Kids with cerebral palsy (CP) can have problems with movement, muscle tone, and/or motor skills. This can make it hard to eat and chew, or to swallow safely or easily. Some also have digestive problems like gastroesophageal reflux and constipation, which make eating uncomfortable.

So it can be hard for kids to get enough to eat, and that can lead to poor growth and/or malnutrition. But it’s possible to find the right diet and feeding approaches so that your child can enjoy eating, feel satisfied, and get the nutrients needed to grow and thrive.

What Nutrients Does a Child With CP Need?

Kids with CP need to get a variety of vitamins and minerals, just like everyone else. But sometimes, they might need more or fewer calories depending on their activity level and muscle tone (how "tense" their muscles are at rest). For example, a child with high muscle tone and a high activity level will use more energy and need to eat more than a child with low muscle tone and a low activity level.

Kids who can't walk or who have trouble getting enough nutrients in their diet due to feeding problems are more likely to have weak bones (low bone density). This makes their bones more likely to fracture, or break.

To help keep bones strong, kids with CP should get enough:

• calcium, a mineral stored in bones and teeth. Best sources of this include milk, yogurt, cheese, and calcium-fortified juices
• vitamin D, which helps the body absorb calcium from food and supplements. It's found in some fish, such as salmon and tuna, fish liver oil, and in the US, fortified products like milk, orange juice, and cereal. Our bodies also make vitamin D when skin that is not protected by clothes or sunscreen is exposed to the sun.
• phosphorus, a mineral that plays a role in the growth of bones and teeth. It's found in milk and milk products, meat, fish, eggs, poultry, nuts, seeds, and whole grains.

Other important vitamins and minerals for bone health include vitamin C, vitamin K, magnesium, copper, zinc, and manganese. These are found in beans, vegetables, and a variety of other foods. Many kids get enough of these nutrients in their regular diets.

How Can I Help My Child Get Enough Nutrients?

The care team can help make sure that your child gets the nutrients needed. The team may include:

• your doctor
• a dietitian
• a speech-language therapist
• an occupational therapist

They will ask for a record of what your child eats, including any food, drink, formulas, blended feedings, or puréed meals. Then, they can see whether your child is getting the right amount of calories, protein, vitamins, minerals, and fluids. A child’s needs vary depending on age, height, weight, growth, and physical activity level.

The care team will make a dietary plan based on this information. The plan helps you make sure that your child grows well and maintains a healthy weight.

Your child's growth and diet will be checked at follow-up doctors' visits. If your child isn't growing as expected or getting the right nutrition, the plan will be updated. Kids' nutritional needs change as they get older, so it's important to follow up with your care team at least annually as your child grows.

Do Kids With CP Need Supplements?

Sometimes a child with CP can't eat enough by mouth to get all the needed nutrients. So, doctors and dietitians recommend a supplement. These could be:

• vitamins or minerals. These come in different forms, like liquid or chewable tablets. For example, a child might need a vitamin D supplement in liquid form. Your child's doctor or dietitian will suggest the best amount and form for your child.
• calorie or protein boosters. These boosters can be store-bought (pre-mixed in a pouch, bottle, or box) or homemade. Adding extra gravy, cheese sauce, or butter can boost calories and protein. The dietitian can provide suggestions based on your child’s preferences and medical condition.
• meal replacements. These formulas are designed to serve as a meal, providing well-balanced nutrition. Several different formulas are available for different dietary needs. You can buy them in stores, and give them as a snack or meal. Homemade formula recipes should be created by a dietitian so that they meet nutrition goals.

Children who have problems swallowing may need thickeners added to their food and beverages to help them swallow safely. A speech-language therapist can see if your child needs a thickener and, if so, suggest the best one for your child.

When Is Tube Feeding Tube a Good Idea?

Feeding tubes allow nutrition to be given without being chewed or swallowed. Meal replacement formulas or puréed meals are put through the tube into the stomach or intestine. They ensure that kids get enough nutrition to grow, develop, and maintain a healthy weight. They also provide fluids to keep kids hydrated.

Deciding on a feeding tube can be a hard for parents. Parents might want their child to eat by mouth, like other kids. But sometimes it's not safe to eat by mouth. Kids who have trouble chewing or swallowing can get food in their airways or lungs, and this can cause respiratory illness and serious medical problems. In this situation, tube feeding is best.

Tube feedings also can help kids who eat safely but can't eat enough (even with supplements) to maintain a healthy weight. In these cases, tube feeding might supplement the regular mealtime routine. These feedings are also helpful when a child grows quickly and needs more nutrients while developing eating skills or has a serious illness. After, the tube can be used less often or removed. 

A tube can be placed:

• through the nose to reach the stomach for short-term feeding support
• through a port on the belly and into the stomach or intestine for long-term feeding support

For many children and families, mealtime and eating can be tiring and stressful. Tube feeding can make mealtimes more fun and social for everyone, and the child can focus on learning to safely eat.

Meeting the nutritional needs for a child with CP is possible with planning and regular checkups with a doctor and dietitian. With the right plan, your child can grow up strong and healthy.