A nutritional evaluation carried out on 114 children with cerebral palsy, treated at the Hospital das Clínicas at Unicamp, found significant rates of malnutrition and concluded that carriers have their own parameters and can survive with minimum values ​​compared to those of healthy children. In some cases, nutritionist Ana Lúcia Alves Caram observed levels below the values ​​recommended by international organizations, such as score 2 – a parameter used to assess degrees of malnutrition and which represents a severe level of nutritional impairment. The data are contained in the unpublished master's thesis from a Brazilian point of view, “Nutritional assessment in children with cerebral palsy”, presented by Ana Lúcia at the Faculty of Medical Sciences. “There are few studies in this area and the results demonstrate the importance of specific monitoring with this type of patient”, she explains.

Researcher asks for the insertion of a nutritionist to assist these patients

Children with paralysis have several limitations caused by syndromes or brain injuries and have difficulty standing. Independent eating is also problematic, which can significantly compromise nutritional status if there is no guidance from professionals in the area. Therefore, Ana Lúcia advocates the inclusion of a nutritionist in health teams that care for children with paralysis. The master's study indicated that around 74% of patients had not received any type of nutritional guidance. “I realized the importance of monitoring based on the work carried out at HC. During the period in which I developed the research, I noticed considerable improvements in referrals and even in the information provided both to those responsible for the patients and to the medical team”, she argues.

Parameters – According to the nutritionist, the experience at the HC was extremely rich and allows for other approaches in relation to monitoring the growth of this category of patients who need to remain bedridden. There are many difficulties in being able to assess the physical growth of children. Ana Lúcia resolved her initial doubts to establish the parameters based on Stevenson's work. The methodology, already used in several countries, consists of measuring various parts of the body, mainly the length between the knee and the calcaneus or heel. By applying a mathematical formula to these measurements, it is possible to estimate the person's height.

In addition to estimated height, weight, body mass index and arm muscle area were also counted as anthropometric evaluation indicators. The nutritionist, guided by professors Elizete Aparecida Lomazi da Costa Pinto and André Morcillo, also related the indicators to variables of gender, social class, type of paralysis, number of hospitalizations, presence of pneumonia, ability to eat independently, difficulty swallowing and the nutritional guidance. The children assessed were between 2 and 12 years old, 57% were male and 90% had several hospitalizations throughout their lives. Based on the results, difficulty swallowing solid foods appeared in all indicators. This aspect, explains Ana Lúcia, would point to the need to use tubes to ensure adequate nutrition.