Poor nutritional status and growth failure are common in children with cerebral palsy (CP). The aim of this study was to assess, within a subgroup of a large and clearly defined population of children with disabilities, the impact of feeding difficulties on (1) the quality (micronutrient intake) and quantity (macronutrient intake) of their diet and (2) their growth. One hundred children with disabilities (40 females, 60 males; mean age 9 years, SD 2 years 5 months; range 4 years 6 months to 13 years 7 months) underwent a detailed dietetic analysis and a comprehensive anthropometric assessment. Diagnostic categories of disability were: CP (n=90); global developmental delay (n=3); Marfan syndrome (n=1); intractable epilepsy (n=2); agenesis of the corpus callosum (n=2); methyl malonic aciduria (n=1); and congenital rubella (n=1). Neurological impairment was classified according to difficulty with mobility which was graded as mild (little or no difficulty walking), moderate (difficulty walking but does not need aids or a helper), and severe (needs aids and/or a helper or cannot walk). Results confirmed the significant impact of neurological impairment in children on body growth and nutritional status becoming worse in those with a greater degree of motor impairment. The major nutritional deficit was in energy intake, with only one fifth reportedly regularly achieving over 100% estimated average requirement (EAR), whilst micronutrient intake was less markedly impaired and protein intake was normal in this group (96% above EAR). Many children with neurological impairment would benefit from individual nutritional assessment and management as part of their overall care. Poor nutritional status and growth failure are common in children with cerebral palsy (Thommessen et al. 1991, Stallings et al. 1995). It has been reported in several studies that such growth failure can be related to an inadequate food intake, resulting from self-feeding impairment and oral-motor dysfunction (Krick and Van Duyn 1984, Gisel and Patrick 1988, Rempel et al. 1988, Stallings et al. 1993, Reilly et al. 1996, Stallings et al. 1996). However, many of these studies contain only a small number of participants. In an attempt to overcome this limitation, we have recently reported the first large-scale epidemiological study of feeding and nutritional problems in disabled children with neurological impairment, called the Oxford Feeding Study (Sullivan et al. 2000). The results of this study highlighted that feeding problems in children with neurological impairment are indeed common and severe and are a cause of much concern to parents. Patrick and Gisel (1990), on the basis of their experience with feeding neurologically impaired children, suggest that nutritional problems are caused primarily by energy deficits rather than by deficits of protein, vitamins or minerals. They maintain that it is because the diet given to people with dis-abilities is qualitatively good but deficient in volume and that the malnutrition found in individuals with disabilities is rarely associated with either skin changes or hair or mucosal changes. This is, of course, quite different from the clinical picture of childhood malnutrition seen in the developing world where micronutrient deficiencies (especially of vita-min A and zinc) together with protein deficiency are much more prominent. The qualitative 'adequacy' but quantitative deficiency of the diets provided for children with disabilities might also be one of the reasons that such individuals can survive in a moderately malnourished state for many years. The aims of the present study were: (1) to test the hypoth-esis that the diet in children with disabilities is lacking in quantity rather than quality and (2) to demonstrate that the dietary deficit and associated growth impairment are worse in those with more severe levels of motor deficit.
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