Feeding and gastrointestinal problems in children with cerebral palsy

Abstract

The aim of our study was to identify feeding and gastrointestinal system (GIS) problems in children with cerebral palsy (CP), and to evaluate the relationship between these problems and the severity of CP. A total of 120 children with CP were enrolled consecutively into the study (67 males, 53 females; mean age: 6.0±2.4 years; range: 2-12 years). The children were classified according to the Swedish classification as diplegic, hemiplegic, or quadriplegic. Severity of CP was classified based on the Gross Motor Function Classification System. The amount of time that the caregiver allocated to mealtimes, modifications of the food, as well as feeding and GIS problems was evaluated. Feeding dysfunction was classified as mild, moderate, or severe. Comparisons of GIS and feeding disorders and the severity of CP were carried out using χ test. The results indicated lack of appetite in 46 of the 120 children (38.3%), sialorrhea in 37 (30.8%), constipation in 30 (25%), difficulty in swallowing in 23 (19.2%), and feeding dysfunction in 26 (21.7%). On the basis of the Gross Motor Function Classification System (GMFCS), the incidence of GIS problems and feeding dysfunction was found to be significantly higher in the children classified in the severe group. The time taken to consume meals was significantly longer among children with feeding dysfunction. Feeding and GIS problems are frequent in children with CP, and more marked in those with severe CP. Approximately one fourth of children with CP suffer from feeding dysfunction, and more time has to be allocated to consume meals.

A systematic review of ordinal scales used to classify the eating and drinking abilities of individuals with cerebral palsy

“…Six of the identified measures included more than one category within each level, creating the potential to assign a child to more than one category. 3,6,20,33,38,40 For example, children able to swallow safely and self-feed but who also received some of their nutrition by tube would not be easily categorized. One measure identified the ability to feed oneself and the ability to bite, chew, and swallow safely as distinct skills; 38 one measure combined the level of assistance required with swallowing safety, assuming close correspondence of these constructs with increasing severity.…”

“…3,6,20,32,33,38,40 Seven measures included information about food texture or fluid consistency managed by the child. 3,33,34,36,38,40,41 Seven measures included details about swallowing 3,32,33,[36][37][38]40 and five scales included information about the oral skills required to bite and chew food. 3,32,36,38,40 Five scales reported 'feeding dysfunction' or 'difficulties', although these were not defined.…”

“…3,6,20,33,35,37,38,40,41 One study 42 made use of a single item taken from the Pediatric Evaluation of Disability Inventory (PEDI). 41 One scale was developed for use in the context of a CP surveillance programme.…”

“…Overall, 13 of the 15 measures were developed as clinical assessments by health professionals; 3,6,8,13,20,[32][33][34][35][36][37][38][39] nine of the measures made use of information gathered in interviews or questionnaires from parents of children with CP or developmental disabilities. 3,6,20,33,35,37,38,40,41 One study 42 made use of a single item taken from the Pediatric Evaluation of Disability Inventory (PEDI).…”

“…3,32,36,38,40 Five scales reported 'feeding dysfunction' or 'difficulties', although these were not defined. 3,13,33,36,37 The safety of oral feeding was included in six scales 3,32,[37][38][39][40] with aspiration being specifically noted by two measures. 8,39 Respiratory function or respiratory illness was included in three measures.…”