Longitudinal study of oropharyngeal dysphagia in preschool children with cerebral palsy

Abstract

Background: Oropharyngeal dysphagia is prevalent in approximately 60% of preschool children with cerebral palsy (CP), with the preschool years representing a time of feeding transition. Aim: To determine changes in prevalence and severity of OPD in children with CP and relationship to health outcomes. Study Design: Longitudinal study of a population-based cohort. Participants & Setting: 109 children with confirmed CP diagnosis participated, assessed first at 18-36 months (Ax1 mean age 27.3 months c.a. (SD=5.1), 70 males, Gross Motor Function Classification System (GMFCS) I=50, II=10, III=21, IV=11, V=17) and again at 36-60 months (Ax2, average time between assessments was 15.3 months). Method: OPD was classified on the Dysphagia Disorders Survey (DDS). Health outcomes included: (1) Nutritional status, measured using Z-scores for weight, height, and body mass index (BMI), (2) Parent stress during mealtimes, (3) Hospitalisations for pneumonia. Gross motor skills were classified on GMFCS and motor type/ distribution. Results: Prevalence of OPD on the DDS reduced from 57% to 40% between assessments. 23% of children had an improvement to severity of OPD (>smallest detectable change), and 5% had poorer OPD. Gross motor function was strongly associated with OPD at both assessments, for OPD classification (Ax1 OR=2.2, p<0.001; Ax2 OR=3.4, p<0.001) and severity (Ax1 β=3.8, p<0.001; Ax2 β=3.9 p<0.001). OPD at 18- 24 months was related to health outcomes at 36 months: the DDS was related to low Z-scores for weight (adj β=1.2, p=0.03) and BMI (adj β=1.1, p=0.048). Conclusion: 18 to 60 months appears to be a time of transition in OPD, with a quarter of children showing improvement in their OPD. OPD is predictive of important outcomes at 36 months, and so should be screened from a young age using standardized measures. These findings will contribute to developing more effective screening considering critical developmental transitions for children from different GMFCS levels.L6129303772016-11-02 <br />