Impact of Feeding Time and Gastroesophageal Reflux Disease (GERD) in Children with Cerebral Palsy on Nutritional Status

Abstract

Background: Children with cerebral palsy (CP) frequently experience feeding difficulties and gastroesophageal reflux disease (GERD), both of which contribute to poor nutritional status. The timing of feeding may influence the severity of GERD and associated nutritional outcomes, but this relationship remains underexplored.

Objective: To assess the feeding time and the severity of GERD in children with CP, and to evaluate the relationship between feeding time, GERD severity, and the nutritional status in this population.

Methods: This was a prospective observational study conducted in the outpatient department and/or inpatient wards of the Department of Paediatrics over a period of 3 months (January to March 2025).

Results: In this study, 68 children with CP were equally divided into three groups based on predominant feeding time: Morning (n=23), Midday (n=22), and Evening/Night feeders (n=23). The mean ages were comparable across groups (Morning: 6.9 ± 3.1 years, Midday: 7.0 ± 3.6 years, Evening/Night: 6.5 ± 3.4 years; p=0.812), with no significant differences in gender distribution, CP subtype, or feeding method. However, significant differences were noted in GERD severity and nutritional outcomes. Mild GERD was observed in 60.9% of Morning feeders and 54.5% of Midday feeders, but only in 26.1% of Evening/Night feeders. In contrast, moderate GERD was found in 56.5% and severe GERD in 17.4% of Evening/Night feeders, compared to much lower proportions in the other groups (p=0.022). Regarding nutritional status, the mean weight-for-age z-scores were -1.4 ± 0.9 for Morning feeders, -1.6 ± 1.0 for Midday feeders, and significantly lower at -2.1 ± 1.1 for Evening/Night feeders (p=0.042). Similarly, BMI-for-age z-scores were lowest in the Evening/Night group (-2.0 ± 1.2), compared to -1.1 ± 1.0 and -1.3 ± 1.1 in the Morning and Midday groups, respectively (p=0.030). Univariate analysis revealed that evening/night feeding was associated with higher odds of moderate-to-severe GERD (OR: 2.8; 95% CI: 1.2–6.5; p=0.011), and multivariate analysis confirmed it as an independent predictor of both GERD severity (adjusted OR: 2.5; p=0.032) and lower BMI-for-age (β = -0.7; p=0.02). Other factors, including CP subtype, gender, and feeding method, did not significantly affect GERD severity or nutritional status.

Conclusion: Predominant evening or night-time feeding in children with CP is associated with increased GERD severity and poorer nutritional status. Optimizing feeding schedules may serve as a simple and effective strategy to improve gastrointestinal and nutritional outcomes in this population