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Assessing pulmonary consequences of dysphagia in children with neurological disabilities: when to intervene?

Feeding problems are common in children with neuromotor impairments. For example, a community-based survey by Reilly et al. demonstrated oral motor dysfunction in more than 90% of a sample of 49 children with cerebral palsy (CP). The sample contained 21 children with diplegia, 20 with quadriplegia, and six with hemiplegia. Most had either predominantly spastic ( n =20) or mixed ( n =22) signs. Thirty-three children were classified as having severe to profound functional impairment according to the Standard Recording of Central Motor Deficit. Over one-third of the sample had severe oromotor impairment and was at risk of chronic undernourishment. Although oral motor impairment was observed in all types of CP, moderate to severe oromotor dysfunction was more common in children with four limbs involved. In clinical populations, 60% of children with CP were found to have swallowing problems, with evidence of chronic aspiration in 41%. In assessing children with dysphagia, two issues are, therefore, paramount: is feeding safe, and is it adequate?