Red Flags for Feeding and Nutrition for Children with Cerebral Palsy

This study aims to develop and validate brief questionnaire (up to 5 questions) to identify those children and adolescents with cerebral palsy who may have feeding difficulties are be undernourished. This would allow children to be referred for full assessment by the relevant health care professional/s to determine the presence and severity of feeding and swallowing difficulties and/or undernutrition and lead to the provision of appropriate clinical care. A total of 100 children between the ages of 2.00 and 17.99 years will be recruited for the study. To be enrolled, children must have a confirmed diagnosis of cerebral palsy and not rely on a feeding tube for enteral nutrition. We will aim to recruit an even distribution across gross motor functional severity. Parents will be asked to answer a series of simple questions regarding their child's feeding and nutritional status. Full feeding assessment and nutrition assessment will then be conducted to determine the presence and severity or absence of feeding difficulties and undernutrition. These will all be conducted on the same day. The nutritional assessment will consist of measures of weight and height (or length or knee height) and triceps and subscapular skinfold thicknesses. A Subjective Global Nutrition Assessment will be performed which involves an interview with the child's primary care giver and the collection of a nutrition related medical history including historical weight and height measurements (if known), full dietary history, presence and severity of gastrointestinal symptoms, and other related medical information. A physical examination of key physical signs associated with undernutrition including subcutaneous fat stores and muscle stores will be conducted. The feeding evaluation will involve the child positioned in their typical mealtime seating, children will be encouraged to consume food and fluids of different textures. When required children will be referred for a more detailed feeding evaluation using an x-ray procedure. This may be conducted on a separate day to the other components.