Parent-reported indicators for detecting feeding and swallowing difficulties and undernutrition in preschool-aged children with cerebral palsy

The assessment of stature in children with cerebral palsy is difficult. This study tested the clinical utility of the segmental measures of upper-arm length, tibial length, and knee height as proxies for stature in children with cerebral palsy. The study included 211 sets of measurements made in 172 children with cerebral palsy attending an outpatient clinic at a pediatric rehabilitation center during a 2-year period. Forty-three percent were female, 20% black, 31% diplegic or hemiplegic, and 52% nonambulatory. An observer measured weight, head circumference, recumbent length or standing height, upper-arm length, tibial length, knee height, midarm circumference, triceps skinfold, and subscapular skinfold. The correlation coefficients were as follows: upper-arm length and stature, .97 (95% confidence interval, .95 to .98) (R2 = .94); tibial length and stature, .97 (95% confidence interval, .96 to .98) (R2 = .94); and knee height and stature, .98 (95% confidence interval, .98 to .99) (R2 = .97). The linear regression equations were used to develop formulas for the estimation of stature from a segmental measure. Upper-arm length, tibial length, and knee height are all reliable and valid proxies for stature in children with cerebral palsy up to 12 years of age. We recommend that either knee height or tibial length be measured in the routine anthropometry of children with cerebral palsy who cannot be measured by standard techniques. Estimates of stature can then be calculated and plotted on standard growth charts.

The aim of this study was to estimate the prevalence and severity of feeding and nutritional problems in children with neurological impairment within a defined geographical area. In a cross-sectional study, a validated questionnaire was sent to 377 parents of children (aged 4 to 13 years) on the Oxford Register of Early Childhood Impairments with oromotor dysfunction. The return rate was 72%. Of these, 93% had cerebral palsy; 47% were unable to walk; 78% had speech difficulty; and 28% continuous drooling of saliva. Gastrointestinal problems were commonly encountered: 59% were constipated; 22% had significant problems with vomiting, and 31% had suffered at least one chest infection in the previous 6 months. Feeding problems were prevalent: 89% needed help with feeding and 56% choked with food; 20% of parents described feeding as stressful and unenjoyable. Prolonged feeding times (3h/day) were reported by 28%. Only 8% of participants received caloric supplements and 8% were fed via gastrostomy tube. Even though 38% of respondents considered their child to be underweight, 64% of children had never had their feeding and nutrition assessed. The results highlight that feeding problems in children with neurological impairment are common and severe, causing parental concern. Many of these children would benefit from nutritional assessment and management as part of their overall care.

To determine the prevalence and nature of feeding difficulties and oral motor dysfunction among a representative sample of 49 children with cerebral palsy (12 to 72 months of age). A population survey was undertaken by means of a combination of interview and home observational measures. Sucking (57%) and swallowing (38%) problems in the first 12 months of life were common, and 80% had been fed nonorally on at least one occasion. More than 90% had clinically significant oral motor dysfunction. One in three (36.2%) was severely impaired and therefore at high risk of chronic undernourishment. There was a substantial discrepancy between the lengthy duration of mealtimes reported by mothers and those actually observed in the home (mean, 19 minutes 21 seconds; range, 5 minutes 21 seconds to 41 minutes 39 seconds). In 60% of the children, severe feeding problems preceded the diagnosis of cerebral palsy. Using a standardized assessment of oral motor function, we found the majority of children to have clinically significant oral motor dysfunction. Contrary to maternal report, mealtimes were relatively brief, and this, combined with the severity of oral motor dysfunction, made it difficult for some children to achieve a satisfactory nutritional intake. The study illustrates the importance of observing feeding, preferably in the home.