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Assessment and Treatment of Feeding in Children and Youth with Cerebral Palsy

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Cerebral Palsy
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Abstract

A significant number of children diagnosed with cerebral palsy (CP) present with early and ongoing histories of feeding dysfunction. This condition may cause stress and present challenges to both children and caregivers and may create barriers to enjoying social mealtime experiences. CP may result in the need for intensive medical interventions to support nutritional and hydration needs over time. The severity of the motor disturbance in CP is often highly correlated with the degree of feeding dysfunction. The link between CP and the functional activity of feeding requires a holistic approach to assessment and treatment. The use of the International Classification of Functioning, Disability, and Health (ICF) framework (WHO 2007) to inform assessment and intervention needs for the child and caregiver relies on understanding the interplay among body structure and function to support the physiological demands of feeding, the ability of the professionals and caregivers to create opportunities for participation in feeding and mealtime activities, the appropriate modifications being made to the environment, and the considerations of the caregiver and child relationship and the personal concerns that may support or limit the activity of feeding for children with cerebral palsy. Feeding assessment and treatment is often cyclical throughout the course of effective intervention as reassessment informs adjustments to treatment. The management of positioning provides the cornerstone that supports respiration, promotes swallowing safety, and improved alignment of feeding structures. Experiential training and the engagement of an interdisciplinary team that includes all stakeholders including the caregivers are among the most important elements for success in treatment of feeding.

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References

  • American Speech-Language-Hearing Association (ASHA) (2016) Code of ethics [Ethics]. Available from www.asha.org/policy

  • Andrew M, Parr J, Sullivan P (2012) Feeding difficulties in children with cerebral palsy. Arch Dis Child Educ Prac Ed 97(6):222–229

    Article  Google Scholar 

  • Arvedson J (2008) Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Dev Disabil Res Rev 14(2):118–127. https://doi.org/10.1002/ddrr.17

    Article  Google Scholar 

  • Arvedson J (2013) Feeding children with cerebral palsy and swallowing difficulties. Eur J Clin Nutr 67(S2):S9–S12

    Article  Google Scholar 

  • Benfer K, Weir K, Bell K, Ware R, Davies P, Boyd R (2017a) Oropharyngeal dysphagia and cerebral palsy. Pediatrics 140(6):e20170731

    Article  Google Scholar 

  • Benfer K, Weir K, Ware R, Davies P, Arvedson J, Boyd R, Bell K (2017b) Parent-reported indicators for detecting feeding and swallowing difficulties and undernutrition in preschool-aged children with cerebral palsy. Dev Med Child Neurol 59(11):1181–1187

    Article  Google Scholar 

  • Brackett K, Arvedson J, Manno C (2006) Pediatric feeding and swallowing disorders: general assessment and intervention. Perspect Swallowing Swallowing Disord (Dysphagia) 15(3):10

    Article  Google Scholar 

  • Brooks J, Day SM, Shavelle RM, Strauss DJ (2011) Low weight, morbidity, and mortality in children with cerebral palsy: new clinical growth charts. Pediatrics 128:e299. originally published online July 18, 2011 (https://doi.org/10.1542/peds.2010-2801)

  • Calis E, Veugelers R, Sheppard J, Tibboel D, Evenhuis H, Penning C (2008) Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Dev Med Child Neurol 50(8):625–630

    Article  Google Scholar 

  • Caramico-Favero D, Guedes Z, Morais M (2018) Food intake, nutritional status and gastrointestinal symptoms in children with cerebral palsy. Arq Gastroenterol 55(4):352–357

    Article  Google Scholar 

  • Costa M (2018) Neural control of swallowing. Arq Gastroenterol 55(suppl 1):61–75. https://doi.org/10.1590/s0004-2803.201800000-45

  • Cowpe (Jebson) E, Hanson B, Smith C (2014) What do parents of children with dysphagia think about their MDT? A qualitative study. BMJ Open 4(10):e005934

    Google Scholar 

  • Cranial Nerves with a Focus on Swallowing and Voice (2019) Retrieved 3 November 2019, from https://studyres.com/doc/2843358/cranial-nerves-with-a-focus-on-swallowing-and-voice.?page=2

  • Dodrill P, Gosa M (2015) Pediatric dysphagia: physiology, assessment, and management. Ann Nutr Metab 66(5):24–31

    Article  CAS  Google Scholar 

  • Endsjo A (2017) Posture problems: how proper wheelchair positioning can prevent Anterior pelvic tilt, posterior pelvic tilt, pelvic obliquity, and pelvic rotation. [Blog] Permobil Blog. https://hub.permobil.com/blog/posture-problems-how-proper-wheelchair-positioning-can-prevent-anterior-pelvic-tilt-posterior-pelvic-tilt-pelvic-obliquity-and-pelvic-rotation. Accessed 17 June 2019

  • Ferluga E, Archer K, Sathe N, Krishnaswami S, Klint A, Lindegren M, McPheeters M (2019) Introduction. [online] Ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/books/NBK132431/. Accessed 14 June 2019

  • Frakking T, Chang A, O’Grady K, David M, Weir K (2016) Aspirating and nonaspirating swallow sounds in children. Ann Otol Rhinol Laryngol 125(12):1001–1009

    Article  Google Scholar 

  • Goday P, Huh S, Silverman A, Lukens C, Dodrill P, Cohen S, Delaney A, Feuling M, Noel R, Gisel E, Kenzer A, Kessler D, Kraus de Camargo O, Browne J, Phalen J (2019) Pediatric feeding disorder. J Pediatr Gastroenterol Nutr 68(1):124–129

    Article  Google Scholar 

  • Haak P, Lenski M, Hidecker M, Li M, Paneth N (2009) Cerebral palsy and aging. Dev Med Child Neurol 51:16–23

    Article  Google Scholar 

  • Harding C, Halai V (2009) Providing dysphagia training for carers of children who have profound and multiple learning disabilities. Br J Dev Disabil 55(108):33–47

    Article  Google Scholar 

  • Harding C, Cockerill H (2014) Managing eating and drinking difficulties (dysphagia) with children who have learning disabilities: what is effective? Clin Child Psychol Psychiatry 20(3):395–405. https://doi.org/10.1177/1359104513516650

    Article  Google Scholar 

  • Hettiarachchi S, Kitnasamy G (2013) Effect of an experiential dysphagia workshop on caregivers’ knowledge, confidence, anxiety and behaviour during mealtimes. Disabil CBR Incl Dev 24(3):75

    Article  Google Scholar 

  • Imms C, Adair B, Keen D, Ullenhag A, Rosenbaum P, Granlund M (2015) ‘Participation’: a systematic review of language, definitions, and constructs used in intervention research with children with disabilities. Dev Med Child Neurol 58(1):29–38. https://doi.org/10.1111/dmcn.12932

    Article  Google Scholar 

  • Kawakami M, Liu M, Otsuka T, Wada A, Uchikawa K, Aoki A, Otaka Y (2013) Asymmetric skull deformity in children with cerebral palsy: frequency and correlation with postural abnormalities and deformities. J Rehabil Med 45(2):149–153

    Article  Google Scholar 

  • Kuperminc M, Gottrand F, Samson-Fang L, Arvedson J, Bell K, Craig G, Sullivan P (2013) Nutritional management of children with cerebral palsy: a practical guide. Eur J Clin Nutr 67(S2):S21–S23

    Article  Google Scholar 

  • Mahant S, Cohen E, Nelson K, Rosenbaum P (2018) Decision-making around gastrostomy tube feeding in children with neurologic impairment: engaging effectively with families. Paediatr Child Health 23(3):209–213

    Article  Google Scholar 

  • Manno C, Fox C, Eicher P, Kerwin M (2005) Early oral-motor interventions for pediatric feeding problems: what, when and how. J Early Intensive Behav Int 2(3):145–159

    Google Scholar 

  • Marques J, Sá L (2016) Feeding a child with cerebral palsy: parents’ difficulties. Revista de Enfermagem Referência, IV Série(11):11–19

    Google Scholar 

  • Massery M (2006) Multisystem consequences of impaired breathing mechanics and/or postural control. In: Frownfelter D, Dean E (eds) Cardiovascular and pulmonary physical therapy evidence and practice, 4th edn. Elsevier Health Sciences, St. Louis, pp 695–717

    Google Scholar 

  • Mills R (2004) The utility of cervical auscultation in the evaluation of dysphagia. Perspect Swallowing Swallowing Disord (Dysphagia) 13(4):14

    Article  Google Scholar 

  • Mishra A, Malandraki G, Sheppard J, Gordon A, Levy E, Troche M (2018) Voluntary cough and clinical swallow function in children with spastic cerebral palsy and healthy controls. Dysphagia 34(2):145–154. https://doi.org/10.1007/s00455-018-9933-4

    Article  Google Scholar 

  • Morris S, Klein M (2000) Pre-feeding skills. Pro-Ed, Austin

    Google Scholar 

  • Mueller M, Piazza C, Moore J, Kelley M, Bethke S, Pruett A, Oberdorff A, Layer S (2003) Training parents to implement pediatric feeding protocols. J Appl Behav Anal 36(4):545–562

    Article  Google Scholar 

  • Paulson A, Vargus-Adams J (2017) Overview of four functional classification systems commonly used in cerebral palsy. Children 4(4):30

    Article  Google Scholar 

  • Penagini F, Mameli C, Fabiano V, Brunetti D, Dilillo D, Zuccotti G (2015) Dietary intakes and nutritional issues in neurologically impaired children. Nutrients 7(11):9400–9415

    Article  Google Scholar 

  • Reilly S, Skuse D, Poblete X (1996) Prevalence of feeding problems and oral motor dysfunction in children with cerebral palsy: a community survey. J Paediatr 129:877–882

    Article  CAS  Google Scholar 

  • Roche W, Eicher P, Martorana P, Berkowitz M, Petronchak J, Dzioba J, Vitello L (2011) An oral, motor, medical, and behavioral approach to pediatric feeding and swallowing disorders: an interdisciplinary model. Perspect Swallowing Swallowing Disord (Dysphagia) 20(3):65

    Article  Google Scholar 

  • Sedky N (2017) Assessment of oral and dental health status in children with cerebral palsy: an exploratory study. J Contemp Dent 7(1):1–11

    Article  Google Scholar 

  • Sellers D, Mandy A, Pennington L, Hankins M, Morris C (2013) Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy. Dev Med Child Neurol 56(3):245–251

    Article  Google Scholar 

  • Sheppard J (1995) Nutritional support. In: Rosenthal S, Sheppard J, Lotz M (eds) Dysphagia in the child with developmental disabilities. The University of Michigan: Singular Publishing, San Diego

    Google Scholar 

  • Steele C, Alsanei W, Ayanikalath S, Barbon C, Chen J, Cichero J, Coutts K, Dantas R, Duivestein J, Giosa L, Hanson B, Lam P, Lecko C, Leigh C, Nagy A, Namasivayam A, Nascimento W, Odendaal I, Smith C, Wang H (2014) The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia 30(1):2–26

    Article  Google Scholar 

  • Sullivan P, Lambert B, Rose M, Ford-Adams M, Johnson A, Griffiths P (2000) Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford feeding study. Dev Med Child Neurol 42(10):674–680

    Article  CAS  Google Scholar 

  • Ueda K (2011) Preventing aspiration pneumonia by oral health care. JMAJ 54(1):39–43

    Google Scholar 

  • Weir K, Bell K, Caristo F, Ware R, Davies P, Fahey M, Rawicki B, Boyd R (2013) Reported eating ability of young children with cerebral palsy: is there an association with gross motor function? Arch Phys Med Rehabil 94(3):495–502

    Article  Google Scholar 

  • World Health Organization (2007) ICF-CY: international classification of function, disability and health: version for children and youth. World Health Organization, Geneva

    Google Scholar 

  • Wilson E, Hustad K (2009) Early feeding abilities in children with cerebral palsy: a parental report study. J Med Speech Lang Pathol

    Google Scholar 

  • Woods E (1995) Radiologic assessment of pediatric swallowing. In: Rosenthal S, Sheppard J, Lotze M (eds) Dysphagia in the child with developmental disabilities. The University of Michigan: Singular Publishing, San Diego

    Google Scholar 

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Correspondence to Marianne E. Gellert-Jones .

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Gellert-Jones, M.E. (2020). Assessment and Treatment of Feeding in Children and Youth with Cerebral Palsy. In: Miller, F., Bachrach, S., Lennon, N., O'Neil, M.E. (eds) Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-319-74558-9_176

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  • DOI: https://doi.org/10.1007/978-3-319-74558-9_176

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