Swallowing difficulties (dysphagia)
Swallowing is a complicated activity. Lots of muscle groups have to work well together and in the right order to get the food or drink from the container, past the lips and to the back of the mouth.
How we swallow
The airway (trachea) has to close and the food tube (oesophagus) has to open.
Some of this is under our control and some of it is not.
Children with Cerebral Palsy have difficulty making muscles work. This means that many cannot organise the muscles in the mouth, lips and tongue to work at the right times and in the right order.
Even children with mild or moderate difficulty may not be able to eat enough to grow well, particularly during growth spurts.
If the child lacks sensitivity in the mouth or is over-sensitive, this can affect swallowing. For instance:
- A child starts to take food but begins to choke and spit when the food touches the back of the mouth. They may thrust food out as the tongue goes its own way and moves the food to the front of the mouth.
- Some children may bite onto a spoon and then cannot release it.
- Some food may go down the entrance to the airway rather than the food tube. This can cause coughing, wheezing and, for some children, problems with the lungs and airways.
- Some children will be sick after or during eating.
Some children do not have a good cough or 'gag' reflex and food may end up in the airways without much fuss. This can lead to illness.
Some children have difficulty bringing their lips together and keeping them closed to take food from a spoon or to keep food inside the mouth. Very often these children have a lot of saliva and may dribble or drool.
Sometimes the tongue is not behind the teeth and gets in the way of eating.
Children with Cerebral Palsy, who have tight muscles (spasticity) or are constantly moving (athetoid), even when they do not walk, use up far more energy than other children their age. This means they need far more food to grow and keep healthy. Sometimes prescribed supplements can help keep up a child's calorie intake.
Where swallowing is very difficult, or where the child is at risk of illness or not growing well, professionals might ask you to think about tube feeding.
It's difficult to eat or drink with your head tilted back. Allow time to help the child into the right position several times during the meal.
Food that allows control
Thick drinks rather than thin juice or water may help to give the child more control over what they are trying to swallow. Sometimes your GP can prescribe a powder, which thickens all drinks, to ease swallowing.
Some children may need food liquidised or finely mashed. Introducing more lumpy foods to these children can be a slow process. Read about food textures.