Gastroesophageal reflux disease (GERD): Children with CP often gag, regurgitate, cough, or vomit stomach contents due to GERD. In this condition, the lower esophageal sphincter relaxes longer and deeper than usual, allowing stomach contents to spill up into the esophagus and even up to (and out of!) the child's mouth. The regurgitated stomach contents can cause irritative esophagitis and may be aspirated into the lungs, precipitating episodes of aspiration pneumonia. Many children with GERD respond well to medicines such as metoclopramide. Others require a fundoplication, which is an operation that tightens the lower esophageal sphincter. Nurses working with these families can teach appropriate feeding techniques for the particular youngster, remind caregivers to keep the child upright after feedings, and help identify foods that exacerbate the GERD.
problems precluding oral feeding:
Because of muscle weakness, spasticity, and oral-motor dysfunctions, many infants
with cerebral palsy have trouble coordinating the complex tasks of latching
on to a nipple, sucking, and swallowing. While most children with CP can learn
to drink and eat, despite oral-motor issues, some require either temporary or
permanent placement of a gastrostomy tube. Inserted through the skin of the
abdomen into the stomach, the tube allows the child's caregivers to pour special
formula, pureed food, fluids, and/or medications directly into the stomach.
Nurses working with these youngsters can teach modified techniques for breast
or bottle-feeding, provide adaptive equipment for drinking and eating, and teach
parents how to safely administer gastrostomy feedings.
Constipation: Children with CP often develop constipation, secondary to spasticity of the abdominal muscles and/or low muscle tone. Many are unable to contract their abdominal muscles to push out rectal contents, while others have no sensation of fullness. Lack of exercise, as well as a diet low in fiber or fluid, can contribute to the constipation. Relief of constipation in children with CP is highly-individualized, and nurses can help families come up with effective patient-centered programs. An increase in dietary fiber and fluid can be helpful for some children; others require stool softeners, mineral oil, or laxatives; and still others need a bowel routine that includes rectal stimulation and/or suppositories and enemas.
tract infections: Children with CP develop urinary tract infections
about three times as often as their peers. Factors contributing to UTIs may
include poor perineal hygiene and chronic constipation. Nurses can play a key
role in implementing preventive measures, including more frequent diaper changes,
better perineal hygiene, and increased oral fluids.