Hard to swallow

THIS WEEK WE LOOK AT THE DIETARY REQUIREMENTS OF CHILDREN WITH CEREBRAL PALSY AND THE NUTRITIONAL AND HEALTH CHALLENGES THEY FACE


Monday August 09 2010

IN THE second week of addressing nutrition in children with special needs, we look at the dietary challenges faced by parents of children with cerebral palsy.

Cerebral palsy describes a group of disorders of the development of movement and posture, which limits activity.

Children can have varying symptoms including loose muscle tone, jerky movements of limbs, unsteadiness/shakiness, poor balance and an inability to hold objects steady which can make feeding difficult.

One of the main challenges facing children with cerebral palsy is malnutrition caused by either under-nourishment or over-nourishment. Poor nutrition can lead to stunted growth, delays in brain development, and low energy levels. It is advised that children with cerebral palsy are monitored by a dietitian.

Many children with cerebral palsy have eating, drinking and swallowing (EDS) difficulties, which can cause eating to be slow — some children with cerebral palsy can take 15 times longer to eat than children without the disorder. In severe cases, being unable to swallow can cause food to enter the lungs which can lead to frequent chest infections and pneumonia.

THE CHALLENGES

Children with cerebral palsy can have problems moving their mouth muscles; having poor tongue thrust, control and lip closure affects feeding. It can also results in loss of calories as a result of food and drink being spilled. Another feeding difficulty is the result of sensitivity to touch around the mouth and face. Some children with cerebral palsy may not like the touch of food or even a teat, a spoon or a hand.

Children with cerebral palsy often experience severe heartburn (gastroesophageal reflux). Self-feeding can be difficult, too, because they may be unable to use feeding utensils such as forks, spoons and cups.

Dietitians advice offering smaller meals throughout the day. This ensures your child gets more nutrition and reduces the stress for your child and yourself.

IMPORTANT FOODS

Fibre can play an important role in the diet of cerebral palsy sufferers as it helps alleviate constipation, to which children with cerebral palsy are susceptible.

This is caused by a lack of fluid and/or fibre, poor muscle tone and insufficient activity. Try to include a variety of high-fibre foods in your child’s diet (such as wholegrain cereals and breads, fruit and vegetables) and increase their fluid intake.

To prevent the risk of osteoporosis include foods high in vitamin D and calcium, such as milk, cheese, yoghurts and green leafy vegetables, such as spinach.

Avoiding foods that are high in fat and sugar (especially fried foods, crisps, chocolate, ice-cream, biscuits, cakes and sugary drinks) is very important for children with cerebral palsy for two reasons.

Firstly, limited physical activity is an issue faced by many cerebral palsy sufferers, which means they are more likely to become overweight and excessive weight can hinder children learning to walk. It can affect wheelchair-bound children’s mobility, making it more difficult for them to move from their wheelchair to bed, the toilet or the car.

Secondly, tooth decay is often a problem for children with cerebral palsy because of their diet, medication or gastroesophageal reflux. This can lead to greater difficulty with feeding as a result of pain and discomfort caused by tooth cavities, so foods high in sugar should also be avoided.

Children with severe feeding difficulties are an exception. In this case a dietitian may recommend foods that are high in protein and calories and, perhaps, the use of nutrition supplements to help prevent malnutrition. (See box below for ways to increase your child’s calorie intake.)

If you have any concerns about your child’s diet and nutrition it is important to speak to your GP or dietitian who can advise you on the best way to ensure your child is getting all the nutrients and calories they need. A dietitian’s recommendations may include changing the normal texture of food by chopping, grinding or pureeing and it may be necessary to thicken your child’s drinks.

For further information or to find a dietician in your area visit www.indi.ie

ZACH ANNER, 26, generated a buzz in the States earlier this year in his audition for Your Own Show, a reality series produced by Oprah Winfrey. Anner, who has used a wheelchair since the age of five, explained he had cerebral palsy, “the sexiest of the palsies”. He didn't win a place on the show but millions of viewers gave his zany humour the thumbs up by voting for him.

MICHAEL KUTCHER, Hollywood star Ashton Kutcher’s twin brother, was born with cerebral palsy. The twins grew up in the cornfields of Iowa and Ashton was Michael’s self-appointed protector. “That was a big part of my life,” Ashton recalls, “kind of looking out for my twin.”