Cerebral Palsy and Dysphagia

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Dysphagia is difficulty swallowing, a common complication of cerebral palsy. Dysphagia makes it challenging to eat and can cause weight loss, heartburn, sore throat, and other symptoms. Treatments include therapy, medication, and surgery.

About Dysphagia

The word dysphagia is the medical name for difficulties with swallowing. When children develop dysphagia, it can manifest in different locations depending upon what area of the brain has been affected.

For instance, some children have trouble coordinating the muscles of the tongue and back of the throat that help you swallow your food without choking. Others will have a problem with the esophagus and have difficulty moving foods and liquids down into the stomach.

Although dysphagia can happen to anyone at any age, children with cerebral palsy are more susceptible because it is a disorder of the central nervous system, which affects the muscles in many parts of the body.

According to the National Center for Biotechnology Information, “dysphagia is closely related to gross motor function in children with CP.”[1]

If your child occasionally gets something caught in their throat and has trouble swallowing, this doesn’t usually indicate dysphagia. However, if the problem is consistent and begins to happen daily, it’s important to get medical help as soon as possible.

Dysphagia Symptoms

The Mayo Clinic reports that the following are the most common symptoms of dysphagia:[2]

• Inability to swallow or difficulty swallowing
• Regurgitation
• Heartburn
• Feeling stomach acid in the throat
• Unusual weight loss
• Hoarse voice
• Getting food stuck in the throat or lower down in the chest
• Gagging and coughing when attempting to swallow
• Drooling
• Delayed (or sometimes absent) swallowing reflex
• Sore throat

Types of Dysphagia

There are two main types of dysphagia, which include:

• Oropharyngeal Dysphagia:  Oropharyngeal dysphagia is characterized by muscle and nerve malfunctions in the oral cavity and pharynx.
• Esophageal Dysphagia: This type of dysphagia is marked by malformations and other conditions affecting the lower portion of the esophageal sphincter.

Diagnosing Dysphagia

There are a series of studies that physicians conduct when diagnosing dysphagia, including:

Ultrasound

An ultrasound shows problems in the esophagus and the surrounding muscles.

Swallowing Test & X-ray

A swallowing test, also known as a dynamic swallow study, is performed by having the patient attempt to eat different textured foods and liquids containing barium. This white substance shows up on X-ray studies.

A test is then performed to see how the foods move down from the mouth as the patient swallows. The barium allows the physician to visualize the swallowing process to see where the problem is occurring. Some children cannot swallow thin liquids, and others have trouble with solid foods. This study helps the team determine which foods are safe for the child to eat.

CT Scan and PET Scan

Imaging tests such as CT and PET scans allow doctors to view cross-sectional images of the soft tissues and bones in the child’s body. In some instances, an MRI will be ordered, which is another type of scan that can reveal more in-depth images of the organs and tissues.

Acid Testing

Doctors test for acid in the esophagus by using a small catheter inserted into the child’s nose and down into the esophagus. The catheter can take readings of the pH and detect if there are abnormal levels of acid in the patient’s esophageal area.

Other tests may be performed, as well. Your child’s doctor should be able to explain to you in detail what studies will be performed.

Dysphagia Treatment Options

Treatment for dysphagia is essential. Coping with this complication improves the quality of life for children living with cerebral palsy.

The type of treatment initiated will depend on the location of the problem. For those children that have difficulty coordinating the swallowing muscles in the upper part of the digestive tract, the first treatment option is to limit their diet. Parents are asked to give their children foods they know they can safely swallow.

For example, depending upon the X-ray findings, foods can be pureed if it was determined that your child could swallow them without any evidence of choking or aspiration.

The second recommendation is to work with the child to learn different swallowing techniques.[3] These may include exercises of the face and jaw muscles carried out by a speech pathologist or an occupational therapist. Chin tucking is a technique that helps children with swallowing. It consists of assisting the child in positioning their chin correctly, which can help to make swallowing easier.

Prescription medication is another option that may help with dysphagia and is used when the problem lies in the esophagus muscles. However, medications are usually more helpful for those with swallowing difficulties due to GERD (reflux) and, therefore, may not work for every child.

If the child has a malformation or tightening of the esophagus, physicians may perform an esophageal dilation. The doctor uses an endoscope with a balloon attached to stretch out and dilate the esophagus in this form of treatment.

Surgery is also an option for cases of dysphagia involving obstructions, strictures, and rings from the pharynx. In children with severe GERD, surgery can be used to support the lower esophageal sphincter, preventing the stomach contents from rising into the esophagus.

The Importance of Getting Timely Treatment for Dysphagia

If your child shows symptoms of dysphagia, it’s imperative to seek medical treatment as soon as possible. Failure to treat and adequately manage dysphagia can lead to several additional health problems, including:

• Dehydration
• Choking and aspiration
• Recurrent respiratory problems
• Pneumonia
• Malnutrition

Dysphagia Prognosis

The long-term outlook will depend on the severity of dysphagia. If treatment is administered in a timely manner, before any serious consequences, the prognosis is favorable.