Overview

Cerebral palsy is a movement disorder that is caused by damage to the brain. There is a wide range of symptoms, and each individual may have a different set of symptoms depending on the severity of the damage. Some of the symptoms include: stiff muscles, weak muscles and tremors. Some individuals may also have epilepsy and learning difficulties. Although cerebral palsy is primarily associated with movement problems, many individuals also have problems with feeding and drinking, because many muscles are involved in completing these tasks. Difficulty with eating can mean that children with cerebral palsy may become malnourished.¹

Signs of feeding difficulties in cerebral palsy

There are signs of children with cerebral palsy having feeding difficulties, which can be determined by:

• Feeding time of more than 30 minutes
• No weight gain for 2-3 months (sign in young children, especially in the first two years of life)
• Gurgly voice
• Vomiting, commonly only in response to certain textures
• Mixed textures, such as pasta pieces in liquid, may be difficult to manage for the child
• Hiding food under the tongue to avoid swallowing
• Problems holding or manipulating food on the tongue
• Food falling out of the mouth
• May put fingers or toys in their own mouth but will not allow others to put things in their mouth, including tasks such as tooth brushing

However, symptoms need to be assessed by a medical professional as symptoms vary and may also become apparent later on in life.²

Diagnosing feeding difficulties in cerebral palsy

Because cerebral palsy symptoms vary for each individual, some patients with cerebral palsy may only have mild feeding problems, whilst others may have severe feeding issues. It is important to monitor how long feeding times are taking, as feeding times longer than 30 minutes may indicate that there are feeding problems.

There are some criteria that must be met for healthcare professionals to confirm that there are issues with feeding for children with cerebral palsy, which include:

• Risk of aspiration (by history or observation)
• Aspiration pneumonia
• Suspicion of a pharyngeal or laryngeal problem, such as husky voice quality

A healthcare professional may observe the child eating in a stress-free setting, however, it may be difficult to determine whether they are experiencing feeding difficulties, as each mealtime may be different and some days are easier than others.  In rare cases, healthcare professionals may request a videofluoroscopy swallow study, which provides a way for specialists to visualise the three different phases of swallowing. This diagnostic may take place if there is suspicion that there is obstruction of the airways.^{2, 3}

Strategies for feeding and nutrition

It is important to consult with a specialist who can help aid in feeding and nutrition strategies, however, there are some tips that may help aid in feeding a child with cerebral palsy.

Associating eating as a stressor may make eating and mealtimes last longer or discourage the child from eating, therefore one of the strategies can include making sure the child can see the plate and food clearly and using colourful plates and utensils can help create positive associations with eating for the child, which can encourage eating behaviour. Allowing the child to touch and smell the food is also a strategy to help feeding behaviour.

It is important to monitor swallowing during mealtime, because cerebral palsy is a disorder of the muscles, which can cause children often have problems swallowing all their food. A speech and language therapist may be able to help your child if they have problems keeping their mouth closed and sticking their tongue out. However, it may also be beneficial to provide soft food that is easier to swallow and in smaller quantities.

Allowing your child to eat independently is also an important strategy, however, this strategy should be employed once you feel more confident about your child’s swallowing abilities. You can employ this strategy by placing a spoon in your child’s hand and helping them guide the food to their mouth.

Because it may be difficult for the child to eat, try and ensure that they are receiving all the nutrients they need, for example, by making smoothies that have extra nutrients, such as food thickeners and caloric supplements added.³ This will help avoid malnutrition and reduce eating in children with cerebral palsy.⁴

The child should be included in family mealtimes even if they are not eating to associate eating with positivity. Older children can be given mouth toys or allowed to put fingers into food and sucking off fingers with small amounts of food on them should be encouraged and providing water via spoon is also helpful.

It is important to note that some children with cerebral palsy may need to have a nasogastric feeding tube to prevent malnutrition and allow improvements in growth to be achieved. However, oral feeding may still be recommended so that the child can become accustomed to oral feeding as well.^{2, 4}

Summary

Some children with cerebral palsy may present with feeding difficulties, which, in turn, can cause malnutrition. It is therefore important to monitor the signs with the help of a healthcare professional to try and avoid this from occurring. Above are outlined some strategies that may help with feeding for children with cerebral palsy. However, it is important to seek the advice of healthcare professionals, as they will be able to provide individualised strategies and information for your child, as cerebral palsy symptoms vary from patient to patient.