Feeding Dysfunction is Associated with Poor Growth and Health Status in Children with Cerebral Palsy

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Abstract

Objective To describe parent-reported feeding dysfunction and its association with health and nutritional status in children with cerebral palsy.

Design Anthropometry was measured and z scores calculated. The Child Health Questionnaire was used to assess health status, and a categorical scale (none to severe) was used to classify subjects according to severity of feeding dysfunction.

Subjects 230 children (9.7±4.6 years; 59% boys) with moderate to severe cerebral palsy were recruited from 6 centers in the United States and Canada.

Statistical analyses Descriptive statistics, the Kruskal-Wallis and Pearson χ2 tests.

Results Severity of feeding dysfunction was strongly associated with indicators of poor health and nutritional status. The mean weight z scores were −1.7, −2.5, −3.3, and −1.8 among children with none, mild, moderate, or severe (largely tube-fed) feeding dysfunction, respectively (P=.003). Similar results were observed for height z score (P=.008), triceps z score (P=.03), and poor Global Health score (part of the Child Health Questionnaire) (P<.001). Subjects who were tube fed were taller (P=.014) and had greater body fat stores (triceps z score, P=.001) than orally fed subjects with similar motor impairment. For subjects exclusively fed by mouth, a dose-response relationship was observed between feeding dysfunction severity and poor nutritional status. Subjects with only mild feeding dysfunction had reduced triceps z score (−.9) compared with those with no feeding problems (−0.3).

Conclusion For children with moderate to severe cerebral palsy, feeding dysfunction is a common problem associated with poor health and nutritional status. Even children with only mild feeding dysfunction, requiring chopped or mashed foods, may be at risk for poor nutritional status. Parental report of feeding dysfunction with a structured questionnaire may be useful in screening children for nutritional risk. J Am Diet Assoc. 2002; 102:361–368, 373.

Section snippets

Methods

This study was conducted as part of the North American Growth in Cerebral Palsy Project (NAGCPP). NAGCPP is a cross-sectional, population-based study of growth and nutritional status in children with cerebral palsy residing in 6 geographic areas of the United States and Canada (4 in the United States: Charlottesville, Va; Philadelphia, Pa; Chapel Hill, NC; Rochester, NY; and 2 in Canada: Vancouver, BC and Hamilton, ON). Design of this project is described in detail elsewhere (18) and is briefly

Results

A total of 668 children were initially identified, of which 477 had moderate to severe cerebral palsy (GMFC III to V); 292 met the inclusion and exclusion criteria, and 235 subjects were enrolled and measured. Of the 235, feeding dysfunction was not assessed on 5 subjects; therefore, results from the remaining 230 subjects are presented. The mean age for this sample was 9.7±4.6 years (range=2.0 to 17.9 years), of which 59% were male, 69% white, 23% black, and 7% of other or mixed ethnicity.

Discussion

To our knowledge, this was the first large, multicenter study focused solely on children with moderate to severe cerebral palsy with the objective of assessing the relationships between feeding dysfunction, health, and nutritional status. Parent-reported feeding dysfunction was strongly associated with indicators of nutritional status and general health, as well as the severity of motor impairment. When a subsample of subjects who were orally fed (non-tube fed) was analyzed separately, a

Applications

■ Feeding dysfunction is common among children with moderate to severe cerebral palsy and is associated with poor health and nutritional status. Children with a pattern of severe feeding dysfunction were at greatest risk for poor nutritional status; even those with only mild feeding dysfunction had poor growth and inadequate fat stores.

■ A simple categorical feeding scale (mild, moderate, severe) along with a validated instrument to assess the severity of motor impairment (GMFCS) were useful in

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