Early feeding abilities in children with cerebral palsy: a parental report study.(Report)

The goals of this study were to (1) describe the feeding skills of young children with cerebral palsy (CP) and (2) elucidate the type and severity of feeding problems for children with and without oral-motor involvement.

Parents of 37 children (16 females, 21 males) with CP, who ranged in age from 11 to 58 months (mean age = 41months), completed questionnaires regarding their child's past and current feeding abilities. Children were also clinically evaluated to determine whether each had evidence of oral-motor involvement.

Children with CP and oral-motor involvement had significantly more difficulty with self-feeding, increased frequency of coughing and choking, increased prevalence of swallowing evaluation and feeding therapy, and were introduced to solid food at a later age relative to children with CP who did not have oral-motor involvement. Both groups of children were similar in their history of tube feeding, bottle feeding, difficulty with solid foods, use of adaptive equipment, duration of mealtimes, and presence of choking, coughing, and gagging.

Children with and without oral-motor involvement initially presented with similar feeding difficulties. However, feeding problems appeared to resolve to a greater extent in children without oral-motor involvement. The difficulties identified early in life, for children with oral-motor involvement, appeared to persist with development.

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Cerebral palsy (CP) is a developmental disability that has been recognized as a chronic and debilitating health problem for well over a century, beginning with the early work of William Little (Little, 1843, 1862). Symptoms of CP may include, but are not limited to increased muscle tone, fluctuating muscle tone, hyperactive reflexes, reduced coordination, random involuntary movements, difficulty walking, difficulty with hand use, difficulty eating, excessive drooling, and difficulty speaking (NINDS, 2006). CP is the most common cause of severe motor disability in children (Lepage, Noreau, Bernard, & Fougeyrollas, 1998); prevalence research indicates that approximately 2 per, 1,000 children have CP (Boyle, Decoufle, & Yeargin-Allsopp, 1994; Winter, Autry, Boyle, & Yeargin-Allsopp, 2002).

A host of disabilities such as mental retardation, seizure disorder, and learning disabilities often cooccur with CP (Murphy, Yeargin-Allsopp, Decoufle, & Drews, 1993; Odding, Roebroeck, & Stam, 2006; Rosenbaum, Paneth, Leviton, Goldstein, & Bax, 2007). Along with gross and/or fine motor involvement, children with CP frequently have oral-motor involvement, which may include oral, pharyngeal, or esophageal dysphagia (Reilly, Skuse, & Poblete, 1996), and/or speech impairment. Although prevalence figures for oral-motor involvement in children with CP have varied among studies, research suggests that oral-motor dysfunction with subsequent feeding problems may be observed in up to 90% of preschool children with CP (Reilly et al., 1996), and even children with very mild CP may show evidence of oral-motor involvement and reduced functional feeding skills (Gisel, Alphonce, & Ramsay, 2000). Not surprisingly, the prevalence of feeding problems in children with CP appears to be positively correlated with severity and extent of motor involvement (Stallings, Charney, Daies, & Cronk, 1993a).