A child, age 3 years, has cerebral palsy (CP) and is hospitalized ...

[Collmarie]

A child, age 3 years, has cerebral palsy (CP) and is hospitalized for orthopedic surgery. His mother says he has difficulty swallowing and cannot hold a utensil to feed himself. He is slightly underweight for his height.
 
  What is the most appropriate nursing action related to feeding this child?
 
  a. Bottle or tube feed him a specialized formula until he gains sufficient weight.
  b. Stabilize his jaw with caregiver's hand (either from a front or side position) to facilitate swallowing.
  c. Place him in a well-supported, semireclining position.
  d. Place him in a sitting position with his neck hyperextended to make use of gravity flow.

Question 2

Gingivitis is a common problem in children with cerebral palsy (CP). What preventive measure should be included in the plan of care?
 
  a. High-carbohydrate diet
  b. Meticulous dental hygiene
  c. Minimum use of fluoride
  d. Avoidance of medications that contribute to gingivitis

[LP]

Answer to Question 1

ANS: B
Jaw control is compromised in many children with CP. More normal control is achieved if the feeder stabilizes the oral mechanisms from the front or side of the face. Bottle or tube feeding will not improve feeding without jaw support. The semireclining position and hyperextended neck position increase the chances of aspiration.

Answer to Question 2

ANS: B
Meticulous oral hygiene is essential. Many children with CP have congenital enamel defects, high-carbohydrate diets, poor nutritional intake, and difficulty closing their mouths. These, coupled with the child's spasticity or clonic movements, make oral hygiene difficult. Children with CP have high carbohydrate intake and retention, which contribute to dental caries. Use of fluoride should be encouraged through fluoridated water or supplements and toothpaste. Certain medications such as phenytoin do contribute to gingival hyperplasia. If that is the drug of choice, then meticulous oral hygiene must be used.

[Collmarie]

TYSM

[tuate]

Excellent