Poor control of the muscles around the mouth can make feeding difficult for individuals with cerebral palsy.
Chewing and swallowing are complex functions that require over 30 different nerves and muscles. Poor oral motor control can cause malnutrition and interfere with growth.
This article will go over different types of feeding problems, signs to look out for, and effective treatment options.
Cerebral Palsy Feeding Difficulties
Up to 90% of children with cerebral palsy have some sort of feeding or swallowing problem.
Cerebral palsy feeding difficulties can arise from dysphagia, gastroesophageal reflux disease, or general motor impairment.
The majority of cerebral palsy patients experience dysphagia (swallowing difficulties).
Typically, if a child with cerebral palsy is having trouble swallowing, it’s because the esophagus cannot move food and liquids from the back of a child’s mouth to the stomach.
Children with spastic cerebral palsy are more likely to have dysphagia because spasticity can result in uncontrolled contractions of the esophagus.
There are two types of dysphagia, oropharyngeal and esophageal.
Oropharyngeal dysphagia is when there are motor problems in the mouth or pharynx.
This can include lack of tongue control, delayed swallowing, drooling, hypersensitivity when food enters the mouth and sucking or chewing difficulties.
Esophageal dysphagia is when motor problems occur in the esophagus.
People often describe feeling as though food is stuck in the esophagus.
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal Reflux Disease (GERD) is also common among children with cerebral palsy and can cause esophageal dysphagia.
GERD is when stomach acids travel up the esophagus and irritate its lining. It can cause your esophagus to narrow and makes it more difficult for food to pass into the stomach.
What Can Happen If Feeding Problems Go Untreated?
If cerebral palsy feeding difficulties go untreated, your child can experience:
- Malnutrition: Children with feeding problems often don’t eat enough food and suffer from poor nutrition.
- Dehydration: Not enough water will slow down bodily functions and cause constipation, dizziness, fatigue, and low blood pressure.
- Respiratory Problems: Children with untreated dysphagia or GERD may experience respiratory problems as food and fluids end up in the lungs (aspiration). In severe cases, this can result in pneumonia, block off an airway, or cause a person to choke.
- Achalasia: Achalasia is when nerve damage to the esophagus prevents foods from passing to the stomach.
To prevent these complications from developing, early intervention for feeding difficulties is essential. Up next, we’ll discuss symptoms of oral motor impairments.
Signs of Cerebral Palsy Feeding Difficulties
Depending on the severity of your child’s cerebral palsy, their dysphagia can range from mild to severe.
Milder cases of dysphagia can be difficult to notice and are often misinterpreted as picky eating or accidents.
However, it’s still very important to keep an eye out for signs of dysphagia to ensure proper development.
Signs of a cerebral palsy-related feeding problem include:
- Long mealtimes (over 30 minutes)
- Weight loss or no weight gain in the last 3 months
- Congestion during meals (stuffiness)
- Difficulties opening and closing the mouth
- Uncoordinated jaw movements
- Pain when swallowing
Now that you understand the symptoms of oral motor impairments, let’s discuss how to manage feeding difficulties.
Tips for Feeding a Child with Cerebral Palsy
Mild feeding problems can be effectively managed through simple adjustments.
Here are 5 easy tips to keep in mind when feeding a child with cerebral palsy:
1) Be Patient
Children with cerebral palsy and feeding difficulties will generally need more time to finish their meals.
Put aside at least half an hour for your child to eat and don’t rush them.
2) Make Sure Your Child Is Chewing Enough
If your child isn’t chewing their food enough, it’s harder to swallow or can get stuck and cause gagging or choking.
Have your child count 30 chews before swallowing their food. You can adjust this number depending on what they’re eating.
For example, softer or more watery foods require less chewing because they’ll travel down your esophagus easier. In contrast, dry foods may need more chewing.
3) Modify Food and Drink Textures
Certain textures and consistencies may be more difficult for your child to swallow than others.
Foods with lots of different textures like soups with noodles and various vegetables can aggravate the senses.
If vomiting occurs, it’s usually in response to a specific texture.
Try pureeing foods or cutting them into very small pieces before giving them to your child. This will change the texture and make it easier to keep the food down.
Thicker liquids move slower through the mouth and will give your child enough time to control their swallowing while thinner liquids may travel to the back of the throat too quickly and can cause choking.
4) Position the Chin Downwards
Having your child tuck their chin down when they eat decreases the space between the back of the tongue and posterior pharyngeal wall.
This adds more pressure and helps push food down the pharynx to the esophagus.
5) Prepare Nutrient-Dense and High-Calorie Foods
Children with feeding problems often don’t eat enough because it’s difficult for them to eat.
Preparing nutrient-dense foods will ensure that they’re getting the vitamins and nutrients they need to keep their bodies healthy.
Preparing high-calorie foods will prevent your child from losing too much weight.
Nutritious, high-calorie foods include peanut butter, olive oil, and avocados.
Professional Treatment of Cerebral Palsy Feeding Difficulties
More severe cases of cerebral palsy feeding problems will require professional interventions like surgery, endoscopy, and therapy.
Feeding Tubes (Gastrostomy)
Did you know that 1 in 15 cerebral palsy patients need the help of a feeding tube?
Feeding tubes are used in severe cases of feeding difficulties where changes to diet or other interventions aren’t effective.
The tube is surgically inserted through an opening in the abdominal wall directly to the stomach, which bypasses many complications of dysphagia.
Endoscopic dilation involves inserting a thin tube (with a camera at the end for guidance) through your mouth into the esophagus.
A doctor will place a dilator (balloon or bougie) in the narrow parts of your esophagus to expands its walls.
This allows for easier swallowing and prevents food from getting stuck in the esophagus.
Speech and Language Therapy
Speech and language pathologists will evaluate and identify the specifics of your child’s feeding difficulties.
They will teach your child mouth exercises that can strengthen the muscles used to chew and swallow.
Cerebral Palsy Feeding Problems
The risks of overlooking feeding problems can dramatically impact your child’s growth and development.
The easiest interventions include adjusting your child’s diet and how you prepare it. These simple changes can make a huge difference in your child’s ability to swallow and digest food.
Even mild forms of feeding difficulties should be taken seriously to optimize your child’s health and wellbeing.
Hopefully, this article helped you get a better understanding of what to expect and how to manage feeding problems in children with cerebral palsy. Good luck!