The Impact of Malnutrition on Hospitalized Children With Cerebral Palsy

Abstract

Children with cerebral palsy (CP) and other medical complexity comprise an outsized proportion of health care use. In this review, we describe the current science of assessment of nutritional status for children with CP, outline a systematic approach to assessing their nutritional status, delineate ramifications of malnutrition on hospitalization-associated outcomes, and identify knowledge gaps and means of addressing those gaps using quality improvement and clinical research tools. Methods to accurately assess body composition and adiposity in this population by using skinfolds, age, sex, and activity level are available but are not widely used. There are limitations in our current method of estimating energy needs in children with CP, who are at higher risk of both obesity and micronutrient deficiencies. There is some evidence of an association between malnutrition, defined as either underweight or obesity, and hospitalization-associated outcomes in children generally, although we lack specific data for CP. The gaps in our current understanding of optimal nutritional status and between current science and practice need to be addressed to improve health outcomes for this vulnerable patient population.

Gastrostomy Tubes in Children with Nonambulatory Cerebral Palsy and Neuromuscular Scoliosis: An Enemy or an Ally?

“…Our understanding of what defines the optimal nutritional state for these at-risk children is incomplete with significant gaps in the known science and clinical practice that require further evaluation. 35 Aside from the restarting of feeding following surgery, the volume and characteristics of the diet may also play a significant role. Children with severe subtypes of CP are at an inherent risk of overfeeding given their lower basal energy expenditure levels and can result in heightened body fat content.…”

Pelvic radiography as a non-invasive screening tool for hiatal hernia in children with cerebral palsy

“…[1,2] Aspiration pneumonia, a complication of GERD, is a leading cause of death and hospitalization in these patients, and other complications such as malnutrition and reflux esophagitis can also have a great influence on their quality of life and long term prognosis. [3][4][5] The causes of severe GERD are complex and varied, but hiatal hernia (HH) is recently considered an important pathogenetic contributor. [6] HH is defined as an axial displacement of the proximal stomach through the diaphragmatic hiatus of the diaphragm.…”

Frequency of Cardiometabolic Diseases and Medications in Children with Cerebral Palsy

“…In recent years, it was found that some of these conditions are associated with nutritional de ciencies. [7] Paired with lack of physical activity, food intake dependent on parental/caretaker assistance, as well as the administration of certain medications, cerebral palsy patients are at risk for de ciencies in vitamin D, vitamin B, iron, and folic acid. [7] This can result in osteoporosis, contractures, fractures, and anemia.…”

“…[7] Paired with lack of physical activity, food intake dependent on parental/caretaker assistance, as well as the administration of certain medications, cerebral palsy patients are at risk for de ciencies in vitamin D, vitamin B, iron, and folic acid. [7] This can result in osteoporosis, contractures, fractures, and anemia. [7,8] Close monitoring of the cerebral palsy patient's nutritional status is crucial to ensure that this patient population does not develop these issues.…”

“…[7] This can result in osteoporosis, contractures, fractures, and anemia. [7,8] Close monitoring of the cerebral palsy patient's nutritional status is crucial to ensure that this patient population does not develop these issues.…”