Feeding children with cerebral palsy and swallowing difficulties

Abstract

Children with cerebral palsy (CP) are at risk for aspiration with oral feeding with potential pulmonary consequences, and commonly have reduced nutrition/hydration status and prolonged stressful meal times. There is considerable variability in the nature and severity of swallowing problems in these children whose needs change over time. Children with generalized severe motor impairment (for example, spastic quadriplegia) are likely to experience greater swallowing deficits than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. This review is focused on dysphagia in children with CP: types of deficits, clinical and instrumental evaluation, management decision making and evidence of effectiveness of interventions.European Journal of Clinical Nutrition (2013) 67, S9-S12; doi:10.1038/ejcn.2013.224Keywords: cerebral palsy; dysphagia; pediatrics; feeding; swallowing INTRODUCTIONChildren with cerebral palsy (CP) commonly have feeding disorders and swallowing problems (dysphagia) that in many instances place them at risk for aspiration with oral feeding, with potential pulmonary consequences. They also commonly have reduced nutrition/hydration status and prolonged stressful meal times. The specific nature and severity of the swallowing problems may differ, at least to some degree, in relation to sensorimotor impairment, gross and fine motor limitations, and cognitive/ communication deficits. Children with generalized severe motor impairment (for example, spastic quadriplegia) are likely to experience greater swallowing deficits 1,2 than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. 3 Concerns are multifactorial and include issues of reduced volume of food and liquid consumed orally, nutrition deficits, inadequate hydration and limited range of textures with slow advance of oral skills.Children with moderate-to-severe dysphagia usually are managed most effectively with an interdisciplinary team that allows for multiple factors to be addressed in a coordinated way. These factors include, but are not limited to, gastrointestinal issues, pulmonary status, nutrition/hydration, oral sensorimotor skills, behavioral issues and family interactions. The importance of a structured approach is stressed to handle these multiple problems. 4 It is critical that all decisions for the management of feeding and swallowing problems are made in consideration of the primary needs of the child that is, a stable airway with adequate nutrition and hydration. In addition, any feeding/ swallowing intervention should be pleasurable and non-stressful for patients and care givers. In some instances, tube feeding may be needed either temporarily or long term. [5][6][7][8] It is expected, with rare exceptions, that these children can cope with at least minimal tastes for pleasure, a practice that may have a positive impact on management of saliva/secretions while maintaining oral function and swallowing.This review paper is focused on dysphagia: types of deficit...

Pressure-Flow Analysis for the Assessment of Pediatric Oropharyngeal Dysphagia

“…Safe, effective and efficient swallowing throughout development relies on intricate sensory development, fine motor coordination of the swallowing musculature, and maturation of feeding skills to ensure airway protection and full bolus clearance from the oropharyngeal segment (1)(2)(3). Physiologically, pressure changes across the pharyngo-esophageal segment drive bolus movement during the swallowing process.…”

Nutritional management of children with cerebral palsy

“…[1][2][3] Determining the need for nutrition intervention in children with CP requires the use of multiple methodologies. 4,5 Indicators may include the following: 2,6 Plateaus in weight gain or growth resulting in deviation from an established 'pattern'. Evidence of low body-fat stores in combination with low weight in respect to height or length.…”

Consistency in Assessing Physical Development of Children With Cerebral Palsy According to Regional and Specialized Centile Scales: A Population-Based Cross-Sectional Stud

“…Практически у всех младенцев (90%) диагностируются орально-моторная и орально-сенсорная дисфункции, для 57% детей харак-терны проблемы сосания, для 38% -проблемы гло-тания; вследствие задержки развития 80% детей при приеме пищи постоянно нуждаются в помощи роди-телей (не могут самостоятельно держать ложку) [4,5]. Нутритивный дефицит у детей с ДЦП способствует повы-шению риска развития интеркуррентных заболеваний (сердечно-сосудистой и иммунной систем, дыхательной недостаточности) [6][7][8], нарушению трофики тканей (возникновение пролежней, замедление заживления ран, атрофия мышц, снижение минерализации костной ткани) [9,10], снижению эффективности специализиро-ванной медицинской помощи (кинезио-и ботулиноте-рапии) [11,12], развитию побочных эффектов от специ-фической терапии (противосудорожной, гормональной и др.) [13].…”

“…Оригинальная статья ния движений (контрактуры суставов, сколиоз, непроиз-вольные мышечные спазмы) и когнитивные нарушения затрудняют процесс антропометрии [8]. При этом во всем мире широкое применение нашли центильные шкалы физического развития, разработанные с учетом мотор-ных функции детей с ДЦП и рекомендованные для при-кладных целей Всемирной организацией здравоохране-ния (ВОЗ) [18].…”