Journal of Family and Reproductive Health 2017. 11(4):197-201.

Evaluation of Feeding Disorders Including Gastro-Esophageal Reflux and Oropharyngeal Dysfunction in Children With Cerebral Palsy
Masoumeh Asgarshirazi, Monir Farokhzade Soltani, Zarrintaj Keihanidost, Mamak Shariat


Objective: This cross sectional study aims to survey developing feeding disorders and nutritional deficiencies disorders in children with neurodevelopmental disorders such as cerebral palsy.
Materials and methods: A total of 50 children (28 boys and 22 girls) with cerebral palsy and symptoms suggesting gastrointestinal problems such as choking, recurrent pneumonia and poor weight gain, who referred to the Pediatric department of Vali-asr Hospital, Imam Khomeini hospital complex between 1 October 2012 and 30 October 2013, were checked. Motor function classification system was used to classify patient's functional gross motor severity. All patients were examined and underwent deglutition videofluroscopy (modified barium swallow) and upper GI endoscopy with esophageal biopsies. Outcome of this study was the prevalence of oropharyngeal incoordination and GERD. Its relationship with some variables like motor and cognitive developmental delay were analyzed and p value < 0.05 was considered significant. Medical therapy and/or oral physiotherapy and nutritional rehabilitation were started. They were examined after 6 months of treatment. Decrease in choking and episodes of respiratory infections that needed hospitalization and weight gain after 6 months treatment were considered as secondary outcomes (response to treatment).
Results: Prevalence of GERD was 66% and oropharyngeal dysphagia was estimated 82%. According to results of video-fluroscopy and endoscopic biopsies, 52% of patients were affected by both GERD and oropharyngeal dysfunction. The gross motor function disability was the only variable that significantly related to the prevalence of feeding disorders (p = 0.015). Despite nutritional rehabilitation only 46% of children have weight gain.
Conclusion: Feeding disorders such as GERD and oropharyngeal dysfunction are more prevalent in children with cerebral palsy especially in children with severe gross motor disabilities. Since, clinical manifestations of these disorders can be similar accurate diagnostic methods should be selected for all children with cerebral palsy and gastrointestinal symptoms. Treatment should start early to reduce the complications and improve outcomes.


Cerebral Palsy; Gastroesophageal Reflux Disorders; Oropharyngeal Dysfunction; Gross Motor Disability

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Andrews G, Pine DS, Anderson TM, Anderson TM,Sunderland M. Neurodevelopmental disorders: Cluster 2 of proposed meta-structure for DSM-V and ICD 11. Psychol Med 2009; 39:2013-23.

Winter S, Autry A, Boyle C, Yeargin- Allsopp M. Trends in the prevalence of cerebral palsy in a population- based study.Pediatrics 2002; 110:1220-5.

Waterman ET, Koltai PJ, Downey JC, Cacace AT. Swallowing disorders in a population of children with cerebral palsy. Int J Pediatr Otorhinolaryngol 1992; 24:63–71.

Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing—normal and abnormal. Phys Med Rehabil Clin N Am2008; 19:691–707.

Brodsky L, Arvedson JC. Anatomy, embryology,

physiology, and normal development. In: Arvedson JC, Brodsky L. eds. Pediatric swallowing and feeding: assessment and management. 2nd edn. Canada: Thomson Delmar Learning. 2002:3–13.

Benfer KA, Weir KA, Bell KL, Ware RS, Davies PS, Boyd RN. Longitudinal cohort protocol study of oropharyngeal dysphagia: relationships to gross motorattainment, growth and nutritional status in preschool children with cerebralpalsy. BMJ Open. 2012; 2: e001460.

Morgan A, Reilly A. Clinical signs, aeitiologies and characteristics of paediatric dysphagia. In: Cichero J, Murdoch BE. Eds. Dysphagia: foundation, theory and practice. Chichester, England: John Wiley & Sons 2006:391–465.

Rogers B, Arvedson JC, Buck G, Smart P, Msall M. Characteristics of dysphagia in children with cerebral palsy. Dysphagia 1994; 9:69–73.

Sullivan PB. Gastrointestinal disorders in children with neurodevelopmental disabilities. Dev Disabil Res Rev 2008; 14:128-36.

Reilly S, Skuse D, Poblete X. Prevalence of feeding problems and oral motor dysfunction in children with cerebral palsy: a community survey. J Pediatr 1996; 129: 77–82.

Palisano R, Rosenbaum P, Walter RS, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39:214–23.

Erkin G, Colha C, Ozel S, Kirbiyik EG. Feeding and gastrointestinal problems in children with cerebral palsy. Int J Rehabil Res 2010; 33:218-24.

Grunow JE, al-Hafidh A,Tunell WP. Gasteroesophageal reflux following precutaneous endoscopic gastrostomy in children. J Pediatr Surg 1989; 24: 42-4.

Campanozzi A, Capano G, Miele E, Romano A, Scuccimarra G, Del Giudice E, et al. Impact of malnutrition on gastrointestinal disorders and gross motor abilities in children with cerebral palsy. Brain Dev 2007; 29:25-9.

Mahant S, Friedman JN, Connolly B, Goia C, Macarthur C. Tube feeding and quality of life in children with severe neurologic impairment. Arch Dis Child 2009; 94:668–73.

Rieken R, Van Goudoever JB, Willemsen SP , Willemsen SP, Calis EA, Tibboel D, et al. Measuring body composition and energy expenditure in children with severe neurologic impairment and intellectual disability. Am J Clin Nutr 2011; 94:759-66.


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