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Nutrition – Feeding difficulties

A person wearing a white shirt and a child in a red shirt embracing indoors
Emily S.
Emily will take you through the feeding difficulties and the nutritional needs of a child with CP:
“ It is not easy but you develop a routine...”

Cerebral palsy and feeding


You might already know that children suffering from cerebral palsy (CP) often have feeding difficulties.

 

“Ever since he was born
he had trouble feeding, everything he did drink
it came back straight back up”

But, why is that?


The act of eating requires the simultaneous coordination of a large number of muscle groups (especially facial muscles). Since CP affects body movement and muscle control, eating can also be affected.


Feeding difficulties can be stressful for the whole family, transforming a time that is supposed to be pleasurable into a lengthy period of trial and error.

A person sharing advice on a child's eating habits in a video


If feeding difficulties persist, your child might not be receiving enough nutrition, and this might affect his/her growth and development.


If this is the case, your team of healthcare professionals can help you plan for and overcome these difficulties.


Please make sure to consult with them before trying something new or deciding to make any changes to your child’s diet.


It is important to remember that your child’s needs will change over time. This is why it is important to check with your healthcare professional before adapting any feeding solution to the physical and overall assessment of your growing and developing child.


Your healthcare professional will ask you a few questions in order to assess feeding or swallowing problems.

Possible questions could be:

  • How long does it take to feed your child?
  • Are meals stressful?
  • Is your child gaining weight adequately?
  • Does your child show any signs of respiratory discomfort (such as coughing or shortness of breath) during or after meal times?

Depending on the answers, your healthcare professional will guide you to the nutritional solution that will best support your child.


But first, you might be asking yourself a number of questions and would like to gather as much information as possible to be fully prepared.

In the following sections, we will present some examples of feeding difficulties and associated conditions.

 

" Your child not eating can take you to places that you don´t want to go...I wasn´t eating because he couldn´t eat”

Miriam, Yehoshua’s mum

A woman talking about challenges with her child not eating

Look out for dysphagia


Dysphagia, also called swallowing difficulties, is by far the most common feeding difficulty in children with moderate to severe cases of cerebral palsy.


Typically, a person with dysphagia has trouble swallowing food and/or fluids. Dysphagia can not only lead to malnutrition, but can also cause a number of respiratory problems, such as pneumonia, due to recurrent aspirations (when food or liquid enter the airway or lungs, due to swallowing problems).


A number of signs could indicate that your child has dysphagia. Here is a partial list:1


  • Coughing and/or chocking during feeding
  • Changes in facial colour during feeding
  • Fatigue/sweating during feeding
  • Difficulty in retaining food in the mouth
  • Prolonged time for feeding
  • A chronic cough
  • Poor weight gain

If you observe any of the signs listed above, or if you have any concerns, we recommend that you talk to your healthcare professional.


Adapting the texture and consistency of your child’s meals and ensuring a correct posture during the feeding process are possible ways to address dysphagia.

→Check out the section related to nutritional strategies


References:

  1. Arvedson JC. Feeding children with cerebral palsy and swallowing difficulties. Eur J Clin Nutr. 2013;67 Suppl 2:S9-12.

Understanding gastro-oesophageal reflux


Gastro-oesophageal reflux, also known as GORD, is another very common feeding difficulty. It happens when stomach content rises back up in the oesophagus. GORD can cause pain, vomiting and harm to the oesophagus, because the liquid that comes back up contains acid from the stomach, as well as enzymes and bile. GORD can be controlled through specific medications that can be prescribed by your healthcare professional.


Certain lifestyle recommendations could also help in alleviating the condition, such as correct positioning of your child and refraining from laying your child down directly after meal times.

Look out for other conditions


Your child may also be suffering from associated conditions, such as:


Constipation

Constipation is also a frequent issue in children with CP. Up to 74% of children with severe disabilities suffer from it.1 The factors that contribute to constipation are:1


  • Reduced fluid and fibre intake
  • Abnormal bowel motility (movement of the bowels)
  • Prolonged immobility
  • Skeletal abnormalities
  • Generalised hypotonia (decreased muscle tone)

Recurrent episodes of constipation can lead to chronic nausea, recurrent vomiting, abdominal pain and, ultimately, reduced food intake.1


A child suffering from constipation might refuse to eat due to pain in his/her tummy and may not get the required nutrition for proper growth and development.1


Obesity

In certain cases of very limited mobility, children are at an increased risk of suffering from obesity.

Overweight children that have a BMI (Body Mass Index) >95th percentile are at an increased risk of obesity and need to follow an individualised nutritional plan.2


References:

  1. Penagini F et al. Dietary Intakes and Nutritional Issues in Neurologically Impaired Children. Nutrients.2015;7(11):9400-15.
  2. Centers for Disease Control and Prevention, Defining Childhood Obesity, available at: https://www.cdc.gov/obesity/childhood/defining, accessed on 27032018
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