Wheelchair or Bed Bound

Many wheelchair or bedbound children have Cerebral Palsy and are often termed "developmentally disabled," or "differently abled." Approximately 25% of these children had feeding problems in infancy as their first symptom.  And they have ongoing nutritional needs that have to be carefully addressed in order to improve their care.

The basic nutritional goals for healthy children and those who are wheelchair or bed bound are similar:

  • Maintain Metabolism (including hydration);
  • Provide Sufficient Energy to withstand stress; and
  • Correct and prevent any deficiencies.

But there are additional needs and considerations.  The disabled child may face other issues: inhaling their food and fluids into their lungs (aspiration), some have difficulty swallowing or problems with self-feeding and oral skills that may require assistance; and regulation of bowel movements, particularly if he or she isn't able to be toilet-trained.  Additionally, many developmentally disabled patients are totally dependent on their caretakers, including for mobility.  Thus, an overweight child (or even one who reaches full adult proportions) may be at risk for ulcers where their tissues press against the wheelchair or bed if they cannot be moved; or their caretakers may be at risk for hernias, back injuries, or heart attack due to the repeated strain of moving and positioning them.  And for overweight kids, the excess weight adds extra work for their lungs and heart.

The time of greatest nutritional risk are in early infancy and then again in the second decade of life, due primarily to feeding problems.  In infancy, low body tone (hypotonia) or increased body tone (hypertonia) often makes it difficult for some of these babies to acquire the oral and swallowing skills that are needed to feed successfully.

FEEDING AND SWALLOWING DISORDERS: CONTRIBUTING FACT0RS
  • Problems with the mouth, face, esophagus (example, Cleft palate)
  • Problems with the way they function (example, increased or decreased oral sensitivity)
  • Neurological problems (examples, seizures, poor tone or coordination)
  • Other medical problems (examples, heart or lung disease causing exhaustion)
  • Behavioral problems (example, irritability or resistance)
  • Environmental considerations (example, parent's emotional or mental disorder)

The problems for the older patient come because they need more food.  They need more nutrients and calories because of their increased size, which requires more effort and time to eat.  This extra effort can wear them out, and their caretakers too, so some older children don't get the nutrition they need.

MALNUTRITION NO LONGER

In the past, severe malnutrition was accepted as a part of their disabilities.  But now, advancements in feeding technology (often with tube feedings) have changed that view.  Several studies demonstrate that increased nutrient intake can improve:

  • Weight;
  • Muscle mass and function;
  • Energy stores;
  • Peripheral circulation;
  • Immune status; and
  • General well being -- 
  • While decreasing their irritability and spasticity.

But even with improved nutrition, children with cerebral palsy and other disabilities often do not grow as well in height well and they still often recover slowly from illnesses.