Dietary considerations in osteopenia in tube-fed nonambulatory children with cerebral palsy

Children with nonambulatory cerebral palsy are frequently found to be osteopenic. We sought factors, in addition to immobility and anticonvulsant therapy, that may contribute to the osteopenia. A retrospective chart review of 19 children with nonambulatory cerebral palsy who received gastrostomy tube feedings of standard commercial formulas was performed. Less than 75% of the Recommended Daily Allowance (RDA) was administered to 95% of the children for calories, 58% for calcium, 68% for phosphorus, and 74% for vitamin D. Five of the 19 children sustained fractures without major trauma. This study suggests that inadequate intake of crucial vitamins and minerals may contribute to the severe osteopenia observed in many children with nonambulatory cerebral palsy. The nutritional needs of these children, including those for micronutrients, must be defined and appropriate supplementation given.