الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Cerebral palsy is an umbrella term for a collection of conditions resulting in lifelong motor disability. They constitute the most common cause of physical impairment in children and are responsible for permanent activity limitation and lifetime participation restriction with a prevalence 17 million people affected worldwide. As cerebral palsy from the most common partly preventable disorder that what making this disorder from the public health priority for prevention as reported by World Health Organization.
The most common causes are congenital syndromes, metabolic disorders, prematurity, perinatal asphyxia, head trauma,meningitis, and traffic or near drowning accidents. Cerebral palsy children phenomenon meaning that this child will suffer from different types of considerable problems, it was reported that (25-80%) of Children with cerebral palsy had cognitive disorders and other major problems like: seizures, visual and hearing impairment, orthopedic problems, communication disorder, swallowing difficulties, frequent drooling, constipation and poor nutritional status.
Impaired growth of children with cerebral palsy is confirmed. Children with cerebral palsy are tend to be smaller and to grow more slowly than typically developing children. Growth disorders and nutritional deficits are present in approximately one third of pediatric patients with cerebral palsy. Even children with cerebral palsy with less sever motor impairment may be at increased risk of being overweight.
Nutritional status has a significant impact on overall health and quality of life in children with cerebral palsy. Both under and over nutrition generally lead to increased health care use and reduced participation in educational and social activities. Malnutrition has been observed in 46-90% of children with cerebral palsy therefore it was important to conduct this study.
Nutritional support is an essential part of the care of children with cerebral as it will improve overall health and quality of life, that what can be achieved by a precise nutritional assessment by collect an accurate medical history, feeding history, anthropometry measurements, serum nutritional markers, longitudinal repeated assessments and a successful nutritional intervention.
The gross motor function classification system is the international language to classify gross motor function of children with cerebral palsy as it enhanced communication between families and professional by providing standardized descriptions of gross motor function foe each level and age band. The five levels of GMFCS describe children typical performance at home and at the community, it assists in setting realistic goals, enhances communication and sharpens focus on function.
This study was conducted on 100 children with cerebral palsy in Nour- El Hayah rehabilitation center and El Rahma rehabilitation center in Alexandria to assess nutritional status and gross motor function level among them. Data was collected using a pre- designed interview questionnaire to assess the: socio-demographic characteristics, medical history, level of gross motor function and level of feeding difficulties. The purpose of the study was to assess different anthropometric measures, red blood indices, and dietary intake, to detect level of gross motor function and to investigate the relationship between levels of gross motor function and the nutritional status of children with cerebral palsy. Anthropometricassessments were carried out for each child to measure weight, height/ length, head circumference, mid upper arm circumference, anthropometric indices was calculated, complete blood count were performed. Assessment of dietary intake and adequacy were done by 3- day food diary and the findings were analyzed by ESHA food processor.
The conclusions of the study can be summarized as follows:
1- Feeding difficulties among children with cerebral palsy are high hindrance problems facing them with it’s different levels.
2- Malnutrition is common among children with cerebral palsy. Underweight and stunting are the most prevalent conditions in both children with cerebral palsy less or more 5 years.
3- Anemia is one of main problem that threaten children with cerebral palsy special less than 5 years.
4- The majority of children with cerebral palsy have inadequate dietary intake from energy, calcium, iron and water.
5- There is positive association between feeding difficulty level and GMFCS as the more high level of GMFCS, the more sever feeding difficulty level.
6- No significant relationship between gross motor function classification system and anthropometric indices in children with cerebral palsy less than 5 years.
7- There is an association between gross motor function classification system and only one of anthropometric indices represented by weight for age Z score in children with cerebral palsy more than 5 years.
8- No significant relationship between anemia and various levels of gross motor function classification system.
9- There is an association between adequacy of dietary intake of iron and water and various levels of GMFCS E&R.
Based on the results of this study, the following can be recommended:
1- Multidisciplinary team for individualized nutrition counseling should be an integral part of care of children with cerebral palsy to ensure close monitoring of nutritional status and success of interventions.
2- Frequent nutritional assessment program include: anthropometric measurements, dietary intake assessment, laboratory investigations and feeding skills evaluation should be done at least every 3-6 months for cerebral palsy children.
3- Successful interventions to get rid of anemiaby monitoring early as much as possible by nutrition education for parents/ caregivers, appropriate iron fortification meals and snacks and the suitable iron supplements for children with cerebral palsy.
4- For the ministry of health: ensure availability of appropriate nutritional education programme in all maternal child health centers to increase awareness of parents towards the importance of good nutrition for children with cerebral palsy.
5- Further follow up researches are needed to emphasize the most precise nutrition intervention programme to be applicable for caregivers of children with cerebral palsy