Feeding method and health outcomes of children with cerebral palsy

Rogers, Bonnie

doi:10.1016/j.jpeds.2004.05.019

Cited by 112 publications

(76 citation statements)

References 43 publications

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“…Oral feeding interventions for children with CP may promote oral motor function, but these interventions have not been shown to be effective in promoting feeding efficiency or weight gain. 23 Scianni et al 24 examined muscle strengthening in children and adolescents with CP (which did not include oral motor muscles), and suggested that strengthening interventions are neither effective nor worthwhile. Although it is not possible to directly correlate approaches to interventions across body systems, these findings suggest that techniques that propose to strengthen the lip, tongue and jaw muscles that are often included in oral-motor therapy should be critically evaluated.…”

Section: Feeding/swallowing Interventions: Evidence Of Effectiveness mentioning

confidence: 99%

Feeding children with cerebral palsy and swallowing difficulties

2013

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Children with cerebral palsy (CP) are at risk for aspiration with oral feeding with potential pulmonary consequences, and commonly have reduced nutrition/hydration status and prolonged stressful meal times. There is considerable variability in the nature and severity of swallowing problems in these children whose needs change over time. Children with generalized severe motor impairment (for example, spastic quadriplegia) are likely to experience greater swallowing deficits than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. This review is focused on dysphagia in children with CP: types of deficits, clinical and instrumental evaluation, management decision making and evidence of effectiveness of interventions.European Journal of Clinical Nutrition (2013) 67, S9-S12; doi:10.1038/ejcn.2013.224Keywords: cerebral palsy; dysphagia; pediatrics; feeding; swallowing INTRODUCTIONChildren with cerebral palsy (CP) commonly have feeding disorders and swallowing problems (dysphagia) that in many instances place them at risk for aspiration with oral feeding, with potential pulmonary consequences. They also commonly have reduced nutrition/hydration status and prolonged stressful meal times. The specific nature and severity of the swallowing problems may differ, at least to some degree, in relation to sensorimotor impairment, gross and fine motor limitations, and cognitive/ communication deficits. Children with generalized severe motor impairment (for example, spastic quadriplegia) are likely to experience greater swallowing deficits 1,2 than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. 3 Concerns are multifactorial and include issues of reduced volume of food and liquid consumed orally, nutrition deficits, inadequate hydration and limited range of textures with slow advance of oral skills.Children with moderate-to-severe dysphagia usually are managed most effectively with an interdisciplinary team that allows for multiple factors to be addressed in a coordinated way. These factors include, but are not limited to, gastrointestinal issues, pulmonary status, nutrition/hydration, oral sensorimotor skills, behavioral issues and family interactions. The importance of a structured approach is stressed to handle these multiple problems. 4 It is critical that all decisions for the management of feeding and swallowing problems are made in consideration of the primary needs of the child that is, a stable airway with adequate nutrition and hydration. In addition, any feeding/ swallowing intervention should be pleasurable and non-stressful for patients and care givers. In some instances, tube feeding may be needed either temporarily or long term. [5][6][7][8] It is expected, with rare exceptions, that these children can cope with at least minimal tastes for pleasure, a practice that may have a positive impact on management of saliva/secretions while maintaining oral function and swallowing.This review paper is focused on dysphagia: types of deficit...

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Section: Feeding/swallowing Interventions: Evidence Of Effectiveness mentioning

confidence: 99%

Feeding children with cerebral palsy and swallowing difficulties

2013

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“…3,4 Newer developments in infant and child nutrition, including increased use of gastrostomy tubes, have improved the survival rate of children with cerebral palsy (CP). [5][6][7][8][9][10][11][12][13] Surgical advances have resulted in an improved survival rate for infants with certain congenital defects including diaphragmatic hernia, abdominal wall defects, esophageal atresia, and cyanotic heart defects. [14][15][16][17][18] Many of these children have systemic health problems including neurodevelopmental disabilities, gastrointestinal illnesses, pulmonary complications, musculoskeletal abnormalities, and nutritional deficits.…”

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confidence: 99%

Increasing Prevalence of Medically Complex Children in US Hospitals

et al. 2010

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OBJECTIVE: In this study we used national data to determine changes in the prevalence of hospital admissions for medically complex children over a 15-year period. PATIENTS AND METHODS: Data from the Nationwide Inpatient Sample, a component of the Healthcare Cost and Utilization Project, was analyzed in 3-year increments from 1991 to 2005 to determine national trends in rates of hospitalization of children aged 8 days to 4 years with chronic conditions. Discharge diagnoses from the Nationwide Inpatient Sample were grouped into 9 categories of complex chronic conditions (CCCs). Hospitalization rates for each of the 9 CCC categories were studied both individually and in combination. Trends of children hospitalized with 2 specific disorders, cerebral palsy (CP) and bronchopulmonary dysplasia, with additional diagnoses in more than 1 CCC category were also examined. RESULTS: Hospitalization rates of children with diagnoses in more than 1 CCC category increased from 83.7 per 100 000 (1991–1993) to 166 per 100 000 (2003–2005) (P[r] < .001). The hospitalization rate of children with CP plus more than 1 CCC diagnosis increased from 7.1 to 10.4 per 100 000 (P = .002), whereas the hospitalization rates of children with bronchopulmonary dysplasia plus more than 1 CCC diagnosis increased from 9.8 to 23.9 per 100 000 (P < .001). CONCLUSIONS: Consistent increases in hospitalization rates were noted among children with diagnoses in multiple CCC categories, whereas hospitalization rates of children with CP alone have remained stable. The relative medical complexity of hospitalized pediatric patients has increased over the past 15 years.

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“…Apesar da maioria dos pacientes ter apresentado deglutição funcional, foi encontrado um alto índice de disfagia orofarín-gea, se forem somados seus diferentes graus (leve, moderada e grave). Tal resultado concorda com estudos da literatura, que afirmam que os pacientes com paralisia cerebral, em decorrência de suas alterações posturais e sensório-motoras, apresentam alterações na função de deglutição, que vão desde comprometimentos no transporte do bolo alimentar para a faringe, até a presença de aspiração traqueal do alimento (1)(2)(3)(4) . Estudo (9) realizado em 32 crianças com PC tetraparética espástica aponta que todas apresentavam alterações na fase oral da deglutição e 40% apresentavam aspiração traqueal, sendo a consistência líquida a mais frequentemente aspirada.…”

Section: Discussionunclassified

“…Os pacientes com paralisia cerebral (PC), devido ao comprometimento motor global decorrente da alteração neurológica, podem apresentar comprometimentos na função de deglutição, que vão desde alterações no preparo oral do alimento (1)(2)(3)(4) , até a presença de sinais sugestivos de penetração e/ou aspiração laringotraqueal do alimento (1,(5)(6)(7)(8) .…”

Section: Introductionunclassified

Incidência de disfagia orofaríngea em pacientes com paralisia cerebral do tipo tetraparéticos espásticos institucionalizados

Flório

Silvério

et al. 2009

Rev. soc. bras. fonoaudiol.

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OBJETIVO: Verificar a incidência de disfagia orofaríngea em pacientes com paralisia cerebral do tipo tetraparesia espástica institucionalizados, correlacionando os achados com a consistência alimentar ingerida e o tipo de hidratação. MÉTODOS: Participaram do estudo retrospectivo 140 pacientes, com média de idade 28 anos. Foram levantados os seguintes dados do prontuário médico: comprometimento da deglutição, sendo utilizado o protocolo ROGS para classificação; via de alimentação e consistências alimentares; forma de hidratação. RESULTADOS: Verificou-se presença de disfagia orofaríngea em diferentes graus, sendo encontrada a deglutição funcional na maioria dos pacientes (40%). Dos pacientes com deglutição funcional e disfagia leve, a maioria, 65% e 50% respectivamente, recebem dieta na consistência pastosa. Daqueles com disfagia moderada, 66,7% recebem dieta na consistência semi-líquida, e 94,7% de pacientes com disfagia grave fazem uso de via alternativa de alimentação. Do total de pacientes, 63,6% recebem líquido fino e 10,7% recebem gelatina como forma de hidratação. CONCLUSÃO: A incidência de disfagia orofaríngea, somando seus diferentes graus de comprometimento, mostra-se alta em portadores de paralisia cerebral do tipo tetraparética espástica, apesar da deglutição funcional ser a mais encontrada. A consistência alimentar pastosa é mais presente nos pacientes classificados como deglutição funcional e disfagia leve. Os pacientes com disfagia grave fazem uso de via alternativa de alimentação em sua maioria. O uso do líquido fino é o mais encontrado como forma de hidratação na maioria dos pacientes, sendo este substituído pela gelatina, mais frequentemente conforme maior o comprometimento dadeglutição.

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Feeding method and health outcomes of children with cerebral palsy

Cited by 112 publications

References 43 publications

Feeding children with cerebral palsy and swallowing difficulties

Feeding children with cerebral palsy and swallowing difficulties

Increasing Prevalence of Medically Complex Children in US Hospitals

Incidência de disfagia orofaríngea em pacientes com paralisia cerebral do tipo tetraparéticos espásticos institucionalizados

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