Development and validation of a screening tool for feeding/swallowing difficulties and undernutrition in children with cerebral palsy

Abstract

AimTo develop and validate a screening tool for feeding/swallowing difficulties and/or undernutrition in children with cerebral palsy (CP).MethodThis cross‐sectional, observational study included 89 children with CP (63 males, 26 females; median age 6y 0mo; interquartile range 4y 0mo–8y 11mo), across all Gross Motor Function Classification System levels. Children with feeding tubes were excluded. Children were classified as well‐nourished or moderately to severely undernourished, using the paediatric Subjective Global Nutrition Assessment. Eating and drinking abilities were classified using the Eating and Drinking Ability Classification System (EDACS) from mealtime observation and videofluoroscopic swallow studies when indicated. Parents/caregivers answered 33 screening questions regarding their child's feeding/swallowing abilities and nutritional status. The diagnostic ability of each question for identifying children with feeding/swallowing difficulties and undernutrition was calculated and the combination of questions with the highest sensitivity and specificity identified.ResultsFeeding difficulties impacted on swallow safety in 26 children (29%) and 26 children (29%) were moderately or severely undernourished. The 4‐item final tool had high sensitivity and specificity for identifying children with feeding/swallowing difficulties (81% and 79% respectively) and undernutrition (72% and 75% respectively). The tool successfully identified 100 per cent of children with severe undernutrition and 100 per cent of those classified as EDACS level IV or V.InterpretationScreening for feeding/swallowing difficulties and undernutrition will enable early identification, assessment, and management for those children in need.What this paper adds A screening tool with high sensitivities and specificities for identifying children with feeding/swallowing difficulties and undernutrition.The tool identified 100 per cent of children with severe undernutrition.The tool identified 100 per cent of children in Eating and Drinking Ability Classification System levels IV or V.

Top-ten tips for managing nutritional issues and gastrointestinal symptoms in children with neurological impairment

“…These recommendations are mainly based on experts' opinion and low/moderate-quality studies. Recently, they have been validated some screening tools aimed to identify risk of feeding and swallowing difficulties or undernutrition earlier, and to assess if further assessment is needed [21]. Nutritional needs are difficult to define in children with NI because of the heterogeneity of clinical aspects.…”

Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy

“…Malnutrition is common in CP. It can be defined by weight for age, triceps skinfold thickness, mid upper arm fat, arm muscle area, or Dual-energy X-ray absorptiometry ( 56 , 108 ). Children with severe CP need less energy than their peers.…”

Sistemas de clasificación para niños, niñas y adolescentes con parálisis cerebral: su uso en la práctica clínica

“…EDACS se ha evaluado en estudios recientes en cuanto a su validez en distintas poblaciones pediátricas con PC demostrando muy buenos resultados de confiabilidad tanto entre profesionales como entre profesionales y familia [28][29][30] . Existe una alta asociación entre los niveles de EDACS con disfagia y dificultades al tragar, sin embargo la asociación entre el EDACS y el GMFCS es moderada [31][32][33] . Aún no son muchas las investigaciones que incorporan esta clasificación, pero se alienta su implementación para la valoración de la PC.…”