Dysphagia and cerebral palsy

Dysphagia is a condition characterized by persistent difficulty or pain when swallowing. There are many causes of dysphagia, and people of all ages can suffer from it (1). 

Dysphagia is especially common for children with complex medical needs, with an estimated 30-80% of children with developmental disabilities having some form of dysphagia (2). Children with cerebral palsy or hypoxic-ischemic encephalopathy (HIE) have high incidences of dysphagia. 19.2-99% of children with CP experience dysphagia or another type of eating dysfunction (2).

Causes of dysphagia

Dysphagia and other swallowing/feeding disorders in children can be caused by or associated with the following (2, 3):

  • Hypoxic-ischemic encephalopathy (HIE)
  • Developmental disability
  • Neurological disorders
  • Genetic syndromes
  • Neuromuscular coordination issues, including prematurity, hypotonia, and others
  • Complex medical conditions, including pulmonary disease, heart disease, and others
  • Structural abnormalities that involve the mouth and throat
  • Medication side effects
  • Sensory issues that affect eating

Signs and symptoms of dysphagia

Many signs and symptoms can be associated with dysphagia, including (1, 2):

  • Inability to swallow
  • Painful swallowing (odynophagia)
  • Hoarse speech
  • Crying during meals
  • Back arching
  • Regurgitation
  • Refusing foods
  • Vomiting
  • Frequent heartburn
  • Gagging or coughing when swallowing
  • Avoiding certain foods because of difficulty swallowing them
  • Feeling that food gets stuck in your throat or chest

Cerebral palsy and dysphagia

As previously noted, dysphagia is very common for children with CP. One study analyzed the meal time behaviors of 166 children with severe CP (4). It used the Dysphagia Disorders Survey (DDS) to determine that dysphagia occurred in 99% of the children. 

Another study used modified barium swallow examinations to analyze the characteristics of 90 children with CP (5). They found that aspiration occurred in 40% of them, delayed swallow reflex occurred in 97% of them, and pharyngeal pooling and swallow delay occurred in 100% of them (4). 

Treating dysphagia

Cases of dysphagia vary greatly in severity and complexity. Because of this, it often requires a full team of professionals to treat dysphagia completely. Most commonly, the team of specialists will be led by a speech/language pathologist who specializes in feeding and swallowing. Additionally, there will likely be a dietician, occupational therapist, physical therapist, psychologist, and general physician on the team (2).

Depending on the needs of the patient, treatments can be focused on the following elements (2):

  • Diet modifications
  • Teaching maneuvers that modify the movements required in swallowing
  • Oral-motor treatments
  • Feeding strategies, such as pacing and cue-based feeding
  • Sensory stimulation techniques
  • Behavioral interventions
  • Tube feeding
  • Assistive technology (prosthetics, weighted silverware, sectioned plates, etc.)
  • Assisting with posture and position while eating

Risks associated with dysphagia

Children with cerebral palsy and dysphagia commonly are associated with an increased risk of the following complications (6, 7):

  • Aspiration with oral feeding
  • Nutritional deficiencies and dehydration
  • Mentally taxing meal times
  • Pulmonary issues
  • Difficulty with general oral skills (speaking, brushing teeth, etc.)

About ABC Law Centers: Birth Injury Lawyers

ABC Law Centers: Birth Injury Lawyers was established to focus exclusively on birth injury cases. A “birth injury” is any type of harm to a baby that occurs just before, during, or after birth. This includes issues such as oxygen deprivation, infection, and trauma. While some children with birth injuries make a complete recovery, others develop disabilities such as cerebral palsy and epilepsy.

If a birth injury/subsequent disability could have been prevented with proper care, then it constitutes medical malpractice. Settlements from birth injury cases can cover the costs of lifelong treatment, care, and other crucial resources. 

If you believe you may have a birth injury case for your child, please contact us today to learn more. We are happy to talk to you free of any obligation or charge. In fact, clients pay nothing throughout the entire legal process unless we win. 

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Sources

  1. Dysphagia. (2018, February 3). Retrieved October 17, 2019, from https://www.mayoclinic.org/diseases-conditions/dysphagia/symptoms-causes/syc-20372028.
  2. American Speech-Language-Hearing Association. (n.d.). Retrieved October 18, 2019, from https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934965§ion.
  3. Krüger, E., Kritzinger, A., & Pottas, L. (2017). Breastfeeding and swallowing in a neonate with mild hypoxic-ischaemic encephalopathy. The South African journal of communication disorders = Die Suid-Afrikaanse tydskrif vir Kommunikasieafwykings, 64(1), e1–e7. doi:10.4102/sajcd.v64i1.209
  4. Calis, E. AC., Veugelers, R., Sheppard, J.J., Tibboel, D., Evenhuis, H.M., & Penning, C. ( 2008). Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Developmental Medicine & Child Neurology, 50, 625-630. 
  5. Rogers, B., Arvedson, J., Buck, G., Smart, P., & Msall, M. (1994) Characteristics of dysphagia in children with cerebral palsy. Dysphagia, 9, 69-73. 
  6. Arvedson, J. C. (2013, December 4). Feeding children with cerebral palsy and swallowing difficulties. Retrieved October 18, 2019, from https://www.nature.com/articles/ejcn2013224.
  7. Malhas, A. (2018, October 15). Difficulties in Swallowing and Coughing in Spastic Cerebral Palsy Focus of Study. Retrieved October 18, 2019, from https://cerebralpalsynewstoday.com/2018/10/15/difficulties-in-swallowing-and-coughing-in-spastic-cerebral-palsy-study-focus/.