Assessment and Treatment of Feeding in Children and Youth with Cerebral Palsy

Abstract

A significant number of children diagnosed with cerebral palsy (CP) present with early and ongoing histories of feeding dysfunction. This condition may cause stress and present challenges to both children and caregivers and may create barriers to enjoying social mealtime experiences. CP may result in the need for intensive medical interventions to support nutritional and hydration needs over time. The severity of the motor disturbance in CP is often highly correlated with the degree of feeding dysfunction. The link between CP and the functional activity of feeding requires a holistic approach to assessment and treatment. The use of the International Classification of Functioning, Disability, and Health (ICF) framework (WHO 2007) to inform assessment and intervention needs for the child and caregiver relies on understanding the interplay among body structure and function to support the physiological demands of feeding, the ability of the professionals and caregivers to create opportunities for participation in feeding and mealtime activities, the appropriate modifications being made to the environment, and the considerations of the caregiver and child relationship and the personal concerns that may support or limit the activity of feeding for children with cerebral palsy. Feeding assessment and treatment is often cyclical throughout the course of effective intervention as reassessment informs adjustments to treatment. The management of positioning provides the cornerstone that supports respiration, promotes swallowing safety, and improved alignment of feeding structures. Experiential training and the engagement of an interdisciplinary team that includes all stakeholders including the caregivers are among the most important elements for success in treatment of feeding.