Growth Failure

Growth failure may be a problem in the child with cerebral palsy. Increased energy requirements and difficulty in handling food in the oral cavity combine to cause growth failure. Energy requirements in the young child with spastic cerebral palsy may be increased to 140 to 160 kcal/kg/day. Chronic failure to thrive decreases energy and strength to accomplish motor tasks and coordinate movement and may impair immunologic function. Children with oromotor dysfunction often have limited skills in handling foods and particularly in handling liquids. These children require high-caloric-density food and may require alternative feedings on a supplemental or primary basis.

Gastrostomy tubes with or without Nissan fundoplications may be in place. Tube feedings may be the primary caloric intake or may be used supplementally (often at night) to improve the nutritional, health, and functional status of the child. Problems with the gastrostomy tube or the skin surrounding it may bring children into the ED. Irritation of the skin site due to movement of the gastrostomy tube may occur with development of granulation tissue and/or leakage of gastric contacts. The stability of the tube needs to be checked, and bumpers holding the tube in place may need to be adjusted. If leakage of acidic contents has caused skin breakdown, the leakage needs to be eliminated, if possible, and a barrier should be used to protect the skin until it heals. Zinc oxide-based creams often are effective, but adherence to the skin can be a problem. An enterstomal therapist may be able to offer assistance in choosing products that offer the best adherence properties. Gastrostomy tubes falling out and being pulled out intentionally or unintentionally also can be an issue. The stoma should be maintained if possible to allow for replacement of an appropriate tube in a controlled manner as soon as possible. Placement of a red rubber feeding tube through the stoma and taping it in place can be effective for up to several days if necessary. If skin irritation or breakdown is a problem, then securing the tube may be a challenge. The physician should attempt to secure the tube without placing tape on macerated skin surfaces.

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