nutritional & hormonal imbalance in children with cerebral palsy
DESCRIPTION
Most of the time children with cerebral palsy suffer from some or other nutritional problems, some time it may be nutritional deficiency and others may have excess of that. hormonal imbalance also lead to lots of nutritional issue and growth problem in children with cerebral palsy. it is very important to understand each and every important step in nutritional requirement of these children so that parents can make fine balance in that for better growth.TRANSCRIPT
Nutritional & hormonal imbalance in cerebral palsy
Dr. Varidmala JainAssociate Prof, SHIAT, Allahabad
Email- [email protected]@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