Question

You are working with a dietitian in a Developmental Disabilities clinic for children. A new patient has just entered the clinic with her mother and grandmother. You are asked to assist in the initial nutrition assessment of the patient and in the development of nutrition goals for the upcoming month.

The patient is Claire, a 4-year-old girl with mild cerebral palsy. A physical assessment shows mild spastic movements of arms legs and face. She can walk with little assistance, vocalizes well, and has normal intellect. Her mother states Claire is a ‘good eater’ and likes a wide variety of foods with little problem chewing or swallowing. However, she is fiercely independent and prefers to feed herself, a process that takes an extended amount of time at meals. She attends a specialized pre-school which is well-equipped to handle her special needs.

The reason for this visit and the referral to you: Claire has experienced repeated episodes of respiratory infections over the past 6 months, accompanied by fever. Antibiotics successfully treat the infection, but often result in appetite loss. As a result, Claire has lost 6-8 pounds over the past 6 months.

What information is needed to complete a nutritional assessment of this patient?

Answer 1

Failure of proper bolus formation, oesophageal peristalsis, glottic closure, and “turn taking” between swallowing and breathing leads to recurrent aspiration of solids and liquids during feeding. Thin liquids are particularly prone to be aspirated. Even between feeds, there is likely to be recurrent aspiration of non-sterile oral and upper respiratory secretions into the (normally sterile) lower airways because of inadequate protective reflexes.

Malnutrition subjects the respiratory muscles to catabolism, leading to atrophy, weakness, and reduced lung function, as well as increasing bacterial colonisation of the airways and reducing resistance to infection. Joint input from dietician and speech therapist is essential: appropriate feeding modification and supplements will be sufficient in some children, while others will require nasogastric feeding; if this is likely to be long term we would usually advocate gastrostomy.

The appetite loss is due to the eating of antibiotics which makes the bacteria resistant to the antibiotic dosage and this disease can even lead to pneumonia which can prove fatal if not treated in time.