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    Nutrition

    Eating well is essential for overall health. Malnutrition and an inadequate diet can exacerbate respiratory muscle weakness and immune system deterioration in disorders such as SMA.

    The number of calories consumed, as well as the amount of fat, protein, carbs, and vitamins and minerals, should all be taken into account in a balanced diet. A healthy diet can lead to benefits in bone health, muscle function, and overall quality of life.

    Dieticians typically estimate that people with SMA need 20–50% less calories per day than others of the same age. Over time, calorie intake falls short of what is advised for a healthy person’s daily intake; this could be because people move less and need less energy as a result. A minor increase in caloric consumption might result in a noticeable increase in weight. A nutritionist can assist you in figuring out how to best balance your child’s intake of carbohydrates, fats, and proteins. They can also suggest foods that your child may be able to eat more of and ensure that your child is getting adequate vitamins and minerals.

    The amount of calories, fat, protein, and carbohydrates must be carefully balanced. Numerous children have been seen to be deficient in both calcium and vitamin D. Both of these supplements may strengthen bones and prevent fractures.

    Nutrition Related Problems Associated with SMA

    Type of issueDescriptionChallengesPrevention
    Feeding issuesDepending on the type and severity of SMA, feeding challenges include difficulty chewing and/or swallowing and choking issues.Mouth opening/bite, tongue control, head control and positioning, facial muscle weakness, range/fatigue in chewing muscles.A semi-solid diet and thickened liquids can be a solution for chewing problems.
    Orthotic devices and varied seating positions also enhance the ability for SMA patients to eat on their own and may improve swallowing efficiency and safety.
    AspirationSmall amounts of food or liquid enter the trachea (windpipe) instead of the esophagus (tube to the stomach).Can also occur due to stomach contents flowing back into the esophagus and then into the lungs. Can cause pneumonia and difficulty breathingNasogastric tubes (a feeding tube up the nose directly into the stomach) and gastrostomy tubes (a tube surgically inserted through the skin directly into the stomach) may be advised for some individuals with SMA to avoid swallowing problems and to allow more nutrition to be given
    Abdominal problems/
    discomfort.    		Diarrhea, bloating, spitting up, vomiting after meals, bad breath, regurgitation of feeds, and/or abdominal distentionMay contribute to undernutrition. 
    GERD (Gastroesophageal Reflux Disease)Most common in individuals with Type I, followed by Type II.
    Scoliosis may contribute to increased abdominal pressure leading to hiatal hernia and reflux gastroesophagitis.
    Constipation can worsen gastric reflux or respiratory symptoms.    		Causes increased danger of aspiration and painGive small meals.
    Avoid irritating foods.
    Management of reflux typically involves the use of acid neutralizers (magnesium or calcium carbonate) or inhibitors of acid secretion.
    ConstipationInfrequent bowel movements. Tied to reduced intake of fiber and/or inadequate fluid intake.Abnormal gastrointestinal motility (ability to move bowels)Give high fiber foods.
    Use of probiotics help maintain a healthy gastrointestinal environment
    Doctor may recommend some laxatives.
    UndernutritionDifficulty growing and gaining weight is common in children with Type I or possibly in those with Type II.Increased risk of infection. Difficulty with wound healing. Tendency for pressure soresSeen mostly in Type 1. Supplements are given. Dietician should be involved when infants are grossly underweight.
    Obesity/overnutrition.Commonly seen in those with milder Type II and Type III. Could increase the burden of care and/or decrease the quality of life.Increased pain & associated complications with hips and back. Increased risk of diabetes and hypertensionSeen mostly in Type 2 &3.
    The calorie requirements could be as low as half of what a normal child may need. Contact a dietician.