New study links gestational age to malnutrition in cerebral palsy

Malnutrition is a common concern in children with cerebral palsy (CP), a condition that can affect movement, feeding, swallowing, and independence. Children born prematurely may face additional challenges because early birth can affect development and feeding ability. However, it has remained unclear how a child's nutritional status relates to functional abilities according to gestational age at birth. A new study now suggests that gestational age should be considered when clinicians assess nutrition and rehabilitation needs in children with CP.

The study included 575 children with CP aged 1-17 years who received rehabilitation and follow-up between July 2020 and December 2021. The researchers grouped the children according to whether they were born before 28 weeks, at 28-32 weeks, at 33-36 weeks, or at term. They assessed nutritional status alongside gross motor function, eating and drinking ability, and activities of daily living. The research was led by Professor Kaishou Xu from the Department of Rehabilitation at Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China. The findings of the study were published on August 11, 2026, in the journal Pediatric Investigation.

The analysis found that about 40% of the children had undernutrition, while nearly half had been born prematurely. Nutritional status was associated with motor function, eating and drinking ability, and performance of daily activities. Children born before 32 weeks were particularly vulnerable: those born before 28 weeks and those born at 28-32 weeks had 4.61-fold and 2.71-fold higher odds, respectively, of moderate undernutrition than children born at term. The findings also showed that more severe difficulties with daily activities were associated with moderate and severe undernutrition, while greater feeding impairment was associated with severe undernutrition.

Rather than viewing nutrition and rehabilitation as separate concerns, the findings point toward a more integrated approach. A child who has difficulty moving, eating, or managing daily activities may have greater nutritional needs or difficulty obtaining enough nutrition. Conversely, inadequate nutrition may make it harder to support growth, physical activity, and rehabilitation. "These findings suggest that nutritional assessment can be an important part of understanding functional needs in children with CP, particularly among those born very preterm," says Prof. Xu. "Considering gestational age alongside nutrition and function may help clinicians identify children who need closer monitoring and more individualized support."

The study may have practical implications for pediatric rehabilitation services. Regular nutritional assessment could help clinicians recognize children at risk earlier and coordinate dietary support with physical and functional rehabilitation. For children with feeding difficulties, the researchers highlight the importance of appropriate early interventions, including strategies to improve feeding and swallowing, while children at risk of unsafe feeding may require specialized nutritional support. Such coordinated care may help integrate nutritional and rehabilitation needs rather than addressing each concern in isolation.

The findings may also encourage collaboration among pediatricians, rehabilitation specialists, dietitians, feeding therapists, and researchers. "Our results support looking beyond a single measure of disability or nutrition when planning care," says Prof. Xu. "A broader view may help teams recognize needs earlier and develop rehabilitation strategies that are better matched to each child."

Future studies could follow children over time to determine whether improving nutritional status leads to measurable gains in motor function or daily independence, and whether the effects differ according to gestational age. Larger and more diverse cohorts could also help clarify how factors such as socioeconomic conditions, diet, and the severity of disability influence these relationships.

In the longer term, this approach could contribute to more personalized rehabilitation planning. Children born very preterm may benefit from closer nutritional surveillance alongside routine functional assessments, potentially allowing problems to be addressed before they become more difficult to manage. Because this was a cross-sectional study, it does not establish that poor nutrition causes functional impairment or that functional impairment causes poor nutrition. However, it strengthens the case for considering the two together. By linking gestational history, nutritional health, and everyday function, the research provides a framework that could help shape earlier, more coordinated care for children with CP.