight for age, weight for height, body mass index, midarm circumference, and triceps skinfold thickness exhibited improvement. Moreover, a significant decrease in number of infections was evident. Frequency of seizures and Gross Motor Function Classification System status did not change. Constipation decreased significantly. Nutritional therapy revealed improvements in some anthropometric findings and a decrease in number of infections. Although there was no difference regarding motor development or seizure frequency, further studies with a longer follow-up are required.

Introduction

Cerebral palsy is a permanent, nonprogressive disease characterized by movement and posture developmental disorders, causing limitations in activity [1], [2]. These gross and fine motor functioning and organization problems can lead to difficulties with walking, feeding and swallowing, coordinated eye movements, articulation of speech, and secondary problems [2]. Because the malnutrition rate is reported to be 46-90% [3], [4], [5], this is generally considered a typical component of cerebral palsy [6]. It may be the case that children with cerebral palsy run an increased risk for feeding problems and undernutrition [7]. However, with close follow-up of nutritional status and early intervention, malnutrition may be prevented [6], [8]. There are different reasons for malnutrition, e.g., increased nutrient losses because of vomiting, and altered energy requirements because of increased muscle tone or involuntary movements [9]. One of the main reasons is inadequate intake as a result of self-feeding impairment and oromotor dysfunction [4]. These disabilities may result in swallowing difficulties, drooling, and choking during meals, and the parents of these children may need to spend more time to feed them. Mealtimes may be stressful for both caregivers and children [4].

Malnutrition itself has some consequences. In addition to growth failure, a decrease in muscle strength may occur, impairing the effectiveness of cough and predisposing the children to aspiration pneumonia [10], [11]. The immune system is also affected, resulting in an increased risk for respiratory and urinary-system infections [4]. The central nervous system is also affected. Cerebral growth and cognitive and motor development may be impaired [12]. Because malnutrition may be corrected with nutritional support, the clinical consequences of malnutrition may also be corrected. In this study, we investigated feeding problems and evaluated the effects of nutritional support on clinical findings in children with cerebral palsy.