Feeding difficulties in children with cerebral palsy

Background Children with cerebral palsy (CP) often have feeding difficulties due to their disability. This results in inadequate calorie intake which finally leads to malnutrition. Several studies found that 30-90% of children with CP have feeding difficulties associ- ated with malnutrition. There has been no sufficient published data about this problem in Indonesia. Objective To determine the prevalence of feeding difficulties and malnutrition in children with CP. Methods A cross-sectional study was done from January to September 2005 in the pediatric outpatient clinic of Dr. Cipto Mangunkusumo Hospital (CMH). Children with CP underwent nutritional and feeding difficulties assessment. Nutritional sta- tus was determined by the ratio of body weight to body height standardized to CDC-NCHS 2000 growth curve and were classified based on Waterlow. Calorie intake was evaluated by dietary analysis and defined as adequate if it reached 13.9 kcal/ em BH ± 10%. Feeding difficulties assessment included history taking, physical examination and observation of feeding skill in the outpatient clinic. Results Fifty-five children with CP were included in this study, most of them were spastic type, mainly spastic diplegic and spastic quadriplegic cerebral palsy (SQCP). Malnutrition was found in 76% subjects, most were SQCP. Feeding difficulties were found in 76% subjects, half of them were SQCP, 38% with spastic diplegic. Thirty- eight percents of the parents whose children had feeding difficulties was not aware of these problems in their children. Parallel with data above, 78% subjects received inadequate calorie intake. Conclusions The prevalence of undernourished and severe malnutrition in children with CP is 66% and 11% respectively. Malnutrition in CP patients tends to be related with inad- equate calorie intake due to feeding difficulties that is found in 78% subjects especially those with SQC