Malnutrition in children with Cerebral Palsy

Children living with cerebral palsy, a movement disorder caused by damage to brain development, are at a high risk of malnutrition. The negative effects of malnutrition include diminished bone and oral health, as well as slower recovery after surgical procedures.

At the ESPGHAN 2025, Prof. Dr. Koen Huysentruyt discussed the relationship between nutrition and cerebral palsy in his presentation Defining Malnutrition in Children with Cerebral Palsy. He highlighted challenges in diagnosing and treating malnutrition and emphasised that nutritional issues in children with cerebral palsy go beyond sufficient caloric intake.

The Gross Motor Function Classification System (GMFCS) is a tool used to categorise the extent of motor disability in children with cerebral palsy.  It ranges from Level 1 (normally functioning) to Level 5 (wheelchair-bound). Each level of motor impairment is associated with nutritional risks; children with GMFCS Levels 3 to 5 are generally considered to be at the highest risk.  

In addition to this,  Dr. Prof. Huysentruyt explains the key contributors to malnutrition:

• Communication challenges: Children with severe motor impairments find it difficult to express feelings of hunger or discomfort related to feeding
• Medication effects: Some children who have cerebral palsy require several medications (polypharmacy) that may have side effects that disrupt appetite, digestion, and nutrient absorption
• Swallowing Problems (Dysphagia): Challenges with swallowing are common and can result in insufficient food intake consumption and a higher likelihood of food going into the airway or lungs and not the oesophagus

Diagnosing malnutrition in children with cerebral palsy requires multi-dimensional approaches, as no single measurement is sufficient to identify it.  Caregivers should be involved in discussions about growth patterns, dietary intake, and intervention strategies for collaborative and effective treatment plans.

Prof. Dr Huysentruyt notes the importance of early intervention to preserve and stop further deterioration of bone health. This includes improving nutritional status, and where necessary correcting  other factors that influence bone health, such as vitamin D, calcium, and phosphorus intake, medication, nutrient supplementation and weight-bearing status.

A significant breakthrough in nutritional assessment has been the creation of growth charts specifically designed for children with cerebral palsy, derived from data involving over 25 000 children in the United States. These charts provide a more precise representation of the distinct growth patterns exhibited by children with cerebral palsy compared to conventional charts.

They not only serve as a more reliable benchmark for tracking development but also assist in determining suitable nutrient requirements and identifying high-risk individuals, particularly those categorised within the “red zone,” which is linked to higher risks of mortality and co-morbid conditions.

New developments around diagnosing cerebral palsy-related malnutrition will have a great impact on assessing the needs of children living with the condition. With this tool, the correct measures can be taken to eradicate micronutrient deficiencies and promote healthy growth and an improved quality of life.