Feeding involves many processes. Naturally, we know of the two basic steps which are: chewing and swallowing. However, Chewing and swallowing are not as simple as we assume. They are fairly complex and involve almost 50 pairs of muscles and nerves. There are three phases involved in chewing and swallowing:
- Oral preparatory and transport phase: It’s a voluntary phase, carried out by the mouth muscles. It includes opening and closing the mouth, mastication (chewing) and mixing the food with saliva.
- Pharyngeal phase: This phase starts when the bolus (formed at the first phase) enters the throat. The beginning of this phase is voluntarily followed by an involuntary action of the bolus entering the esophagus.
- Esophageal phase: The bolus moves further down the esophagus, to the stomach
For the child with Cerebral Palsy, the first phase is usually challenging.
Feeding difficulties for a child with Cerebral Palsy
Children who have Cerebral Palsy frequently have feeding challenges from as early as breastfeeding. This is due to varying neuromuscular difficulties. It is important for parents/caregivers to know possible interventions to prevent choking when feeding a child with cerebral palsy.
In this article, we will look at four main areas that will enable you to safely feed a child with Cerebral Palsy. These include Feeding position, Feeding Utensils, Change in food and liquid consistency and Encourage chewing.
1. Proper Feeding Position
When feeding a child with Cerabral Palsy, it is important to consider their feeding position. From breastfeeding an infant to feeding a growing child, proper feeding position will help to prevent the child from choking
Feeding Position For a Breastfed and or Bottle Fed Baby
While breastfeeding a baby with Cerebral Palsy, position him/her in a half-sitting position with his/her head slightly forward. To keep the head from pushing back, hold the shoulders forward, keep the hips bent, and push firmly on the chest.
While bottle-feeding the baby, position the baby so that the head is slightly forward, and the bottle comes from in front, not above.
Feeding Position for an Older Child with Cerebral Palsy
The child must be upright either on a feeding chair or an adapted wheelchair that has a feeding table. The Rifton Hi-Lo Activity Chair (image below) helps to stabilize the feet, hips, chest and head areas. Once stabilized, the child can focus on feeding. In addition the chair also encourages symmetry and eye contact during feeding.
Even without a feeding chair, various adaptations can be made as seen in the next photo. The most is important is that the child is upright and the points of control are stabilized.
2. Use Adapted Feeding Utensils
A child with Cerebral Palsy requires adapted feeding equipment to enable them to feed with ease and also promote self-feeding. Self-feeding is a very important skill which should be encouraged. Let the child touch and see food, this enables the child to get used to how the food feels. Make it a habit to eat together with the child for them to see how to feed, then, let them experiment on their own.
For example, using an adapted cup or a cut-out cup will enable the child to drink and they will not have to tilt their head back.
3. Change the Food and Liquid Consistency
When feeding a child with Cerebral Palsy, it is recommended to change in the consistency of foods (textures, temperature, fluidity, and tastes). Benefits of changing food consistency include:
- Ensures that swallowing is safe and that the food/liquid does not enter the airway in case of delayed swallowing
- Enhances sensory stimulation; different textures and temperatures of food may stimulate oral movement and trigger the swallowing.
Gradually increase the density/thickness of the food and later on the ‘lumpiness’ of the food. However, ensure the feeding is safe and that the child is not choking or coughing.
4. Encourage chewing
While feeding, place the food on the side of the child’s mouth, between the teeth, to encourage chewing and side to side tongue movement. Initially use softer foods, such as bananas, well-cooked vegetables or fruits, macaroni and bread. Place foods on the weaker side.
Some children might have great difficulties feeding and chewing even with the above recommendations; if this happens, consult with a specialized Medical practitioner, Speech and language therapist, and an occupational therapist to further assist.