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Food and fluid texture consumption in a population-based cohort of preschool children with cerebral palsy: relationship to dietary intake.
BENFER, KATHERINE A 1; WEIR, KELLY A 2; BELL, KRISTIE L 1; WARE, ROBERT S 3,4; DAVIES, PETER S W 5; BOYD, ROSLYN N 1
[Article] Developmental Medicine & Child Neurology. 57(11):1056-1063, November 2015.

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AIM: 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).

METHOD: A cross-sectional, population-based cohort study comprising 99 young children with CP (65 males, 35 females) aged 18 to 36 months (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).

RESULTS: 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: [beta]=0.9, p=0.002) in their diets and fewer chewable foods (level III: [beta]=-0.7, p=0.03; levels IV-V: [beta]=-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).

INTERPRETATION: These findings indicate that swallowing safety, feeding efficiency, and energy/water intake should be considered when providing feeding recommendations for children with CP.

What this paper adds:

* Food/fluid texture modifications present in 39% of preschool children with cerebral palsy, based on parent reporting.

* Children consumed equivalent amounts (grams), but energy intake decreased with poorer gross motor function.

* Children on average had 50% of intake as fluid, which was most commonly unsafely swallowed.

* Children with poorer gross motor function consumed less chewable items and more fluids compared to those with better gross motor function.