Malnutrition is a common problem in hospitalized children with central nervous system disorders. This may be due to a neurological disorders, feeding difficulties and inadequate supply of calories. 
Immobilization of patients, neurological disease itself and its metabolic consequences are factors which deepening malnutrition 
The consequences of malnutrition and the consequences of neurological disease are an important factor in extending hospitalization and increasing the cost of treating children with CNS disorders. 
Knowledge of the causes, symptoms, methods of diagnosing malnutrition and effective therapies is a key element of therapeutic success.
BMI is the most commonly used nutritional status indicator, as monitoring of body weight is a simple and available method of assessing the imbalance between supply and demand and which allows, in case of indications, targeted intervention.
Malnutrition is a common problem among children with cerebral palsy, as documented in literature [12,13].
Using the BMI cutoff criteria for deficiency of body weight, overweight and obesity (assumptions as above), a comparison and next the evaluation of disorders were made in the study group. The analysis of the study showed weight deficiency in 75% of children and overweight or obesity in only 4% based on BMI, referring to WHO reference values (two standard deviations). Andrea A. et al. demonstrated weight loss in more than half of children with cerebral palsy. In their work on the basis of anthropometric studies, body composition, food calorie intake they assessed the nutritional status of 30 children with cerebral palsy, showing an increased risk of malnutrition in children with severe CP. . Similar results are reported by Karagiozoglou-Lampoudi et al., who reported weight deficiency in 40% of children during assessing the risk factors affecting the feeding and nutritional status of children with cerebral palsy. They evaluated, in the group of 42 patients with CP, the anthropometric measurements and compared them to the WHO standards and presented the relationship of the diet quality index (DQI), used to evaluate the quality of the diet, to the BMI (z-score).  Also, J. Socas Teixeira, M. Martins Gomes, in their work on anthropometric measurements of children with non-communicable encephalopathy, found 71% of children with malnutrition, referring to WHO standards and charts developed by Krick et al. The study involved 20 children who underwent anthropometric measurements - body weight, body length / height, length-to-age ratio, body weight to body length, thickness of the triceps muscle, middle arm circumference, and arm muscle circumference.  An important parameter during evaluation of the nutritional status in our study were results of anthropometric tests such as measurement of the skin fold thickness over the triceps, biceps and under the shoulder, measurement of the arm circumference and arm muscle. Comparing these values to the reference values by WHO in more than half of the children fold thickness over biceps and triceps was below 3 percentile. In contrast, the thickness below the 3 percentile was observed in about 60% of children. Circumference of the central arm and arm muscle circumference in 75% of children was two standard deviations according to WHO. The values of the above parameters were similar to values obtained by Andrea A. Garc-Contreras et al. Also, M. Sangermano et al. in their work on nutritional problems in children with neurological disorders report that in about 40% of children with neurological disorders, the thickness of the triceps fold was less than 3 percentile and 10% of children had values above 85 percentile. In addition to measurements of folds, they took weight, body height, BMI and biochemical parameters. 
In our observation only less than 3% of children with neurological disorders had triceps thickness over 85%.J.Socas Teixeira et al. found that based only on the thickness over the triceps malnutrition was presented in 80% of children, based on the middle arm circumference - 43%, and based on circumference of the arm - 60%.  Frisanho in the 1970s described the arm measurement standards as indicators of nutritional status for the pediatric and adult population that was currently used. We also use biochemical nutritional status indicators to assess nutritional status.Taking into account the biochemical nutritional status, no significant deviations were found in the analysis of the examined children.Anemia was found only in 10% of children with CNS damage.Similarly, M. Sangermano et al., who reported anemia in 13% of patients. M. Santos, T. et al., in their work on the impact of motor dysfunction of the gastrointestinal tract on the nutritional status of children with cerebral palsy show the correct values for hemoglobin in almost all of 43 examined children. 
In case of anemia and iron deficiency, the concentration of ferritin, which is responsible for the storage of iron in the body, should be remembered. In our own studies, abnormal ferritin levels were observed in 18% of children. Similar results are reported by Hillesund, in his work on the nutritional status of children with cerebral palsy based on micronutrients content in the body, reduced ferritin values were found in 13% of patients. 
In conclusion, it can be assumed that malnourished children with CNS damage mostly have normal values of hemoglobin and ferritin. A small percentage of these children are diagnosed with iron deficiency anemia.
The analysis of our material showed hypoalbuminemia in 17% of children. Italian authors report albumin deficiency in nearly 40% of the examined children, which is significantly different from our studies. This may be due to a smaller study group, which in Italian researchers included 30 patients. Lark R et al. describe albumin deficiency and pre-albumin in children with cerebral palsy and their lack of influence on nutritional assessment. 
The vitamin 25(OH) D3 may prove to be a very important biochemical parameter.
The more authors describe the role of this vitamin in practically all physiological processes.
In a child with CNS damage, muscle weakness and constant non-use of muscle result in reduced bone expansion. This often causes osteoporosis, resulting in an increased number of fractures. Hence, a very important function of vitamin D3 in this group of children.
In our analysis, one third of children had vitamin 25(OH) D3 deficiency, more than 5% had total calcium deficiency and 6% had phosphorus deficiency. Similar results are reported by Tyson Ware et al. in the work on the effect of vitamin D on the bone status of children with CP. They report vitamin D deficiency in 34% of children with cerebral palsy.  Hillesund also reported a vitamin 25 (OH) D3 deficiency in 1/3 of patients and total calcium deficiency and phosphorus deficiency in 5%.
Considering the way of feeding and caloric content of meals, it was observed that more than half of the children were fed orally and 40% enteral (tube / PEG), while only less than half of children had proper calorie-related meals for sex and age. Also, other studies have shown that caloric content of meals for children with neurological disorders was too small. M.Sangermano and Rob Rieken et al. also reported abnormal caloric content of meals for half of examined children. 
In the study participated a large group of 74 children with central nervous system damage, in which the nutritional status was assessed on the basis of anthropometric, biochemical, and history , in which not only children with CP but also with progressive encephalopathies and metabolic diseases, CNS defects and unknown causes of CNS damage were involved.
Unfortunately, the actual incidence of malnutrition, growth inhibition and overweight is not known in children with CNS damage. So far, only the estimates for cerebral palsy have been published in literature, where malnutrition was found in 29- 46% and overweight in 8-14%.
In order to deepen the assessment of existing disorders, in a group of children with CNS damage selected anthropometric and biochemical parameters have been investigated, whereas the impact on the detailed test results can have neurological disease, the degree of dysphagia and age.
The rationale for conducting a careful assessment and monitoring of nutritional problems in children with severe damage to the central nervous system is introducing early nutritional intervention thereby contributing to improve the quality and extend the life of these patients.