Prevalence of feeding problems and oral motor dysfunction in children with cerebral palsy: A community survey

doi:10.1016/S0022-3476(96)70032-X

The Journal of Pediatrics

Volume 129, Issue 6, December 1996, Pages 877-882

https://doi.org/10.1016/S0022-3476(96)70032-X Get rights and content

Abstract

OBJECTIVE: To determine the prevalence and nature of feeding difficulties and oral motor dysfunction among a representative sample of 49 children with cerebral palsy (12 to 72 months of age). STUDY DESIGN: A population survey was undertaken by means of a combination of interview and home observational measures. RESULTS: Sucking (57%) and swallowing (38%) problems in the first 12 months of life were common, and 80% had been fed nonorally on at least one occasion. More than 90% had clinically significant oral motor dysfunction. One in three (36.2%) was severely impaired and therefore at high risk of chronic undernourishment. There was a substantial discrepancy between the lengthy duration of mealtimes reported by mothers and those actually observed in the home (mean, 19 minutes 21 seconds; range, 5 minutes 21 seconds to 41 minutes 39 seconds). In 60% of the children, severe feeding problems preceded the diagnosis of cerebral palsy. CONCLUSIONS: Using a standardized assessment of oral motor function, we found the majority of children to have clinically significant oral motor dysfunction. Contrary to maternal report, mealtimes were relatively brief, and this, combined with the severity of oral motor dysfunction, made it difficult for some children to achieve a satisfactory nutritional intake. The study illustrates the importance of observing feeding, preferably in the home. (J Pediatr 1996;129:877-82)

Section snippets

Sample

Subjects were ascertained from the disability registers of two district health authorities in inner London, which covered populations of 415,800 (8065 live births per year) and 197,700 (3633 live births), respectively. Any child with a confirmed diagnosis of cerebral palsy aged between 12 and 72 months, regardless of severity or type, was eligible. The diagnosis had been determined initially by the community pediatrician responsible for the child's care. The names of 74 potential subjects were

Characteristics of the sample

Full feeding histories and interview data were obtained on 27 boys and 22 girls (aged 12 to 72 months). Developmental ages were substantially delayed (Table I), with 66% classified as having a severe cognitive deficit. Of these, 80% also had severe functional motor impairments as measured by the Standard Recording of Central Motor Deficit.¹⁹ Table II shows the distribution, type, and severity of the motor disorder of the sample.

Twenty-four subjects (50%) were preterm, with a gestational age

DISCUSSION

More than 90% of our population sample of preschool children with cerebral palsy had clinically significant OMD; one in three of these children had such severe OMD that their oral intake was restricted to either liquids or pureed foodstuffs. This is much higher than previously reported figures based on a population of clinic attenders. However, none included a direct assessment of oral motor function and may have failed to identify the severity and extent of the problem. We assessed oral motor

Acknowledgements

We thank Professor Brian Neville, Mr. David Scrutton, and Dr. Helen McConachie for their advice in the preparation of this manuscript, the Consultant Paediatricians and health care professionals who helped, and the families and children who gave freely of their time.

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Se estudiaron 30 pacientes con DOF y 30 sin DOF. El sexo, la edad, el peso al nacer y la edad gestacional tuvieron distribución similar en los dos grupos. De los datos percibidos por las madres al momento de la alimentación, la mayor frecuencia de la dificultad en el traslado del bolo alimenticio en el grupo con DOF mostró diferencia estadística significativa (p < 0.001); de los factores estudiados, el nivel V de la afectación motora gruesa se asoció con mayor frecuencia de DOF (OR: 5.7; IC 95%: 1.8-17.5).
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^☆: From the Behavioural Sciences Unit, Institute of Child Health, London, United Kingdom

^☆☆: Supported by SCOPE (formerly known as the Spastics Society).

^★: 0022-3476/96/$5.00 + 0 9/21/76241

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Prevalence of feeding problems and oral motor dysfunction in children with cerebral palsy: A community survey☆,☆☆,★

Abstract

Section snippets

Sample

Characteristics of the sample

DISCUSSION

Acknowledgements

Curr Paediatr

Lancet

Brain Dev

Current status of infant stimulation or enrichment programs for children with developmental disabilities

Pediatrics

Applied behavior analysis in the treatment of childhood feeding problems

Dev Med Child Neurol

The health and social needs of young adults with physical disabilities

Speech performance, dysphagia and oral reflexes in cerebral palsy

J Speech Hearing Dis

Growth and nutrition in children with cerebral palsy [Lancet Leading Article]

Lancet

Nutrition-related growth failure of children with quadriplegic cerebral palsy

Dev Med Child Neurol

Assessment of linear growth of children with cerebral palsy: use of alternative measures to height or length

Dev Med Child Neurol

Clinical correlates of linear growth in children with cerebral palsy

Dev Med Child Neurol

Time use of mothers with young children: the impact of a child's disability

Dev Med Child Neurol

Characteristics and management of feeding problems of young children with cerebral palsy

Dev Med Child Neurol

Risk and resistance factors in the adaptation of parents of children with severe physical disability

J Child Psychol Psychiatry

Time use of mothers with preschool children: a pilot study

Am J Occup Ther

Oral-motor dysfunction and failure to thrive among inner-city infants

Dev Med Child Neurol