Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy.
Half of toddlers with CP show swallowing danger signs—run the free 16-item parent checklist before the next bite.
01Research in Context
What this study did
Doctors watched 16 feeding actions in toddlers with cerebral palsy. They also asked parents the same 16 yes-no questions.
Kids were grouped by how well they could sit, stand, and walk. The team wanted to see if swallowing trouble rose as movement got worse.
What they found
Half of the toddlers showed clinical signs of pharyngeal dysphagia. Signs grew more common as gross motor scores dropped.
Parent answers matched the doctor’s watch list only modestly, so both checks are needed.
How this fits with other research
Robertson et al. (2017) pooled 20 studies and agreed: people with CP and severe motor limits are at high risk for dysphagia. The toddler numbers line up with their wider review.
Pierce et al. (1994) first showed that texture refusal follows clear patterns. Their food probe method pairs well with the new 16-item checklist; use both to find why a child struggles.
Waldron et al. (2023) tested a Swedish swallow tool in adults with CP. They look at different ages, so the papers do not clash—they simply cover the lifespan.
Why it matters
You now have a quick 16-question parent screen for swallow risk. Give it before starting feeding therapy. If half or more items are flagged, refer to SLP and record gross motor level; poorer movers need closer watch.
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02At a glance
03Original abstract
This study aimed to determine the discriminative validity, reproducibility, and prevalence of clinical signs suggestive of pharyngeal dysphagia according to gross motor function in children with cerebral palsy (CP). It was a cross-sectional population-based study of 130 children diagnosed with CP at 18-36 months (mean=27.4, 81 males) and 40 children with typical development (TD, mean=26.2, 18 males). Sixteen signs suggestive of pharyngeal phase impairment were directly observed in a videoed mealtime by a speech pathologist, and reported by parents on a questionnaire. Gross motor function was classified using the Gross Motor Function Classification System. The study found that 67.7% of children had clinical signs, and this increased with poorer gross motor function (OR=1.7, p<0.01). Parents reported clinical signs in 46.2% of children, with 60% agreement with direct clinical mealtime assessment (kappa=0.2, p<0.01). The most common signs on direct assessment were coughing (44.7%), multiple swallows (25.2%), gurgly voice (20.3%), wet breathing (18.7%) and gagging (11.4%). 37.5% of children with TD had clinical signs, mostly observed on fluids. Dysphagia cut-points were modified to exclude a single cough on fluids, with a modified prevalence estimate proposed as 50.8%. Clinical signs suggestive of pharyngeal dysphagia are common in children with CP, even those with ambulatory CP. Parent-report on 16 specific signs remains a feasible screening method. While coughing was consistently identified by clinicians, it may not reflect children's regular performance, and was not sufficiently discriminative in children aged 18-36 months.
Research in developmental disabilities, 2015 · doi:10.1016/j.ridd.2014.12.021