CEREBRAL PALSY What Went Wrong?

Cerebral palsy is the dysfunction of the portion of the brain that controls motor
function resulting in partial paralysis and uncontrolled movement. The dysfunc-
tion might be caused by hemorrhage, anoxia, rubella during pregnancy, malnu-
trition, or other conditions that might affect normal development of the brain.
The dysfunction might be caused during pregnancy by the mother contract-
ing rubella or other infection, malnutrition, abnormal attachment of the pla-
centa, toxemia, radiation, or medication. Cerebral palsy could also be caused
by a difficult birth, prolapsed umbilical cord, or multiple births. An infant
might develop cerebral palsy if the infant becomes infected or as a result of
trauma and result in prolonged anoxia or decreased circulation to the brain.
There are three types of cerebral palsy:
  Spastic (most common): The cortex is affected resulting in the child
having a scissor-like gait where one foot crosses in front of the other
foot.
  Athetoid: The basal ganglia are affected resulting in uncoordinated
involuntary motion.
  Ataxic: The cerebellum is affected resulting in poor balance and diffi-
culty with muscle coordination.

Nutritional assessment should include

Nutritional assessment should include

Dietary intake

  Dietary history by 24-hour recall, food diary, or record to note the

nature and amount of foods and beverages consumed

Clinical examination

  Chart weight, height, and head circumference (for infants) on a

growth chart; if child is <5th percentile or >95th, an insufficient or

excess intake is likely present.

  Calculate body mass index (BMI):Weight in kilograms divided by

height in meters squared.

  Skin changes such as loss of skin turgor, elasticity of the skin, or

edema, swelling or puffiness indicating dehydration or fluid overload.

  Delayed wound healing (poor protein intake/malnutrition).

  Flabby skin or stretch marks can indicate food/excesses.

  Other physical changes noting malnourishment or excess dietary intake

nurse :nutritional assessment

An essential element in the assessment is evaluation of the child’s nutritional
status from a physical examination and a biochemical perspective, as well as
the usual dietary intake. It is important to collect data from the child and fam-
ily members regarding nutrition habits. Inquire about community access to
variety of food types and factors impacting food choices, such as location of
stores, fast-food choices due to time constraints, and economic barriers to pur-
chase of sufficient quantities of fresh fruits and vegetables and low-fat cuts of
meat, as well as fish and fowl choices. If the family practices vegetarianism,
inquire about the specific foods allowed and assess adequacy of intake of nutri-
ents from all food groups. Assess overweight (85–95% for body mass index
[BMI]) or obesity, weight above 95th percentile for BMI in the child or family
members because family eating habits will play a large part in childhood obe-
sity moving into adulthood.