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.

What Is 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 them swallow food without choking. Others will have a problem with the esophagus and difficulty moving foods and liquids 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 research, children with more severe CP and more impaired gross motor function are more likely to have dysphagia.[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

These 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 occurs. Some children cannot drink 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, 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 pH readings and detect if there are abnormal acid levels in the patient’s esophageal area.

Other tests may be performed, as well. Your child’s doctor should be able to explain 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. There are several ways to treat or manage dysphagia:[3]

• Changing the diet. Often, the first step in treating dysphagia is to change the diet to make eating easier. Softer foods in smaller pieces are often easier to swallow. For some children, food must be pureed.
• Changing meal times. Children with dysphagia also often benefit from a few changes when eating. Sitting upright and learning to chew more thoroughly can help.
• Botox injections. When dysphagia results from a neurological condition like CP, botox injections may relieve muscle spasms preventing swallowing.
• Widening the esophagus. 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 treatment.
• Surgery. Surgery is also an option for cases of dysphagia involving obstructions, strictures, and rings from the pharynx. In children with severe GERD, surgery can support the lower esophageal sphincter, preventing the stomach contents from rising into the esophagus.
• Feeding tube. A child may need a feeding tube for adequate nutrition in the most severe cases.

Speech-language pathologists can provide therapy to help a child with dysphagia. Regardless of the underlying cause, these professionals work with patients to change their diet, make lifestyle changes, and practice better swallowing techniques.[4] 

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 depends on the severity of dysphagia. The prognosis is favorable if treatment is administered promptly before any serious consequences.