Abstract
Objectives
To determine changes in prevalence and severity of oropharyngeal dysphagia (OPD) in
children with cerebral palsy (CP) and the relationship to health outcomes.
Design
Longitudinal cohort study.
Setting
Community and tertiary institutions.
Participants
Children (N=53, 33 boys) with a confirmed diagnosis of CP assessed first at 18 to
24 months (Assessment 1: mean age ± SD, 22.9±2.9mo corrected age; Gross Motor Function
Classification System [GMFCS]: I, n=22; II, n=7; III, n=11; IV, n=5; V, n=8) and at
36 months (Assessment 2).
Interventions
Not applicable.
Main Outcome Measures
OPD was classified using the Dysphagia Disorders Survey (DDS) and signs suggestive
of pharyngeal dysphagia. Nutritional status was measured using Z scores for weight,
height, and body mass index (BMI). Gross motor skills were classified on GMFCS and
motor type/distribution.
Results
Prevalence of OPD decreased from 62% to 59% between the ages of 18 to 24 months and
36 months. Thirty percent of children had an improvement in severity of OPD (greater
than smallest detectable change), and 4% had worse OPD. Gross motor function was strongly
associated with OPD at both assessments, on the DDS (Assessment 1: odds ratio [OR]=20.3,
P=.011; Assessment 2: OR=28.9, P=.002), pharyngeal signs (Assessment 1: OR=10.6, P=.007; Assessment 2: OR=15.8, P=.003), and OPD severity (Assessment 1: β=6.1, P<.001; Assessment 2: β=5.5, P<.001). OPD at 18 to 24 months was related to health outcomes at 36 months: low Z
scores for weight (adjusted β=1.2, P=.03) and BMI (adjusted β=1.1, P=.048), and increased parent stress (adjusted OR=1.1, P=.049).
Conclusions
Classification and severity of OPD remained relatively stable between 18 to 24 months
and 36 months. Gross motor function was the best predictor of OPD. These findings
contribute to developing more effective screening processes that consider critical
developmental transitions that are anticipated to present challenges for children
from each of the GMFCS levels.
Keywords
List of abbreviations:
BMI (body mass index), CP (cerebral palsy), DDS (Dysphagia Disorders Survey), GMFCS (Gross Motor Function Classification System), OPD (oropharyngeal dysphagia)To read this article in full you will need to make a payment
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References
- Oropharyngeal dysphagia and gross motor skills in children with cerebral palsy.Pediatrics. 2013; : e1553-e1562
- Validity and reproducibility of measures of oropharyngeal dysphagia in preschool children with cerebral palsy.Dev Med Child Neurol. 2015; 57: 358-365
- A report: the definition and classification of cerebral palsy April 2006.Dev Med Child Neurol Suppl. 2007; 109 ([published erratum appears in Dev Med Child Dev 2007;49:480]): 8-14
- Feeding children with cerebral palsy and swallowing difficulties.Eur J Clin Nutr. 2013; 67: S9-12
- Dysfunctional swallowing and respiratory disease in children.Adv Pediatr. 1994; 41: 135-162
- Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study.Dev Med Child Neurol. 2000; 42: 674-680
- Impact of feeding problems on nutritional intake and growth: Oxford Feeding Study II.Dev Med Child Neurol. 2002; 44: 461-467
- Development of feeding.Clin Nutr. 1986; 5: 210-218
- Validity and reliability of the Mastication Observation and Evaluation (MOE) instrument.Res Dev Disabil. 2014; 35: 1551-1561
- Anatomy, physiology, and development of feeding.Semin Speech Lang. 1996; 17: 261-268
- Feeding behaviors and other motor development in healthy children (2-24 months). J Am Coll.Nutr. 2002; 21: 88-96
- Prevalence of feeding problems and oral motor dysfunction in children with cerebral palsy: a community survey.J Pediatr. 1996; 129: 877-882
- Characteristics and management of feeding problems of young children with cerebral palsy.Dev Med Child Neurol. 1992; 34: 379-388
- Feeding and nutritional characteristics in children with moderate or severe cerebral palsy.Acta Paediatr. 1996; 85: 697-701
- Early feeding abilities in children with cerebral palsy: a parental report study.J Med Speech Lang Pathol. 2009; 17: 31-44
- Early feeding problems in children with cerebral palsy: weight and neuro-developmental outcomes.Dev Med Child Neurol. 2002; 44: 40-43
- Objective measures of dysphagia complexity in children related to suckle feeding histories, gestational ages, and classification of their cerebral palsy.Dysphagia. 2001; 16: 200-207
- Longitudinal changes in feeding among children with cerebral palsy between the ages of 4 and 7 years.Dev Neurorehabil. 2011; 14: 191-198
- A prospective, longitudinal study of growth, nutrition and sedentary behaviour in young children with cerebral palsy.BMC Public Health. 2010; 10: e179-e191
- Australian Cerebral Palsy Child Study: protocol of a prospective population based study of motor and brain development of preschool aged children with cerebral palsy.BMC Neurol. 2013; 13: e57-69
- Longitudinal cohort protocol study of oropharyngeal dysphagia: relationships to gross motor attainment, growth and nutritional status in preschool children with cerebral palsy.BMJ Open. 2012; 2 (Available at:) (Accessed August 27, 2012): e001460
- Clinimetrics of measures of oropharyngeal dysphagia for preschool children with cerebral palsy and neurodevelopmental disabilities: a systematic review.Dev Med Child Neurol. 2012; 54: 784-795
- Dysphagia Disorders Survey and Dysphagia Management Staging Scale (adult and pediatric applications): user's manual: Australian edition.The Centre for Developmental Disability, Ryde2003
- Dysphagia in children with severe generalized cerebral palsy and intellectual disability.Dev Med Child Neurol. 2008; 50: 625-630
- Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy.Res Dev Disabil. 2015; 38: 192-201
- Development and reliability of a system to classify gross motor function in children with cerebral palsy.Dev Med Child Neurol. 1997; 39: 214-223
- Classification and definition of disorders causing hypertonia in childhood.Pediatrics. 2003; 111: e89-98
- Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers.Dev Med Child Neurol. 2000; 42: 816-824
- Census of population and housing: Socio-Economic Indexes for Areas (SEIFA), Australia.2011 (Available at:) (Accessed June 25, 2014)
- Preterm birth: fact sheet N°363.2013 (Available at:) (Accessed May 29, 2014)
- CDC growth charts: United States advance data from Vital and Health Statistics, No. 314.National Center for Health Statistics, Hyattsville2000
- Use of segmental measures to estimate stature in children with cerebral palsy.Arch Pediatr Adolesc Med. 1995; 149: 658-662
- Schedule for Oral Motor Assessment: administration manual.Whurr Publishers, London2000
- Oropharyngeal dysphagia in preschool children with cerebral palsy: oral phase impairments.Res Dev Disabil. 2014; 35: 3469-3481
- Prognosis for gross motor function in cerebral palsy: creation of motor development curves.JAMA. 2002; 288: 1357-1363
- Gastrostomy tube feeding of children with cerebral palsy: variation across six European countries.Dev Med Child Neurol. 2012; 54: 938-944
- Motor severity in children with cerebral palsy studied in a high-resource and low-resource country.Pediatrics. 2014; 134: e1594-e1602
Article info
Publication history
Published online: December 18, 2015
Footnotes
Current affiliations for Weir, School of Medicine, The University of Queensland, Brisbane, and Menzies Health Institute of Queensland, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia.
Supported by the National Health and Medical Research Council Postgraduate Medical and Dental Scholarship (1018264–KB), Career Development Fellowship (APP1037220–RB), and Project Grants (grant nos. 569605, 465128); and by the Speech Pathology Australia Post Graduate Student Research Grant to conduct reliability ratings.
Australian New Zealand Clinical Trials Registry Registration No.: 1261200169820.
Disclosures: K.L.B. reports a financial relationship with Danone and Nutricia outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
