Under nutrition, growth failure, overweight and micronutrient deficiencies

Ekow Grimmond Thompson, Emotional Surgeon

 Under nutrition, growth failure, overweight, micronutrient defi­ciencies, and osteopenia (a condi­tion that begins as you lose bone mass and your bones get weaker) happen when the inside of your bones become brittle due to loss of calcium. It is very common as you age.

Total bone mass peaks around age 35. Sometimes, osteopenia is a precursor to osteoporosis (nutritional comorbidities that affect the neurologically impaired child). Monitoring neurologically im­paired children for nutritional comor­bidities is an integral part of their care.

Early involvement by a multidisci­plinary team of emotional surgery spe­cialists, physicians, nurses, dieticians, occupational and speech therapists, psychologists, and social workers is es­sential to prevent the adverse outcomes associated with feeding difficulties and poor nutritional status.

Careful evaluation and monitoring of severely disabled children for nutrition­al problems are warranted because of the increased risk of nutrition-related morbidity and mortality. Neurological impairment refers to a broad spectrum of neurological disorders that are char­acterised primarily by gross and fine motor dysfunction and may be associat­ed with cognitive or speech delay.

Under nutrition and overweight lead to increased health care use, hospital­isation, and physician visits, as well as diminished participation in home and school activities. Adequate nutrition­al support may restore linear growth, normalise weight, improve health and quality of life, reduce the frequency of hospitalisation, decrease irritability and spasticity (muscle and joint deformi­ties/muscle stiffness causing movement to be less precise and making certain tasks difficult to perform/muscle fa­tigue/abnormal muscle tightness due to prolonged muscle contraction).

It is a symptom associated with dam­age to the brain or motor nerves, in­crease alertness, enhance developmen­tal progress, improve wound healing and peripheral circulation, decrease the frequency of aspiration, and ameliorate gastro esophageal reflux (acid reflux occurs when the stomach contents back up into the esophagus and or mouth) in these children.

Children with neurological disabilities usually have progressive weight deficits due to fat loss, although muscle and visceral proteins are maintained. Some children demonstrate a lack of weight gain in the presence of linear growth, leading to a decreased body mass index (BMI). Others have progressive muscle atrophy (decrease in size and wasting of muscle tissues. With muscle atrophy, your muscles look smaller than normal.

Muscle atrophy can occur due to malnutrition, age, genetics, a lack of physical activity or certain medical conditions unresponsive to nutritional intervention because of their underlying disorder. Although neurologically im­paired children usually are shorter and weigh less than unaffected children, a small proportion may be overweight based on weight-for-height or triceps skinfold thickness criteria.

The prevalence of overweight may be underestimated because weight-for-height gains are overlooked in the pres­ence of a small body size or an aberrant distribution of body fat that may be present in some neurological disorders. Weight-for-height comparisons may be monitored less frequently than weight alone because of the difficulty obtain­ing accurate height measurements.

Non-nutritional factors including the type and severity of neurological dis­ability, ambulatory status, and cognitive ability contribute to growth failure in neurologically impaired children. Children with seizures or spastic quad­riplegia (a form of cerebral palsy that affects both arms and legs and often the trunk of the human body and face) and those who are non-ambulatory have lower height Z scores than children who lack these disabilities.

Children with spastic hemiplegia (a type of cerebral palsy that occurs when the condition of muscle stiff­ness impacts one full side of the body) have smaller measures of breadth and length on the affected side, sug­gesting that the neurological defect influences growth. Inherent genetic factors may be associated with per­manent linear stunting. Height-for-age Z-scores may decrease with advancing age independently of weight-for-age Z-scores, suggesting that the effect of scoliosis (abnormal lateral curvature of the spine). It is most often diagnosed in childhood or early adolescence.

The spine’s normal curves which occur at the cervical, thoracic and lumbar regions in the sagittal plane contractures worsens over time. Height and weight Z-score deficits generally correlate well in neurologically im­paired children, suggesting that nutri­tional factors contribute to their growth failure.

Nutritional status explains 10 to 15 percent of the variability in linear growth in children with cerebral palsy. Nutritional status has a stronger effect on linear growth in younger than in old­er children, attesting to the irreversible effects of long-term under nutrition on growth.