Cerebral Palsy and Respiratory Health
This article has been fact checked by a Board Certified Pediatrician. Sources of information for the article are listed at the bottom.
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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, the latter causing spastic movements which make it difficult or impossible to walk. Other muscles can be affected too, including those that control breathing and swallowing.
Children with cerebral palsy are also vulnerable to respiratory complications like frequent upper respiratory infections, aspiration, and pneumonia. Because these children typically move less, are unable to exercise, and their breathing is more shallow, 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 due to abnormalities in the 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 are known to greatly contribute. For example, weakness in those muscles involved in breathing and swallowing can cause aspiration of food, or even saliva, or the inhalation of foreign objects. Approximately 25 percent of children with CP struggle with aspiration (when something other than air is taken into the trachea or lungs.)
Weakness or spasticity in the muscles of the digestive tract may also cause breathing problems, as that can contribute to 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.
Another complication is the fact that children with CP are sometimes unable to cough satisfactorily. This plays a role when they have a respiratory tract infection and are unable to clear their secretions. These infections can more readily progress into pneumonia, which is very difficult for them to overcome. Aspiration events also lead to pneumonia, so there are quite a few predisposing factors for pneumonia in children with cerebral palsy.
Breathing difficulties may also be caused by spinal curvature, also known as scoliosis. Depending upon the severity of the curvature, this deformity can affect the ability of the lungs to expand and make breathing more difficult. The curve will often increase as the child grows, especially if they are wheelchair-bound, which causes further restriction in lung function. The lungs may also be affected by hypoventilation as children with CP are less active and their breathing is more shallow. Less carbon dioxide is exchanged with oxygen as the breathing is impacted by the disability, and this causes problems with normal functions of the body.
Types of Respiratory Problems
Children with cerebral palsy are likely to have breathing difficulties due to the above reasons and maybe even 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 or swallow normally, limited lung function, and lack of 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 becomes easily obstructed. This obstruction can happen while the child is awake, but it is particularly dangerous during sleep. A sign of this would be long pauses without a breath while sleeping. In those cases, perhaps even the chest is moving, but no air is flowing through the nose or mouth.
A child with CP may also experience atelectasis, the collapse of small parts of the lung obstructing airflow to those areas, or bronchiectasis, chronic inflammation caused by recurrent infections in the airways.
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. The symptoms may sometimes be overlooked because they can be similar to other breathing problems that children with cerebral palsy experience.
Monitoring Respiratory Health
Because there are so many potential respiratory issues experienced by children with CP, respiratory health must be carefully and regularly monitored. Observation of the child’s breathing patterns can help a parent or caregiver know when something is different, which may prevent more serious issues like aspiration events or infections that can be deadly. Regular maintenance of good respiratory health can keep a child more comfortable and may also save lives.
Life expectancy for a child with CP is greatly 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 function 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. The energy demands on a child who has difficulty moving and breathing well are increased, making it challenging to meet their daily caloric needs.
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 the chance of complications.
Dietary assessments, for instance, can evaluate for and help a child maintain good nutrition in spite of any difficulty experienced while swallowing and breathing. Supplements and nutritional shakes that are easier to swallow can help to prevent the effects of malnutrition.
Oxygen therapy, or giving supplemental oxygen, can assist a child when breathing is difficult due to weakened muscles or poor lung function. Inhalers, nebulizers, incentive spirometers, and respiratory vests may also help open up the airways to make breathing easier, as can therapy that teaches a child to better position their body to breathe more easily.
Treatments for certain respiratory conditions can also help. A vest that administers high-frequency vibrations has been shown to reduce the number of respiratory-related hospitalizations in children with severe CP. It may even reduce the incidence of pneumonia. This is a treatment that can supplement traditional methods of improving breathing like respiratory therapists that perform chest percussion and encourage the draining of fluids by positioning.
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 by taking deeper breaths and strengthening the muscles involved in breathing and coughing.
For severe cases of CP in which swallowing has become a serious issue, a feeding tube may be used. This device can supplement the child’s nutrition when they are unable to eat enough calories. In more serious cases, it may be used when it is no longer advisable to take anything by mouth due to aspiration risk.
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 ranges 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 more comfortably.
If you have a child with CP, be aware of the potential associated breathing issues and talk to your doctor about what you should be doing to keep your child safe and healthy.