Many children are fussy, finicky eaters with a strong aversion to trying new foods. But feeding a child with intellectual disability (e.g. cerebral palsy) comes with added meal time challenges, making it harder to provide your child with sufficient nutrition for growth and health. Among the difficulties your child might face are:

1. Difficulty chewing and swallowing

This is one of the most common meal time challenges for children with many different types of physical and intellectual disabilities – and it can have serious consequences. Affected children may not have control over their tongue or lips, making it difficult for them to chew their food effectively. As a result, choking is a common problem. Cut food into small pieces, mash or purée it to help your child swallow safely. Make sure you know how to react quickly to dislodge food if your child starts choking. Most first aid training courses include specific instructions to deal with choking in babies and small children.

Swallowing is a complex reflex action, during which the airway closes to prevent food particles from entering the lungs. Children with intellectual and physical disabilities may have weak larynx muscles which allow food and drink to pass into the lungs, leading to pneumonia. Many of the LITTLE EDEN residents have regular chest physiotherapy to prevent lung problems. Speech and music therapy can also be helpful to strengthen muscles in the larynx. Some children have a bite reflex, causing then to bite down hard on a spoon. If your child does this, use a soft plastic coated baby spoon to protect their teeth.

Feeding tubes

Depending on the severity of your child’s condition, your paediatrician may recommend the use of a feeding tube. There are two main types:

• Nasogastric tube – this is a narrow flexible tube which is inserted through the child’s nose into the stomach. Once it’s in place, it is unlikely to cause discomfort, although it’s usually a short-term solution. If a child needs a feeding tube for longer, your medical team may suggest a gastrostomy tube.
• Gastronomy tube – this is surgically inserted through the wall of the child’s abdomen into the stomach, and a special liquid feed is pushed through the tube to ensure your child gets the nutrients needed for good health. Once in place, a PEG or Mic-Key tube should not interfere with normal activities and is easily concealed beneath clothing. Some children may require this type of feeding for life.

2. Obesity

Weight gain is common in children who lack mobility. Because they’re burning fewer calories, they need to eat less. Children with Down Syndrome may be very active. But they may also be susceptible to weight gain because they have low muscle tone or bone problems.

It’s important to establish a healthy diet from the start with all children. But when it comes to feeding a child with intellectual disability, it’s even more crucial. From the beginning, offer water, rather than sweetened juices, to quench thirst. Developing a life-long ‘taste’ for water is one of the healthiest habits you can instill in any child. You should also limit your child’s experiences with sugary foods and fatty ‘fast foods.

3. Underweight

Children affected by conditions like cerebral palsy may have muscular spasms that burn calories at a great rate. Others may have an unusually speedy metabolism or medical conditions that interfere with the absorption of nutrients. If these conditions are coupled with a poor appetite or difficulties with chewing and swallowing, your doctor may prescribe vitamin or protein supplements to ensure healthy growth.

4. Acid reflux/heartburn

Reflux is more common during feeding a child with intellectual disability. Reflux is when stomach acid or food particles back up in the oesophagus, as a result of weak or ineffective  muscles in the area between the oesophagus and stomach. This can lead to heartburn, vomiting, a feeling a fullness after eating very little and poor weight gain.

Symptoms can be lessened by making sure the child sits upright during feeding and for at least 20 minutes afterwards. If your child is unable to sit by himself, use pillows or rolled up towels to prop him up as straight as possible. In particular, it’s important to make sure that the child’s head is not tilted back or forward, both of which make swallowing more difficult. Symptoms may also be alleviated by offering smaller meals more frequently.

If these techniques don’t help, your doctor may prescribe medication, or even surgery.

5. Constipation

Numerous studies reveal that children and adults with profound intellectual disability are at greater risk of constipation than the general population. Immobility, lack of dietary fibre, dehydration and some medication are among the causes. Look out for signs of abdominal pain, which recede after a bowel movement, as well as small, hard stools. Chronic, untreated constipation can lead to serious problems, such as an impacted bowel.

If your child needs a laxative, bulk-forming or fibre types are safest to use. However, long-term use of laxatives can lead to dependency. Even though these medications are available over the counter, you should consult your doctor for advice if your child suffers from chronic constipation.

6. Poor appetite

Your child may lack interest in food for any number of reasons. It could be boredom if the same foods are consumed at every meal. Be sure to try out an assortment of different tastes and textures to stimulate your child’s interest and enjoyment.

Lack of appetite may also be caused by certain medication, undiagnosed constipation, or even depression. If your child has lost interest in activities or interaction they previously enjoyed, they may be suffering from depression.

7. Poor hydration

Not drinking enough fluids can be a problem for children who aren’t able to reach out for drinks or tell you when they are thirsty. Be sure to offer drinks regularly, especially during the warmer weather. Giving sips of water between solids at meal times is also recommended, especially if the child struggles to chew and swallow. Insufficient fluid intake can cause tiredness and constipation.

Although feeding a child with intellectual disability has its challenges these become easier once routines are established. Just like any other child, your special son or daughter should be encouraged to try a wide variety of foods, with the emphasis on fresh fruit and vegetables (even if these need to be pureed) and whole grains.

If you have suggestions or tips of your own, please do share these in the comment section below. We also welcome blog articles on related topics from parents and medical professionals in the field of intellectual disability.