Gastrointestinal and Nutritional Issues in Cerebral Palsy

INTRODUCTION CP is a broad-spectrum neurologic disorder commonly defined as a non-progressive static encephalopathy which affects approximately 4 per 1000 live births. Its etiology is unknown although many children with CP have underlying anatomic anomalies not associated with the central nervous system suggesting a disorder in fetal development. CP leads to a wide array of neurologic disorders including mental retardation, seizures, and other neuromuscular disorders. Table 1 delineates some of the more common presentations of CP. The inherent neuromuscular abnormalities of this disorder make it common for CP patients to have gastrointestinal abnormalities such as dysphagia, GERD, altered gastric motility, and constipation (1). ESOPHAGEAL CONSIDERATIONS Feeding problems are common in CP and have been reported in 37% of children with diplegia or hemiplegia and in 86% of children with quadriplegia. In general, affected children with severe motor delay are more likely to have feeding and swallowing problems which places them at risk of nutritional failure and respiratory infections from aspiration. Previous studies have demonstrated that inherent dysphagia associated with CP requires a longer feeding period for the child and lack of caretaker time in giving a child adequate caloric intake. Both of these factors may affect nutrition (2). The use of an occupational therapist with expertise in this disorder is very helpful for training parents correct feeding patterns. The impaired swallow in a child with CP can present as increased drooling, recurrent pneumonias, and poor growth. Radiographic testing often is needed to A SPECIAL ARTICLE