Impact of malnutrition on gastrointestinal disorders and gross motor abilities in children with cerebral palsy

Abstract

Children with cerebral palsy (CP) often demonstrate abnormal feeding behaviours, leading to reduced food consumption and malnutrition. Moreover, most of them present with gastrointestinal disorders, such as gastroesophageal reflux disease (GERD) and/or chronic constipation (CC), and poor motor function rehabilitation. The aim of our study was to assess the possible relationship between malnutrition and gastrointestinal problems and to evaluate the role of nutrition on their gross motor abilities in a population of children with CP and mental retardation. Patients: Twenty-one consecutive children (10 boys; mean age: 5.8 ± 4.7 years; range: 1–14 years) with CP and severe mental retardation. Methods: Nutritional assessment included the measurement of body mass index (BMI = W/H 2), fat body mass (FBM) and fat free mass (FFM). Children with symptoms suggesting GERD underwent prolonged 24 h intraesophageal pH monitoring and/or upper GI endoscopy with biopsies before and after a 6 months of pharmaceutical (omeprazole) and nutritional (20% increment of daily caloric intake) treatments. The motor function was evaluated by “The Gross Motor Function Measure” (GMFM) before and after the 6 months on nutritional rehabilitation. Results: BMI for age was ⩽5° percentile in 11 children (52%) and FBM was ⩽80% of ideal value for height in 15 (71%). GERD was present in 14 children (67%), 9 of them were affected by both GERD and CC. Among children with FBM ⩽ 80%, GERD was present in 11 (73%) and CC in 9 (60%). Considering the group of patients with BMI ⩽ 5° percentile, 9 out of 11 children had GERD (82%) and 7 had CC (64%). Fourteen malnourished children (FBM ⩽ 80%) completed the 6 months nutritional trial. Their starting and final means ± SD BMI were 13.56 ± 1.31 and 14.15 ± 1.85 ( p = 0.08), respectively. GMFM values were significantly ( p < 0.05) improved in 9/14 pts (Group A), while it remained unchanged in 5/14 pts (Group B). Nine children with GERD and malnutrition completed the 6 months of pharmaceutical and nutritional treatments. Their initial mean ± SD weight was 10.1 ± 2.9 kg, whereas the final mean ± SD weight was 12.7 ± 4 kg ( p < 0.05). A marked improvement of GERD was noted in four of nine (44.4%) children. Despite successful nutritional rehabilitation with a BMI achievement of ⩾25° percentile, five of nine (55.5%) patients had persistent GERD when they were taken off the medication. Conclusions: Malnutrition and gastrointestinal disorders are very common in children with cerebral palsy. Improved nutritional status, particularly fat free mass gain, appears to have an impact on motor function in children with CP.