Feeding Therapy for Children Diagnosed with Cerebral Palsy
This week I am exploring feeding issues found with children diagnosed with cerebral palsy. The information surrounding this topic is very vast and extensive. My goal for this post is to provide useful information and resources for both therapists and parents.
Let's begin with WHO is capable of addressing feeding issues with young children. Although speech language pathologists are sometimes the main therapist addressing feeding, there are other professionals who can add expert advice and assistance. As stated in The Cerebral Palsy Handbook, by Marion Stanton, "To get advice on this one aspect of a child's life you may have to go to as many as five different professionals. The physiotherapist will concentrate on the best positioning of your child. The dietician can advise on the best kinds of food to give her. The speech and language therapist can advise on the best ways to achieve a good chewing pattern and mouth closure. The occupational therapist can advise appropriate feeding equipment and seating. Finally, you may need to discuss any digestive problems with the (nutritional) consultant".
With several of the children I have treated who had been diagnosed with CP, I worked closely with both an OT through Early Intervention services and a dietitian through the child's private insurance. We collaborated about what the children needed, such as the recommended amount of calories, the textures they should be ingesting and how to strengthen their bite, chew and swallow, etc. Having this interdisciplinary collaborative approach is truly ideal, although with budget cuts and a lack of resources and professional availability, it may not always be possible. However, it is important information to know and to ask about when in team meetings and in a doctor's office planning out your child's therapeutic plan.
In addition, when you are developing the plan it is essential for parents and professionals to know how children with Cerebral Palsy benefit from nutrition and dietary therapy as well as possible areas of concern. The MY CHILD website reminds us that because "the majority of individuals with cerebral palsy report feeding or digestive difficulties, a dietary counseling program can be highly beneficial...Depending on the severity level of the individual's cerebral palsy, his or her digestive challenges and the ability to properly chew, swallow, and self-feed, effective dietary therapy can be devised to meet the individual's unique needs. Some of the more common dietary concerns for those with cerebral palsy include:
Ways to prepare food- dietary practitioners can adjust textures and consistency of food by pureeing, chopping and grinding foods for a more palatable experience. Foods can be softened by adding broth, gravy, milk, or juices to accommodate constipation issues. Liquids can be thickened for ease in swallowing.
Ways to feed- optimally, practitioners look for ways a person can self-feed, a skill that greatly enhances quality of life. This may include training an individual to use adaptive equipment. However, when caregivers are needed to assist in feeding, practitioners can teach effective ways of doing so. This can involve appropriate space between servings to allow for natural swallow, or feeding smaller portions more often throughout the day. In some cases, individuals with cerebral palsy must rely on a feeding tube for partial or total nutrition intake.
When to feed- adjusting timing of meal times may involve smaller, more frequent meals throughout the day. Sufficient time is required between bites or drinks to allow for natural swallowing. Sometimes meals are scheduled around medication needs to avoid stomach upset, curve appetites, and address drowsiness.
What to feed- if an individual with cerebral palsy has trouble with asphyxiation, reflux, or pneumonia, it is important to avoid foods that are more likely to exasperate these conditions, like nuts, seeds, and hard or stringy foods. Diets can be adjusted to provide more energy, balance metabolism, compensate for deficiencies, and enhance digestion. Vitamin, mineral and food supplements may assist those with malabsorption or who tire when eating. High fiber diets curb constipation. Prune and apricot juices may provide natural laxative qualities. Some foods enhance absorption of vitamins and calcium.
Providing proper mouth care- drooling, aspiration, and long-term anti-seizure medication use can contribute to an increased risk of dental decay, cavities, gum disease, and bacterial infections. Dietary practitioners can substitute sugars and carbonation with fresh fruits and vegetables. They also consult dental specialists to encourage proper dental hygiene, which may include regularly brushing, drinking fluorinated water, and scheduling dental check-ups.
*I hope that today's post has given parents and professionals some points to think about,
as well as some resources to consider when preparing a child's therapeutic feeding plan.