Cerebral Palsy (or CP) is a term used to describe a group of chronic conditions affecting body movements and muscle control. CP is caused by damage to one or more specific areas of the brain, and usually occurs before, during, or shortly after birth.
Although cerebral palsy is marked by poor muscle control, the problem is not with the individual’s muscles. The muscles of persons with CP are healthy; the loss of motor control is due to the brain’s inability to fully control the muscles.
The brain damage that has occurred in a person with CP is static. Although symptoms may improve over time due to therapy or worsen over time due to growth, the brain damage itself does not change.
The incidence of cerebral palsy is about 1.5 to 4 per 1000 live births.
Cerebral palsy is classified by both the groups of muscles involved and the quality of movement:
Muscle Group Classification
- Tetraplegia/Quadriplegia: involves all four limbs, the trunk, and head.
- Diplegia: involves the legs to a greater degree and the arms to a lesser degree.
- Hemiplegia: involves one half of the body, either the right arm and leg or the left arm and leg.
Quality of Movement Classification
- Ataxia: decreased voluntary control of muscles
- Athetosis/Dyskinesia: involuntary body movements
- Spasticity: tight muscles
NOTE: Quite often, a person with CP has a mix of two or more of the above classifications.
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Feeding and Nutrition of Children with Cerebral Palsy
Children with cerebral palsy are at high risk for feeding difficulties (and resulting malnutrition). Children can have difficulties with drinking liquids, swallowing, and/or chewing. Due to tone issues and involuntary movements, children with CP often have decreased coordination of suck-swallow breath patterns which can lead to poor nutritional intake during feedings.
Causes of Feeding Difficulties in CP:
- Weak oral muscles, including the muscles of the lips, tongue, jaw, and throat
- Extra movements of the oral muscles
- Poor coordination of the oral muscles
- Poor posture and head control
A child with CP should be offered structured, nutritionally balanced meals and snacks. Frequent snacking in between meals can lead to poor overall intake and a diet poor in nutritional quality. Meals should be balanced, containing a carbohydrate, protein, fruit and vegetable source.
Often children with CP have difficulty meeting their nutritional needs by mouth. If the child receives tube feeding, these needs can be met through a combination of tube feeding and oral eating. If the child does not receive tube feeding, supplementing usual intake with calorie or protein dense foods can help your child to receive the nutrition they need to grow and develop. A child who is not receiving adequate nutrition in the form of calories, protein, vitamins and minerals will not be able to respond to therapies to the best of their abilities. Growth and development can be compromised.
A list of high calorie and protein foods can be found here.
For best results, a team approach to feeding is recommended so that all the child’s needs can be taken under consideration. The team, who may include caregivers, a speech-language pathologist, an occupational therapist, a physical therapist, a dietitian, and/or a physician, may utilize some of the following techniques to assist in improving feeding and nutrition:
- Adaptive seating: Improved head control and posture can often be achieved by changing the child’s mealtime seating to something that encourages proper pelvic positioning and has trunk supports if needed.
- Adaptive utensils: Sometimes kids do better with special cups, plates, and spoons. There is a wide variety of such products on the market. As each child’s needs are unique, the feeding team will need to make specific recommendations for each child.
- Diet Modifications: Some children may not be able to handle a diet that is typical for other children their age. For example, some kids may need to drink thickened liquids so they can control the liquid better as they are swallowing. Or, some kids may not be able to handle harder textures that require chewing, so they may need to have some foods mashed or ground up. Again, the feeding team can determine the appropriate dietary modifications for each child.
- Changes in Feeding Techniques: A feeding team might recommend specific techniques for feeding children with cerebral palsy that can encourage improved control and safety. For example, to encourage more active lip involvement in removing the food from the spoon (rather than having to scrape the spoon on the top of the child’s mouth to get the food off), the caregiver might learn to place the bowl of the spoon on the child’s tongue and apply gentle pressure until the child closes her mouth to remove the food herself. Or, in order to encourage improved cup drinking, the caregiver can provide a little support to the child’s jaw with her hands.
- Tube Feeding: Occasionally, despite the best efforts, a child with CP may not be able to eat safely by mouth. When swallowing, food might get into the lungs, causing choking or pneumonia. Sometimes, kids can eat safely but they are unable to eat enough by mouth, leading to malnutrition. In these instances, the feeding team will need to consider tube feeding. There are different kinds of tubes that can deliver food through the nose or directly to the stomach. The child’s team will decide which method is best. Just because a child begins tube feedings does not necessarily mean they can no longer eat by mouth. The feeding team will make recommendations for oral feeding depending on how safe the child’s swallowing is.
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