Here is a brief introduction to some of the issues around mealtimes, for either children or adults with Cerebral Palsy. Always seek professional guidance.
Aversive feeding difficulties
Some children and adults with cerebral palsy stop wanting to eat and drink. This might be because they have experienced difficulties with reflux, vomiting or swallowing in the past. Sometimes it can continue, even when the original cause of the difficulty has been resolved. It is important not to force people to eat and drink if they do not want to, as this can make it even harder for them to eat and drink. Eating and drinking should be an enjoyable experience. A GP, dietician and Speech and Language Therapist will be able to give support and strategies to ensure mealtimes are safe, enjoyable and provide enough nutrition.
Bite reflex is when someone 'locks' their mouth onto anything that is introduced into it. They have no control of this and it may only happen occasionally. Sometimes a speech and language therapist can show you how to 'unlock' the jaw if the reflex occurs. A plastic weaning spoon will lessen the chance of injury to the mouth or damage to the teeth.
Choking can be caused by poor positioning of the head and body or if your child has difficulties chewing their food. Your therapy team will be able to provide advice on good positioning for eating and drinking. Regular choking can cause considerable anxiety at mealtimes for everyone. In the worst case scenario it may even result in death. Ask a doctor, physiotherapist or speech and language therapist about how to react to choking and what to do in an emergency. If choking is persistent, ask your doctor to investigate.
Constipation is common in people with Cerebral Palsy, especially if they have reduced mobility. An underlying medical problem, poor diet or inadequate fluid intake may be the cause. Adding more fruit, vegetables and whole grains can help. If the problem is frequent, seek medical advice.
Regular teeth brushing is important and can help reduce the risk of chest infections. You can start brushing a child’s teeth as soon as you start to see the first tooth appearing.
Dental care for people with Cerebral Palsy
A nourishing and balanced diet is important for health. This can be difficult if you can only eat certain types of food or can only manage small amounts. Some people with Cerebral Palsy experience a lot of involuntary movements. These movements burn up energy, so a person with Cerebral Palsy may need to consume extra calories to compensate. Sometimes a food supplement can help meet a person’s nutritional needs. These food supplements will include calories and nutrients for a healthy diet.
Health Visitors can advise on food consistencies and suitable diets to wean babies onto. The advice of a dietician may be helpful, both for children and adults. Speech and language therapists can also provide advice, especially on food texture and consistency.
Dysphagia is a medical term for swallowing difficulties.
Equipment and utensils
You can feed most babies with the ordinary spoons designed for young children available in high street stores. Special plates, bowls, cups, adapted cutlery and non-slip mats are also available. An occupational therapist should be able to advise on adaptive kitchen utensils and how to get them.
Read more on excessive saliva and drooling.
Feeding and swallowing advisory clinics
To attend a specialist clinic, you will need a referral from a health professional such as your GP.
A high palate is not uncommon in people with Cerebral Palsy. Should food gather here, it's likely to stick, so remove it during the meal to avoid the possibility of choking.
Some disabled people have difficulty with eating because they are unusually sensitive to being touched on their faces or mouths. A Speech and Language Therapist may be able to help with this.
Positioning is important for eating. This will vary depending on a person's medical condition. The physiotherapist or occupational therapist, together with the speech and language therapist, are the best people to advise on positioning.
Reflux can cause discomfort during or after eating. Sometimes it may cause vomiting and can put people off wanting to eat and drink. Medical or anatomical problems, allergy or limited movement patterns can be factors. Ask your doctor for advice.
Tongue thrust is a strong, inappropriate and unconscious forward movement of the tongue that pushes food out of the mouth. Do not confuse this with behaviour that looks similar but is someone communicating that they do not wish to eat what's in their mouth. Seeking professional advice from a speech and language therapist on techniques that may help with tongue thrust.
Tube or non-oral feeding
Tube feeding may be necessary for some people who are not able to suck or swallow to get proper nutrition or to avoid food passing into the lungs rather than the stomach. Some people need tube feeding to make sure they get enough calories to stay healthy. Others may need tube feeding to avoid food and drinking going down into the lungs. Nasogastric tubes (NGT) pass directly into the tummy via the nose and PEG (Percutaneous Endoscopic Gastrostomy) pass directly through the skin into the stomach. Some people have some food via their mouth and some food via the tube. Your Speech and Language Therapist and Dietician will be able to advice how much to give via the mouth and tube.
Vomiting can be distressing for everyone. Keeping upright when eating and drinking and avoiding moving too quickly or lying down too soon after eating can help. Vomiting may put people off wanting to eat and drink. Ask your GP to investigate the causes of frequent vomiting.
Eating problems: further help
Talk to the Scope online community about diet and nutrition.
You can find further help for disabled children with eating problems or feeding issues from: