Children with cerebral palsy (CP) may have difficulty gaining enough weight. If you have any concerns regarding your child’s weight gain please discuss these with your child’s doctor or dietitian. To help your child gain weight, you may need to consider the following areas:
Positioning for Mealtimes
Good positioning is one of the most important things to help your child eat and drink well. Many children with CP have their own customised seating, but may need additional body and head support to keep them stable and comfortable during mealtimes. Supportive positioning will also help stop them getting too tired during meals and to make sure they can best use their muscles required for eating, drinking and swallowing.
General tips for positioning:
- Encourage an upright, aligned body position (where their head is over their trunk/upper body and their trunk is over their pelvis). However some children may need to use “tilt-in-space” to provide extra support for the body and to assist sucking and swallowing. Remember the 90º: 90º: 90º rule (90 º at knees, hips and head as shown in picture). This will achieve the safest position for swallowing and allow your child to see his/her food or drink.
- Use trunk support or straps that have been provided with your child’s chair as this allows for your child’s body to be supported and stable. Supports should be firm.
- Position your child at a table or use a tray, to help maintain a more upright body position and encourage self-feeding.
- The position of your child’s head is very important. Try to encourage a slight chin tuck position (chin pointing down towards chest) and a long back of neck as this is a better position for swallowing.
- Give careful consideration to the position of the feeder/helper, as this may influence your child’s head position. It is best if they are positioned at the same level as the child.
Note: There may be more specific positions that will be better suited to your child to assist with mealtimes.
A speech pathologist, occupational therapist or physiotherapist will be able to help you with this.
Suitable types of food and drink
Children with CP may have difficulty with eating, drinking or swallowing. Particular food textures or fluid consistencies may be easier and safer for them to eat or drink. Speech Pathologists can assist in recommending appropriate food textures and fluid consistencies for your child.
Appropriate utensils and specialised equipment may assist children with CP to better manage food and fluid, and/or encourage them to feed themselves, e.g. easy to hold cutlery, non-slip matting. Make sure all utensils and equipment are within reach to encourage self-feeding. Occupational therapists can assist in recommending appropriate equipment or utensils.
Increasing Energy and Protein
Extra nutrition can be provided through calorie and protein dense foods. A dietitian can provide you with suggestions to increase your child’s energy and protein intake.
Here are some tips to “make every bite count”:
- Include high protein and high energy foods at every meal and snack (some examples are listed in the table below)
- Offer your child 3 meals and 2 – 3 snacks each day
- Take advantage of times when your child feels hungry to encourage them to eat
- Encourage your child to drink nourishing fluids such as milkshakes
- Keep lots of ready-to-eat snacks handy such as yoghurt, cheese and dips
Commercial supplements (recommended by your child’s dietitian or doctor) or fortified milk (see recipe on page 3) can be used to increase your child’s energy intake.
100kcal energy boosters
- Margarine, butter, oil – 1tbsp
- Thickened cream – 1 heaped tablespoon
- Double cream – 2 tablespoons
- Sweetened condensed milk – 1 heaped tablespoon
- Mayonnaise – 1 heaped tablespoon
- Sour cream – 1 tablespoon
- Cheese – 30gms/ 2 slices
- Milk powder – 2 tablespoons (add to 1 cup milk)
- Peanut butter – 1 tablespoon
- Full fat yoghurt – ½ 200gm tub
- Avocado – ¼ avocado or 4 tablespoons
- Hummous – 2 tablespoon
High protein foods
Example of high protein foods include:
- Dairy products e.g. full cream milk, cheese, yoghurt
- Meat, fish and chicken
- Legumes e.g. beans and lentils
- Nuts, seeds and their pastes (e.g. peanut butter)
RECIPE High energy milkshake
(Provides approximately 400cals)
- 1 cup milk
- 1 heaped scoop Vanilla Ice Cream
- 1 tablespoon cream
- 1 tablespoon milk powder
- Flavour using chocolate or strawberry syrup
Queensland Paediatric Rehabilitation Service
Queensland Children’s Hospital
Level 6, 501 Stanley Street, South Brisbane 4101
t: 07 3068 2950
t: 07 3068 1111 (general enquiries)
f: 07 3068 3909
In an emergency, always call 000.
If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.
Cerebral Palsy League of Queensland (2001). “Help me Grow”. Nutrition for Children with Cerebral Palsy. A guide for parents and carers. Booklet
Winstock, A. (1994) ‘The Practical Management of Eating and Drinking Difficulties in Children’, United Kingdom: Winslow Press Limited Novita Speech Pathology
Novita Children’s Services Fact Sheets, Retrieved July 2009, from https://www.novita.org.au/