Oropharyngeal dysphagia in preschool children with cerebral palsy: oral phase impairments.
Nearly all preschoolers with CP have oral swallow problems, and tube use lowers meal efficiency—screen early and plan shaping.
01Research in Context
What this study did
Laugeson et al. (2014) looked at preschoolers with cerebral palsy. They wanted to know how many had trouble swallowing food or drink.
They used a short checklist with parents and therapists. The checklist asked about chewing, moving food with the tongue, and keeping food in the mouth.
They also noted if the child used a feeding tube and how well the child ate by mouth.
What they found
Almost every child, 94 out of 100, showed oral-phase dysphagia. Kids with lower GMFCS levels had worse problems.
Children who got part of their food through a tube ate less by mouth during meals.
How this fits with other research
Chien-Hu et al. (2013) saw the same GMFCS link. Higher GMFCS scores meant slower gains in talking, moving, and self-care.
Geckeler et al. (2000) offers hope. One preschooler on full tube feeds learned to eat by mouth after a shaping plan. The plan used tiny bites, praise for swallowing, and no attention for refusal.
Together, the papers say: check GMFCS early, expect feeding risk, and know that tube weaning is possible with steady shaping.
Why it matters
If you work with CP, add a quick swallow screen to your intake. Watch for longer meal times, food loss, or gagging. Kids on partial tube feeds may need calorie-dense purees or shorter but more frequent meals. Share the Geckeler et al. (2000) protocol with your OT or SLP to start a shaping plan when the family is ready.
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02At a glance
03Original abstract
PURPOSE: This study aimed to document the prevalence and patterns of oral phase oropharyngeal dysphagia (OPD) in preschool children with cerebral palsy (CP), and its association with mealtime duration, frequency and efficiency. METHODS: Cross-sectional population-based cohort study of 130 children diagnosed with CP at 18-36 months ca (mean = 27.4 months, 81 males) and 40 children with typical development (mean = 26.2, 18 males). Functional abilities of children with CP were representative of a population sample (GMFCS I = 57, II = 15, III = 23, IV = 12, V = 23). Oral phase impairment was rated from video using the Dyspahgia Disorders Survey, Schedule for Oral Motor Impairment, and Pre-Speech Assessment Scale. Parent-report was collected on a feeding questionnaire. Mealtime frequency, duration and efficiency were calculated from a three day weighed food record completed by parents. Gross motor function was classified using the Gross Motor Function Classification System (GMFCS). RESULTS: Overall, 93.8% of children had directly assessed oral phase impairments during eating or drinking, or in controlling saliva (78.5% with modified cut-points). Directly assessed oral phase impairments were associated with declining gross motor function, with children from GMFCS I having a 2-fold increased likelihood of oral phase impairment compared to the children with TD (OR = 2.0, p = 0.18), and all children from GMFCS II-V having oral phase impairments. Difficulty biting (70%), cleaning behaviours (70%) and chewing (65%) were the most common impairments on solids, and difficulty sipping from a cup (60%) for fluids. OPD severity and GMFCS were not related to mealtime frequency, duration or efficiency, although children on partial tube feeds had significantly reduced mealtime efficiency. CONCLUSIONS: Oral phase impairments were common in preschool children with CP, with severity increasing stepwise with declining gross motor function. The prevalence and severity of oral phase impairments were significantly greater for most tasks when compared to children with typical development, even for those with mild CP. Children who were partially tube fed had significantly lower feeding efficiency, so this could be a useful early indicator of children needing supplementation to their nutrition (through increasing energy density of foods/fluids, or tube feeds).
Research in developmental disabilities, 2014 · doi:10.1016/j.ridd.2014.08.029