Feeding Difficulties and Children with Cerebral Palsy

Children with cerebral palsy may present with feeding difficulties which have an effect on growth, nutrition, general health and social interaction.  These feeding difficulties in children with cerebral palsy include issues such as choking, feeding time greater than 3 hours per day, frequent vomiting and and difficulties with chewing.  One protocol that has been created to help with difficulties chewing is the Functional Chewing Training.   The Functional Chewing Training was created to improve chewing function by providing postural alignment, sensory and motor training, and food and environmental modifications.

The Functional Chewing Training includes 5 steps to address feeding difficulties in children with cerebral palsy:

Step 1:  Positioning the child. A proper head and trunk control is crucial to facilitate smooth chin and lip closure and encourage
tongue movement.   For Functional Chewing Training the child is placed in a sitting position with the body tilted 60–90° tilted and head in neutral position, with the arms and legs supported.  Read more on postural control and mealtime here.
Step 2: Positioning the food.  The food is placed through corners of lips to the molar area during every feeding to help prevent abnormal reflexes.
Step 3:  Sensory stimulation of the upper and lower gums from the front teeth to molar area using massage helps to encourage lip closure, tongue lateralization and rotary chewing.  This helps to prevent tongue thrust, decrease tactile hypersensitivity and facilitate chewing function.
Step 4:  The chewing exercises are performed using a chewing tube placed in the molar area of the child.  The caregiver moves the tube from one side of the mouth to other side which the child completes the chewing exercises.
Step 5:  Adjustment of food consistency included increasing the food consistency gradually.

When a 12 week Functional Chewing Training program was completed in a double blind randomized group of 80 children with cerebral palsy who experienced feeding difficulties, the training program was shown to improve the chewing performance and mealtime functioning of children with cerebral palsy.

Additional research indicated that the Functional Chewing Training program is an effective approach on the severity of tongue thrust and drooling in children with cerebral palsy.

You can read the full article on Functional Chewing Training here.

References:

Inal, Ö., Serel Arslan, S., Demir, N., Yilmaz, Ö. T., & Karaduman, A. A. (2017). Effect of Functional Chewing Training on tongue thrust and drooling in children with cerebral palsy: A randomised controlled trial. Journal of Oral Rehabilitation.

Serel Arslan, S., Demir, N., & Karaduman, A. A. (2017). Effect of a new treatment protocol called Functional Chewing Training on chewing function in children with cerebral palsy: a double‐blind randomised controlled trial. Journal of oral rehabilitation, 44(1), 43-50.

Meal Time Rubrics include assessments for: finger feeding, using a spoon, using a fork, using a knife to cut, using a knife to spread, drinking from a cup, drinking with a straw, drinking from a water fountain, pouring liquids, cafeteria, meal preparation, cleaning up from meal, manners and independent feeding. The rubrics will be delivered electronically in PDF format and in a word processing format so that you can edit the document if necessary. This allows you to customize the rubric to your individual caseload if necessary.

Some suggested uses of Meal Time Rubrics are:

• assessment at initial evaluation and annual reviews
• progress reports
• establish entrance or exit criteria for therapy
• creating measurable goals

FIND OUT MORE ABOUT MEAL TIME RUBRICS AND DOWNLOAD A FREE SAMPLE RUBRIC.

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