Dysphagia, also called swallowing difficulties, is by far the most common feeding issue in children with moderate to severe cases of cerebral palsy.1
Typically, a child with dysphagia has trouble swallowing food and/or fluids. Greater swallowing difficulties are observed in children with spastic quadriplegia.2
A number of signs could indicate that the child has dysphagia. Here is a partial list of possible signs:2,3
- Coughing and/or chocking during feeding
- Changes in facial colour during feeding
- Fatigue/sweating during feeding
- Difficulty in retaining food in the mouth
- Prolonged time for feeding
- A chronic cough
- Poor weight gain
- Recurrent chest infections
- Altered breathing patterns
|Diagnosis Tools in Dysphagia Evaluation
|Careful feeding history
|Physical examination (especially neurological examination)
|Modified barium swallow (videoftuoroscopy)
|Oesophageal pH monitoring
|Endoscopic evaluation (hypopharynx or oesophageal)
Diagnostic tool table Source: DeLegge MH. Enteral nutrition and the neurologic diseases. In: Rolandelli RH. Enteral and Tube Feeding, eds. 4th ed. Elsevier, Inc., 2005, p. 410.
Dysphagia can not only lead to malnutrition, but can also cause a number of respiratory problems, such as pneumonia, due to recurrent aspirations (when food or liquid enters the airway or lungs due to swallowing problems).4 Aspiration is a dangerous side effect that requires close monitoring and careful interventions to prevent. In certain circumstances, it can be silent, so careful and early diagnosis may therefore be life-changing to the patient.
Major risk factors for aspiration include:5
- Decreased level of consciousness
- Neuromuscular diseases and structural abnormalities of the aero-digestive tract
- Endotracheal intubation
- Persistently elevated gastric residual volumes
- Need for prolonged supine positioning of the patient
- Previous episodes of aspiration
The effective management of dysphagia needs the collaboration of a multidisciplinary team. Indeed, gastrointestinal issues, pulmonary status, nutrition/hydration, oral sensorimotor skills, behavioural issues and family interactions all need to be managed in parallel.5
Adapting the texture and consistency of your patient’s meals and ensuring a correct posture during the feeding process are possible ways to address dysphagia.
→For more details on how to adapt texture and consistency, refer to the section related to nutritional solutions
- Penagini F et al. Dietary Intakes and Nutritional Issues in Neurologically Impaired Children. Nutrients.2015;7(11):9400-15.
- Arvedson JC. Feeding children with cerebral palsy and swallowing difficulties. Eur J Clin Nutr. 2013;67 Suppl 2:S9-12.
- Nice Guidelines: National Institute for Health and Care Excellence. Cerebral palsy in under 25s: Assessment and management. Full Guideline. NG62. 2017. Available at: https://www.nice.org.uk/guidance/ng62/evidence/full-guideline-pdf-4357166226
- Garcia-Peris P et al. Management of patients with dysphagia: Update on chronic patients in need of nutritional support. Nutr Hosp Supl. 2012; 5(1): 33–40.
- DeLegge MH. Enteral nutrition and the neurologic diseases. In: Rolandelli RH. Enteral and Tube Feeding, eds. 4th ed. Elsevier, Inc., 2005, p. 410.