Longitudinal changes in parent-reported eating and drinking ability from eighteen months to ten years on a validated visual analogue scale

Abstract

Objective: Children's feeding skills typically undergo a series of important changes through the preschool years to a period of skill consolidation in the primary school years; however this has not been well documented in children with cerebral palsy (CP). This study aims to describe the changes to parent-reported eating and drinking ability from 18 months to ten years using a validated feeding scale. Design: Prospective population-based longitudinal cohort study. Method: 53 children with CP (n = 37 male; mean age final assessment = 9.3 years SD = 1.1; Gross Motor Function Classification System [GMFCS] I = 29 [54.7%], II = 12 [22.6%], III = 6 [11.3%], IV = 1 [1.9%], V = 5 [9.4%]). Screening for feeding difficulties was rated by parents using two 10 point visual analogue scales (eating and drinking), which has been validated against gold standard tools. A cutpoint of ≥7 on either scale indicates children likely to have moderate-severe eating and drinking difficulties. Direct assessments of oropharyngeal dysphagia using the Dysphagia Disorders Survey, Schedule for Oral Motor Assessment and observation of clinical signs were conducted by a certified speech pathologist from video. Proportion of children with moderate-severe eating and/or drinking difficulties was dichotomised using the published cutpoints. The longitudinal analysis of feeding difficulty was conducted using multilevel mixed effects logistic regression (odds ratios [OR]) with interaction terms between age and GMFCS. Results: The percentage of children with parent-reported moderate-severe eating and drinking difficulty remained unchanged between timepoints. Eating difficulty: 18-24 months corrected age (CA) (n = 6, 24.0%, 95% CI 10.7, 45.4), 60 months CA (n = 8, 16.7%, 95% CI = 8.4, 30.4), and 8-12 years CA (n = 11, 20.8%, 95% CI = 11.7, 34.1) (OR = 1.0, p = 0.17). Drinking difficulty: 18-24 months CA (n = 2, 8.0%, 95% CI 1.8, 28.5), 60 months CA (n = 5, 10.4, 95% CI 4.3, 23.1), and 8-12 years CA (n = 8, 15.1, 95% CI 7.6, 27.7) (OR = 1.0, p = 0.24). There was a significant increase in feeding difficulties for children from GMFCS III-V (OR = 6.4 [95% CI 2.7 to 15.2]; p < 0.001) relative to GMFCS I-II. Conclusion: Parent-reported moderate-severe eating and drinking difficulties remain relatively unchanged from 18-24 months through until late primary school. This level of feeding difficulty is likely to impact on children's nutritional status. Clinicians need to screen feeding difficulties at preschool age, and should be providing early feeding and nutritional support to ensure adequate growth is maintained.L6381699672022-06-10 <br />