Food and fluid texture consumption in a population-based cohort of preschool children with cerebral palsy: relationship to dietary intake.

Abstract

To determine the texture constitution of children's diets and its relationship to oropharyngeal dysphagia (OPD), dietary intake, and gross motor function in young children with cerebral palsy (CP). A cross-sectional, population-based cohort study comprising 99 young children with CP (65 males, 35 females) aged 18 to 36months (mean age 27mo; Gross Motor Function Classification System [GMFCS] level I, n=45; II, n=13; III, n=14; IV, n=10; V, n=17). CP subtypes were classified as spastic unilateral (n=35), spastic bilateral (n=49), dyskinetic (n=5), and other (n=10), in accordance with the criteria of the Surveillance of Cerebral Palsy in Europe. Habitual dietary intake of food textures, energy, and water were determined from parent-completed 3-day weighed food records. Parent-reported feeding ability of food textures was reported on the Pediatric Evaluation of Disability Inventory and a feeding questionnaire. OPD was classified based on clinical feeding assessment using the Dysphagia Disorders Survey (rated by a certified assessor, KAB) and a subjective Swallowing Safety Recommendation (classified by a paediatric speech pathologist, KAB). Food/fluid textures were modified for 39% of children. Children with poorer gross motor function tended to receive a greater proportion of energy from fluids (GMFCS levels IV-V: β=0.9, p=0.002) in their diets and fewer chewable foods (level III: β=-0.7, p=0.03; levels IV-V: β=-1.8, p<0.001) compared to level I to II participants. Fluids represented a texture for which children frequently had OPD and the texture most frequently identified as unsafe (or recommended for instrumental assessment). These findings indicate that swallowing safety, feeding efficiency, and energy/water intake should be considered when providing feeding recommendations for children with CP.