Nutritional screening of children and adolescents with cerebral palsy: a scoping review

Abstract

Aim To examine nutritional screening methods for children and adolescents with cerebral palsy. Method A scoping review was performed using established methodologies. In June 2020 we searched PubMed, Embase, CINAHL Complete, and the Cochrane Central Register of Controlled Trials to identify articles on tools/methods for nutritional screening of our target groups. Results Thirty studies were included, containing various tools/methods used to identify under‐ and/or overnutrition by weight/height, circumferences, skinfolds, questionnaires, and/or technically advanced or invasive methods. Questionnaires, weight/height, circumferences, and skinfolds were considered feasible based on clinical utility, whereas bioelectrical impedance analysis and blood samples were not. Interpretation We identified two screening tools for undernutrition that include no physical measurements, but did not find any screening tools for overweight and obesity. Most of the studies recommended one or more methods, indicating that determining nutritional status most likely includes a combination of methods, not all of which may be feasible in clinical practice. No nutritional screening tool using anthropometry or body composition was discovered. Heterogenous methods to identify under‐ and/or overnutrition are recommended. Preferable methods for nutritional screening include assessment of body composition. A validated nutritional screening tool for identification of overweight is warranted.

The significance of MUAC z-scores in diagnosing pediatric malnutrition: A scoping review with special emphasis on neurologically disabled children

“…The subjective clinical assessment (i.e., visible severe wasting) is considered to perform poorer than any anthropometry-based method, while WFH/l-based case-detection methods are considered to perform worse than MUAC, especially in certain circumstances ( 39 , 40 ). Hence, MUAC, based on the currently available evidence, is considered to be the best case-detection method for pediatric malnutrition in terms of easiness, age independence, precision, accuracy, sensitivity, specificity and lack of special equipment, formal training requirement or calculation ( Table 2 ) ( 39 , 40 ).…”

“…The subjective clinical assessment (i.e., visible severe wasting) is considered to perform poorer than any anthropometry-based method, while WFH/l-based case-detection methods are considered to perform worse than MUAC, especially in certain circumstances ( 39 , 40 ). Hence, MUAC, based on the currently available evidence, is considered to be the best case-detection method for pediatric malnutrition in terms of easiness, age independence, precision, accuracy, sensitivity, specificity and lack of special equipment, formal training requirement or calculation ( Table 2 ) ( 39 , 40 ). Simplicity: MUAC was reported to be faster and easier to perform screening in the community setting than other indicators including WFA, HFA and WFH ( 41 ) and to reveal immediate classifications of malnutrition by using a readily understandable “traffic light” system with colors ( 39 ).…”

“…Accordingly, given the weak correlation between standard growth charts and specific references for CP, particularly in case of higher severity of motor impairment, using curves with special reference standards for CP population is considered important in nutritional screening of children with CP, while the existing CP growth charts are not recommended in clinical practice ( 24 , 26 , 28 , 40 , 64 , 72 , 74 , 75 ). Therefore, there is still room for improvement in nutritional rehabilitation practice among children with CP in terms of assessment tools that enable developing more realistic nutritional goals in accordance with the accurately identified anthropometric profile ( 24 , 40 , 64 , 75 ).…”

Gurka vs Slaughter equations to estimate the fat percentage in children with cerebral palsy from all subtypes and levels of the Gross Motor Function Classification System

“…The assessment of nutritional status in children with cerebral palsy (CP) is not simple [ 1 ]. Therefore, the measurement and evaluation of body composition should be considered an essential and routine indicator in the evaluation, assessment, and nutritional intervention of these children [ 2 – 6 ].…”

Embracing the Nutritional Assessment in Cerebral Palsy: A Toolkit for Healthcare Professionals for Daily Practice

“…For children with CP, anthropometric measurements can be difficult to assess, mainly if they have contractures, spasticity, scoliosis, and positioning problems that hinder the use of conventional weighing and other measuring methods [ 20 ]. In the last few decades, several indirect methods to determine anthropometrics in children with CP were developed, albeit with no consensus on the ideal one/ones despite de extensive discussion on the topic [ 20 , 21 , 22 ]. A variety of growth charts can be used to assess and monitor growth [ 23 ].…”