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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Food Tactile Play and Food Preferences

As parents and teachers, how many times have you said to children, “stop playing with your food”? There is evidence based research indicating an association between food tactile play and food preferences in children.  A recent experimental study examining preschool children and their parents, indicated that children in a sensory fruits and vegetable play condition tried more fruits and vegetables than both children in a non-food sensory play task and children in the visual fruits and vegetable exposure task.  It not only occurred for the five foods used in the activity but also three additional foods that were not used in the activity.  The researchers concluded that sensory play activities using fruits and vegetables may encourage fruit and vegetable tasting in preschool children more than non food play or visual exposure alone (Coulthard & Sealy, 2017).

A previous study evaluated children and their parents’ enjoyment of a tactile play task, measures of food neophobia (aversion) and tactile sensitivity using questionnaires.   The results indicated strong associations between parent and child scores across all three measures of food neophobia, tactile sensitivity and tactile play enjoyment. The variables most strongly related to child food neophobia were parental neophobia and enjoyment of tactile play (parent and child).  The researchers concluded that tactile processing is associated with food neophobia (Coulthard & Sahota, 2016).

Need some ideas for tactile food play?  How about trying some of the suggestions below on a large tray or bowl.  Children can finger paint, scoop, pour and explore for a tactile play experience.

1. yogurt
2. frozen peas or other frozen vegetables
3. baby food
4. pureed fruit for paint
5. smashed bananas
6. smash cooked vegetables (let the kids smash it, then play with it)
7. wash the fruit and vegetables
8. slice fruit and vegetables

References:

Coulthard, H., & Sahota, S. (2016). Food neophobia and enjoyment of tactile play: Associations between preschool children and their parents. Appetite, 97, 155-159.

Coulthard, H., & Sealy, A. M. (2017). Play with your food! Sensory play is associated with tasting of fruits and vegetables in preschool children. Appetite.

Therapeutic Food Survey: Do you have students who need interventions due to sensory, self-help, oral, and oral-motor problems such as chewing, swallowing, touch, taste, or texture? Do you want a tool to help you work hand in hand with your client’s family to prioritize and set goals?

This Therapeutic Food Survey can be used to:
• Discover what and how much your client is and is not presently eating.
• Interview family members about history and family goals.
• Narrow down vague descriptions and create hard data.
• Use data to establish achievable goals.
• Use data to document progress.

FIND OUT MORE.

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Feeding Patterns of Autistic Children

Pediatrics published research on young children with autism and their feeding habits. Questionnaire data was compiled on 79 children with autism at 6, 15, 24, 38 and 54 months of age. Results indicated the following for the children with autism compared to control group:

• late introduction of solids after 6 months with slow feeding characteristics
• children were reported to be "very choosy" and "difficult to feed" from 15-54 months
• at 15 months their diet was less varied
• at 24 months they were more likely to eat different meals than their mothers
• 8% at 54 months had a special "allergy" diet
• overall ate less vegetables, salad, fresh fruit and fizzy drinks
• at 38 months consumption of Vitamins C and D were less
• no differences were seen in body mass index, weight or height at 18 months or 7 years
• no differences in energy intake or growth

Reference: Emond, Alan, Emmett, Pauline, Steer, Colin, Golding, Jean
Feeding Symptoms, Dietary Patterns, and Growth in Young Children With Autism Spectrum Disorders Pediatrics 2010 126: e337-e342