Dietary Needs for Kids With Cerebral Palsy

Kids with cerebral palsy (CP) have problems with their muscle tone, movement, and/or motor skills. This can make mealtimes challenging.

Some kids may not have the coordination to feed themselves or chew and swallow safely or successfully. Digestive problems like gastroesophageal reflux and constipation can make eating uncomfortable. So it can be hard for kids to get enough to eat, and that can lead to poor growth and/or malnutrition.

But the right diet and feeding techniques can help many kids with CP have a productive mealtime experience, enjoying the meal while getting the nutrients they need to thrive.

What Nutrients Does My Child Need?

Kids with CP need good nutrition and healthy foods just like other kids do. But sometimes, they might need more or fewer calories depending on their activity level and muscle tone (how "tense" their muscles are at rest). For example, a child with high muscle tone and a higher physical activity level will use more energy and need to eat more than a child with low muscle tone and a lower activity level.

Kids who can't walk or who have trouble getting enough nutrients in their diet due to feeding problems are more likely to have weak bones (low bone density). This makes their bones more likely to fracture, or break.

To help keep bones strong, kids with CP need to get enough of these three nutrients:

1. Calcium, a mineral that supports bone and tooth structure and function. Best sources of this include milk, yogurt, cheese, and calcium-fortified juices.
2. Vitamin D, a vitamin that helps the body absorb calcium from food and supplements. It's found in some fish, such as salmon and tuna, fish liver oil, and fortified products like milk, orange juice, and cereal. Our bodies also make vitamin D when skin that is not protected by clothes or sunscreen is exposed to the sun.
3. Phosphorus, a mineral that plays a role in the formation of bones and teeth. It's found in dairy products, meat, fish, eggs, poultry, nuts, seeds, and whole grains.

Other important vitamins and minerals for bone health include vitamin C, vitamin K, magnesium, copper, zinc, and manganese. These are found in beans, vegetables, and a variety of other foods. Many kids get enough of these nutrients in their regular diets.

Is My Child Getting Enough Nutrients?

The care team can make sure that your child gets the nutrients needed. The team may include:

• your doctor
• a dietitian
• a speech-language therapist
• an occupational therapist

The team will ask for a detailed food record of what your child eats, including any formulas or puréed meals. Then, they can see whether your child is getting the right amount of calories, protein, vitamins, minerals, and fluids. This depends on your child's age, height, weight, growth trend, and physical activity level.

They'll make a customized dietary plan from this information. The plan helps you make sure that your child grows well and maintains a healthy weight.

Your child's growth and diet will be checked at follow-up doctors' visits. If your child isn't keeping a healthy weight or getting the right nutrition, the feeding plan will be modified. Kids' nutritional needs change as they get older, so it's important to follow up with your care team regularly as your child grows.

Supplements

Sometimes a child with CP can't eat enough by mouth to get all the needed nutrients. So, doctors and dietitians might recommend a supplement. Supplements might be specific vitamins or minerals, or calorie or protein boosters. These boosters can be store-bought (pre-mixed in a pouch or box) or homemade. Several different formulas are available for different dietary needs. Homemade formula recipes should be created by a dietitian to ensure they meet nutrition goals.

Some kids might need supplements to get more of individual nutrients, such as calcium and vitamin D, if they don't get enough from their diet or if they have a nutritional deficiency. Vitamin and mineral supplements come in different forms, like liquid or chewable tablets. Your child's doctor or dietitian will suggest the best form for your child.

Children who have problems swallowing may need thickeners added to their food and beverages to help them swallow safely. A speech-language therapist can see if your child needs a thickener and, if so, find the right texture and consistency your child needs.

Tube Feeding

Feeding tubes allow food to be ingested without having to be chewed or swallowed.

Deciding on a feeding tube can be a hard decision for parents. Parents might want their child to eat by mouth, like other kids. But it's not safe for some kids with CP to eat by mouth. Kids who have trouble chewing or swallowing can get food in their airways or lungs, and this can cause respiratory illness. In this situation, feedings by mouth would not be allowed and all nutrition would be provided by tube.

Tube feeding also might be a good idea for kids who can eat safely, but can't eat enough (even with supplements) to maintain a healthy weight. In these cases, tube feeding might supplement a child's regular mealtime routine.

Tube feeding can make mealtimes easier and happier for kids. Mealtimes are less tiring and stressful, and more enjoyable for kids who have trouble eating. And caregivers know that their child is getting the nutrition needed.

A child's tube can be placed:

• through the nose to reach the stomach for short-term feeding support
• directly through a port on the belly and into the stomach for long-term feeding support

Complete, nutritionally balanced formulas or puréed meals are fed through the tube. These ensure that kids get enough calories and the nutrition needed to grow and maintain a healthy weight. They also provide fluids to keep kids hydrated.