Cerebral Palsy and Faltering Growth

Cerebral palsy (CP) is an umbrella term for a group of disorders of movement and posture, resulting from abnormal development or non-progressive damage to the brain (the cerebrum).1

It is the most common motor-neurodisability in childhood with a prevalence of ~0.2% of the population in high income countries.2

Did you know? 40% of children with Cerebral Palsy are undernourished.3

Feeding challenges are common which can impact nutritional intake and contribute to growth deficits.4-6

Common feeding challenges

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Oral-motor difficulties

  • Difficulty chewing7
  • Difficulty swallowing7
  • Excess drooling7
  • Aspiration risk7
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Physical difficulties affecting feeding

  • Difficulty using utensils7
  • Reduced self-feeding ability8
  • Need for caregiver assistance8
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Gastrointestinal complications

  • Gastro-oesophageal reflux9
  • Chronic constipation10
  • Vomiting, bloating, retching7
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Mealtime challenges

  • Prolonged mealtimes11
  • Feeding fatigue7
  • Stress during mealtimes11

These nutritional concerns are often a low priority or under-recognised by healthcare providers.12

Malnutrition in children with Cerebral Palsy contributes to  long-term health consequences.7,13-15 

Long term consequences of malnutrition in CP patients

Decreased:

Increased:

  • Immunity4
  • Growth (stunting) & cognitive potential7
  • Bone health16
  • Socialisation16
  • Infection risk4
  • Vulnerability to complications4
  • Micronutrient deficiencies10
  • Hospitalisations13

“Malnutrition should not be considered normal in any child with cerebral palsy.”17

Timely intervention and nutritional management

ESPGHAN suggests the use of 1 or more of the following red flag warning signs for the identification of undernutrition in children with Cerebral Palsy.7

Dietetic referral and timely nutrition intervention should be prioritised in these children.

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When nutritional intake is insufficient and the child has safe swallow, oral intake should be optimised via food fortification, texture modification when applicable, and the prescription of oral nutrition supplements. Hydration status should also be carefully monitored in children with Cerebral Palsy.10,18

Fortini provides first-line nutritional support.7,10

With the widest range of flavours, textures and formats, Fortini supports complex feeding challenges in children with Cerebral Palsy through choice.19

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Food fortification with Fortini

The Fortini range includes neutral flavours which can be added to foods and recipes to help support compliance and nutritional intake.

Find out how you can incorporate Fortini into recipes. Download the Fortini recipe book for parents.

~3 in 4 children with CP have chronic constipation.20

Fortini is the widest range of paediatric oral nutrition supplements containing a mix of soluble and insoluble fibres, clinically proven to reduce constipation and laxative use.21-23

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Learn more about Nutricia’s unique multi-fibre blend, MF6ᵀᴹ

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~3 in 4 children with CP experience reflux.9

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Fortini Compact Multi Fibre is nutritionally complete in ~40% less volume.^

Low volume, high energy feeds can help reduce reflux in children.23

Discover the clinical evidence behind Fortini Compact Multi Fibre

Over 8 in 10 children with CP have swallowing difficulties.4

Fortini Smoothie Multi Fibre summer fruit 200ml packshot

Fortini Smoothie Multi Fibre is the only paediatric oral nutrition supplement with 15% real food,¹⁹ providing high energy nutrition in a thicker consistency (Indicative IDDSI Level 2*)

View datacard
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Consider for children on blended diets
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Fortini Creamy Fruit is the only yoghurt-style paediatric ONS with 5% real food, providing a unique smooth texture for children who require a thicker, spoonable ONS (Indicative IDDSI Level 4*).¹⁹

View datacard
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IMPORTANT NOTICE: : The Fortini Range are Foods for Special Medical Purposes for the dietary management of disease related malnutrition and growth failure in children from one year onwards, and must be used under medical supervision. Refer to label for details.

  1. Upadhyay et al. Clin Exp Pharmacol Physiol. 2020.47(12):1891-1901
  2. McIntyre et al. Dev Med Child Neurol. 2022;64:1494–1506
  3. Silva et al. Public Health. 2022. 205;192e201.
  4. Calderone et al. Ital J Pediatr. 2025 Feb 22;51(1):57.
  5. National Institute for Health and Care Excellence (NICE). Cerebral palsy in under‑25s: assessment and management (NG62). London: NICE; 2017 
  6. ESPGHAN. Common gastrointestinal problems in children with neurological impairments: evaluation, treatment and monitoring. 2019.
  7. Romano, et al. J Pediatr Gastroenterol Nutr. 2017;65(2):242-64.
  8. Fogarasi, et al. Disabil Rehabil. 2022;44(22):6668-75.
  9. Fernando, Goldman. Can Fam Physician. 2019;65(11):796-8.
  10. NICE. Cerebral palsy in under‑25s: assessment and management (NG62), 2017.
  11. Sullivan, et al. Dev Med Child Neurol. 2000;42(10):674-80.
  12. Sullivan. Eur J Clin Nutr. 2013;67(Suppl 2):3–4.
  13. Foster, et al. Hosp Pediatr. 2020;10(12):1087-95.
  14. Kuperminc et al. Eur J Clin Nutr. 2013. 67(Suppl 2);S21–S23
  15. Fung et al. J Am Diet Assoc. 2002. 102(3):361-73. 
  16. Huysentruyt, et al. Clin Nutr. 2020;39(2):548-53.
  17. Andersen. In: Nutrition and Neurodisability. Mac Keith Press; 2020. Available from: https://explore.mackeith.co.uk/wp-content/uploads/2024/10/HB-Sullivan-Nutrition-Chapter-9.pdf. Accessed: March 2026.
  18. Penagini, et al. Nutrients. 2015;7(11):9400-15.
  19. Market comparison of formats, flavours and textures of UK and Ireland paediatric ONS. MIMS. Accessed: April 2026.
  20. Del Giudice, et al. Brain Dev. 1999;21:307–11. 2.
  21. Trier, et al. J Pediatr Gastroenterol Nutr. 1999;28:595.
  22. Hofman, et al. Clin Nutr. 2001;20(Suppl 3):63-4.
  23. Daly, et al. J Hum Nutr Diet. 2004;17(4):365-70.
  24. Vandenplas, et al. J Pediatr Gastroenterol Nutr. 2009;49(4):498–547.

CP: cerebral palsy; ONS: oral nutritional supplement; ESPGHAN: European Society for Paediatric Gastroenterology, Hepatology and Nutrition.

^Standard 200ml 1.5kcal/ml ONS Fortini Multi Fibre vs. Fortini Compact Multi Fibre. Datacard for Fortini Multi Fibre available at www.nutricia.co.uk/hcp/pim-products/fortini-multi-fibre.html Accessed April 2026. Datacard for Fortini Compact Multi Fibre available at www.nutricia.co.uk/hcp/pim-products/fortini-compact-multi-fibre.html Accessed April 2026.

*These are indicative values only. Fortini ONS are not IDDSI batch tested, and can vary by batch, flavour and temperature. Use of Fortini range products in patients with dysphagia is undertaken on the clinical judgement of an appropriate healthcare professional.

†International Dysphagia Diet Standardisation Initiative. www.iddsi.org. Available at: Patient Handouts - Resources – IDDSI. Accessed: April 2026.

 

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