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Article Excerpt
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).
Regardless of the severity of the problems, prolonged feeding disorders can have a cascade of negative effects. For example, continual feeding problems can result in deficits in cognitive, emotional, and physical development (Manikam & Perman, 2000). Fung et al. (2002) reported that feeding difficulties in children with moderate to severe CP resulted in poor nutritional status and health, a finding that was also confirmed by Rogers (2004) who reported that "children with cerebral palsy are at high risk for feeding and swallowing disorders that can have significant health implications, including limited caloric intake and acute and chronic malnutrition" (p. S31). Unfortunately, malnutrition in individuals with CP is relatively common. In an investigation of 90 children with CP, Troughton and Hill (2001) determined that nearly half were undernourished
Results of investigations on undernutrition during early childhood suggest that "undernourished children generally had poorer fine and gross motor function, and levels of school achievement and cognitive function" (Grantham-McGregor & Ani. 2001, p. 4). Also documented were social and attentional deficits (Grantham-McGregor & Ani, 2001!. Moreover, disordered feeding may also lead to increased vulnerability to illness and can eventually cause death (Manikam & Perman, 2000).
Previous investigations have examined feeding abilities in a wide range of individuals with CP (Figure 1). However, a majority of these investigations over the past 15 years have included broad age ranges of participants with varying degrees of motor involvement. In most of these studies, data were pooled across children of various ages, making age-specific interpretation difficult. Yet, studies generally have shown that individuals with CP may have persistent difficulty in all stages of the feeding (e.g., self-feeding) and swallowing process. For example, problems may include the oral preparatory stage (e.g., poor mastication), the oral transport stage (i.e., inadequate lingual tone for bolus transport), the pharyngeal stage (e.g., coughing/choking, aspiration), and/or the esophageal stage (e.g., recurrent vomiting). The persistent feeding and swallowing problems may also result in continual malnutrition and consequential growth retardation.
[FIGURE 1 OMITTED]
Although early feeding problems are common in children with CP, the type and extent of these problems remains largely unexplored (Rogers, 2004). In addition, whether feeding problems resolve over time in certain children is unclear. The goal of the present investigation was to examine the development of feeding in a cohort of young children with CP who were between the ages of approximately 1 and 5 years. The primary data used in the study were from parent report; however, participants were also assessed clinically for the presence or absence of oral-motor involvement. Feeding abilities were considered separately for children with CP who did and did not have evidence of oral-motor impairment. This unique description of early feeding abilities will provide necessary information to help identify children with CP who may have persistent feeding problems and those who may outgrow their feeding problems. The specific goals of the present study were to:
1. describe the feeding skills of young children (aged approximately 1-5 years) with CP;
2. elucidate the type and severity of feeding problems for children with and without oral-motor involvement.
METHOD
Participants
Participants in this study were from the upper Midwest portion of the United States. Children and their parents were recruited through a regional CP clinic, and through physicians in Southern Wisconsin serving children with CP. In addition, children were recruited through birth-to-three service providers and early intervention programs. Inclusion criteria for participation required that children (1) have a medical diagnosis of CP; (2) be between the ages of approximately 12 months and 5 years of age; and (3) have hearing abilities within normal limits. Data reported here are from...
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