Cerebral palsy is a motor disorder, a condition in which muscles are affected. The more obvious effects are to the larger muscles of the arms and legs that cause spastic movements or make it difficult or impossible to walk. Other muscles can be affected too, including those that control breathing and swallowing. Oral motor dysfunction makes it difficult to swallow, but can affect breathing too.
Children with cerebral palsy are also vulnerable to respiratory complications like infections, aspiration, and respiratory distress syndrome. Because these children typically move less, are unable to exercise, and therefore breathe less deeply, they are more likely to develop infections and struggle with breathing. Several other factors play a role in causing all kinds of respiratory illnesses. Monitoring respiratory health and using treatments and therapies to make breathing easier is crucial for children with CP.
Causes of Respiratory Problems
Cerebral palsy can directly impact breathing because of issues with muscles, but breathing problems may also arise for other reasons. It is not uncommon for children with physical disabilities of all types to have underlying respiratory problems. In fact, according to statistics, 77 percent of the deaths of children with severe disabilities were caused by pneumonia, an infection of the lungs.
Exactly why physical disabilities like CP put children at risk for respiratory difficulties is not fully understood, but there are several factors that may contribute. For example, muscle weakness in those muscles involved in breathing and swallowing can cause aspiration, or the inhalation of foreign objects. Approximately 25 percent of children with CP struggle with aspiration.
Weakness or spasticity in abdominal muscles may also cause breathing problems, including aspiration. Children with CP are much more likely to experience gastroesophageal reflux, probably for this reason. When material from the stomach rises up to the esophagus, aspiration can occur. Further complicating aspiration is the fact that children with CP cannot always cough satisfactorily.
Breathing difficulties in children with cerebral palsy may also be caused by spinal curvature. This deformity can restrict the function of the lungs and make breathing more difficult. The lungs may also lose function due to atrophy as children with CP are less active and breathe less deeply. They also often struggle to get adequate nutrition because of feeding problems, and this can cause atrophy in the lungs as well.
Types of Respiratory Problems
Children with cerebral palsy are likely to have breathing difficulties due to the above reasons and probably because of other causes still undiscovered. Infections are a major issue, especially pneumonia. This lung infection is the number one reason that children with CP are admitted to the hospital. Gastroesophageal reflux, a limited ability to cough, limited lung function, and limited physical activity all contribute to the development of pneumonia and other respiratory infections.
Children with CP are also more likely to experience obstructive sleep apnea. The upper airway in children with CP becomes easily obstructed. This can happen while awake, but is particularly dangerous during sleep. Labored and noisy breathing is a sign of this. A child with CP may also experience atelectasis, the collapse of part or all of a lung, or bronchiectasis, chronic inflammation caused by infections in the bronchi of the airwaves.
Asthma is fairly common in all children. There does not seem to be a greater prevalence in children with CP, but for these kids it can be more problematic. It is often overlooked because the symptoms of asthma are similar to other breathing problems that children with cerebral palsy experience.
Monitoring Respiratory Health
Because there are so many potential respiratory issues that children with CP may experience, it is crucial that respiratory health is carefully and regularly monitored. Careful monitoring of how a child breathes can prevent more serious issues like infections that can be deadly. Regular maintenance of good respiratory health can make a child more comfortable, but may also save lives.
Life expectancy of a child with CP is impacted by respiratory health. Obvious reasons for this include infections like pneumonia and sleep apnea, but there are other, more subtle ways in which poor respiratory health shortens a child’s life expectancy. Malnutrition, for example, is a common problem with children who struggle to breathe and eat at the same time.
Respiratory Interventions and Treatments
There are a number of strategies that can be used to prevent, treat, and improve respiratory difficulties in children with CP as well as decrease or eliminate the complications of these breathing issues. Nutritional and dietary assessments, for instance, can help a child maintain good nutrition in spite of the difficulty she experiences swallowing and breathing. Supplements and nutritional shakes that are easier to swallow can divert malnutrition.
Oxygen therapy, or giving a child supplementary oxygen, can help when breathing is difficult due to weakened muscles or atrophied lungs. Inhalers and nebulizers may also make breathing easier, as can therapy that helps a child learn how to better position his body to breathe more easily. For some children, using antibiotics prophylactically, to prevent serious infections, may be an option.
Treatments for certain respiratory conditions can also help. A vest that administers high frequency waves has been proven to reduce the number of respiratory-related hospitalizations in children with severe CP.
This is a newer treatment that is potentially more effective than more traditional methods of improving breathing like chest percussions and draining fluids. It may even reduce the incidence of pneumonia.
Exercise has also been shown to be a useful therapy for children with CP. Controlled exercise, especially a swimming program, helps children to develop better lung function and strengthen atrophied muscles involved in breathing and swallowing.
For severe cases of CP in which swallowing has become a serious issue, a feeding tube may be used. This device helps a child to suck, swallow, and chew more effectively, which leads naturally to easier breathing. There are different types of feeding tubes that may be used, although if these can be avoided by less invasive strategies, it is always better for the child.
Respiratory health in children with CP is almost always an issue. The disability causes breathing problems in most children, but the severity of the issues range from mild to severe and depends on individual factors. It is crucial to monitor the respiratory health of children with CP, to use preventative interventions and therapies, and to try treatments that will help children breathe more easily and live longer.
If you have a child with CP, be aware of the potential breathing issues he may face and talk to your doctor about what you should be doing to keep him safe and healthy.