Nutritional & hormonal imbalance in cerebral palsy

Dr. Varidmala JainAssociate Prof, SHIAT, Allahabad

Email- varidmala@rediffmail.comjjain999@gmail.com

www.samvednatrust.com, www.trishlaortho.comFb:samvednatrust.cerebralpalsy

Youtube:jjain999

Introduction

• Most of the time children with cerebral palsy suffer from some or other nutritional problems—

• Deficiencies

• Imbalances

• Hormonal problems leading to nutritional deficiencies & growth retardation

Common Nutritional deficiency & hormonal disorder

• Protein-energy Malnutrion

• Vit D, Calcium, Phosphorus, Magnesium

• Vit B12

• Vit C

• Iron & folic acid

• Thyroid

• Growth hormone

Protein energy malnutrition

Etiology-• Frequent infection and / or hospitalisation• Feeding, eating, drinking and swallowing (FEDS)

problems• Modified consistency of diet (e.g. soft, minced &

moist, or puréed)• Reliance on others for feeding• High nutritional needs• Poor appetite due to constipation or reflux

Contd.

• More spasticity more energy expenditure

• Ambulatory spastic CP –medium energy expenditure.

• Athetoid CP - higher energy expenditure

• Wheel chair bound/non ambulatory - lower energy expenditure

• Factors for estimating energy needs: age, activity level, growth rate and muscle tone.

Overweight

• Because of reduced physical activity & increase intake of fat & fast food.

• Common in Quadriplegic non walker GMFCS 4/5

• Difficulty to mobilize & transfer.• Wt gain itself detrimental to person’s physical

activity and it becomes vicious cycle. • Proper nutritional advice & increase physical

activity

Contd.

• Good balanced diet • With high protein and fibers• Fats – less in obese but extra in severely

undernourished• Thumb rule is it should contain good mixture of

fruits, green vegetables, cereals, pulses and eggs or fish

• Plenty of fluids. 

Vit D Deficiency

• Limited exposure to the sunlight • Poor nutritional intake • Anticonvulsant medications • Rickets of Prematurity• Vit D deficiency can be one of the cause of loss

of seizure control • Osteomalacia in adolescent & rickets in younger

children • Symptom- Bone pain, proximal muscular

weakness, failure to thrive, stress fracture

Treatment

• Calcium rich food & supplement

• Vitamin D supplement

• Exposure to sunlight

• Avoidance of trauma

• Standing, walking, out door activity, swimming & regular physical therapy

Vit C

• Pain, limping & swelling

• Progressive leg weakness

• Subcutaneous bleeding

• Bleeding gums and loosening of teeth

• Fatigue, failure to gain weight, loss of appetite, and irritability

• Anemia

• Vit C supplements

Vit B12, iron & folic acid deficiency

• Faulty dietary habit & poor intake

• Worm infestation

• Anemia, peripheral neuropathy

• Supplement

Hypothyroidism

• Hypothyroidism can be the cause of floppy baby D/D hypotonic CP

• Hypothyroidism are very common in severely affected CP Child & adult

• Mother with hypothyroidism are more prone to deliver cerebral palsy child

• Hypothyroidism can cause wt gain & anemia

• Regular checkup in doubtful cases

Growth hormone deficiency

• Commonly in severely affected cases

• Can cause stunted growth..

• Face appears younger than children of the same age.

• They may also have a chubby body build.

• Late Puberty

• Growth hormone assay & supplement

Contd.

• These problems are result of---1. Feeding, Eating, Drinking and Swallowing

Difficulties (FEDS)

2. Oro-motor Difficulties:

3. Self-Feeding:

4. Sensory Difficulties:

5. Gastro-esophageal Reflux:

6. Constipation

7. Tooth Decay

Feeding, Eating, Drinking & Swallowing Difficulties (FEDS)

• One third of growing children with CP are poorly nourished due to FEDS

• Increase meal time

• Swallowing difficulty leads to choking & safety hazards – repeated pneumonia

Oro-motor Difficulties:

• It include tongue thrust, poor lip closure & inadequate tongue movements.

• causes food and drink to spill from the mouth, resulting in loss of calories and hydration.

Tt- • A modified consistency diet may be required for

safe feeding.• Oro pharyngeal exercises • Oral / Tube feeding / Gastrostomy tube

Self-Feeding:

• Some children may have difficulties using standard utensils such as spoons, forks and cups.

• They may require adaptive utensils to promote safety and independence

• Adjusting seating

• More time given for self feeding

• Small but frequent interval meal

Sensory Difficulties:

• Overly sensitive to touch in & around the mouth and face.

• Sensory modification like light stroke, massage will help out in this problem

Gastro-esophageal Reflux:

• Gastro-esophageal reflux or regurgitation of acid and or food contents from the stomach back up into the esophagus.

• Thickening of food along with small feed

• Seating arrangement during feed to prevent regurgitation

• Antacids

Constipation

• Caused by poor oral fluid intake, poor fiber intake, poor muscle tone, inactivity & certain medications.

• Intake of high fiber foods

• Increase in fluid intake

• Continuation of physical therapy

• Maintenance of ambulation at least standing & supported walking

• Stool softener / Suppository

Tooth Decay

• Causes are faulty diet, feeding difficulties, medication or Gastro-esophageal reflux.

• Tooth grinding can be common. • Tooth decay increases discomfort during

eating and drinking. • It is best to avoid excess sugary foods and

drinks, and to clean teeth twice daily. • Milk and water are the most tooth friendly drinks.

Message • Poor growth of children with CP occur

because of malnutrition, abnormal endocrine function, decreased weight bearing that have other negative health consequences that pose a significant burden to families and to society

• Proper understanding of problem & their solution can prevent child undergoing into another problem.

•Thanks