NUTRITION AND DISABILITY

SOMETIhIES, when seeing children who have difficulties with activity levels, or stress-related headaches, or anorexia, one wishes that the magazines they read were not so full of nutritional suggestions. The parents of the over-active child are convinced the cause is lead; the headaches are due to chocolate; and one anoresic child seen recently displayed an encyclopaedic knowledge of the caloric value of every food she ingested, which resulted in her avoiding virtually all food. By contrast, the children with moderate to severe disability often present with what appears to be an ignored nutritional problem. In the week I write this, I have seen an eight-year-old child with severe developmental disability who presented wi th length on the 50th centile and with weight way, way below the third centile; yet he attends an escellent school and has a devoted family, and only recently has his nutritional status became a cause for concern. This means that the health professionals who had seen the child had not previously been alerted to the problem. I n any surveys of populations of disabled people, nutritional problems stand out. In the study I conducted with my colleagues four years ago, we found 40 per cent of the sample to be either obese or 'thin', and we rated one in 10 of the young people as being emaciated'. Apart from obvious dwarfism, many of the young people had short stature, which is broadly regarded as being associated with undergrowth of the lower limbs. Undergrowth has also been found as a feature of rare conditions, as has recently been reported in Rett syndrome2, but its cause remains uncertain. This array of nutritional problems in disability is still something that people seem to ignore, and even in a condition such as PraderWilli where overeating is part of the syndrome, the consequences are not always taken seriously enough. Obesity is a feature of a number of common disabling conditions. We found it in 20 per cent of young adults with spina bifida and although our judgement was a clinical one, because we were seeing these young people in the home, we had no concerns about the reliability of our diagnosis: many of the young people would tell us that they knew they weighed 20 stone. Obesity can be a feature of the wheelchair-bound individual with cerebral palsy and, as reported in this issue (pp. 1074-1082), i t can be a problem for 50 per cent of people with Duchenne muscular dystrophy. At the other end of the spectrum, we found that 16 per cent of young people with cerebral palsy were emaciated, and one child with spina l w h 0