Longitudinal Study of Oropharyngeal Dysphagia in Preschool Children With Cerebral Palsy

Katherine A. Benfer, Kelly A. Weir, Kristie L. Bell, Robert S. Ware, Peter S. Davies, Roslyn N. Boyd

To determine changes in prevalence and severity of oropharyngeal dysphagia (OPD) in children with cerebral palsy (CP) and relationship to health outcomes. Longitudinal cohort study. Community and tertiary institutions. 53 children with confirmed CP diagnosis assessed first at 18-24 months (Ax1 mean age 22.9 months c.a. (SD=2.9), 33 males, Gross Motor Function Classification System (GMFCS) I=22, II=7, III=11, IV=5, V=8) and at 36 months (Ax2). none MAIN OUTCOME MEASURES: OPD was classified using the Dysphagia Disorders Survey (DDS) and signs suggestive of pharyngeal dysphagia. Nutritional status was measured using Z-scores for weight, height, and body mass index (BMI). Gross motor skills were classified on GMFCS and motor type/ distribution. Prevalence of OPD reduced from 62% to 59% between ages. 30% of children had an improvement in severity of OPD (>smallest detectable change), and 4% had worse OPD. Gross motor function was strongly associated with OPD at both assessments, on the DDS (Ax1 OR=20.3, p=0.011; Ax2 OR=28.9, p=0.002), pharyngeal signs (Ax 1 OR=10.6, p=0.007; Ax2 OR=15.8, p=0.003), and OPD severity (Ax1 β=6.1, p<0.001; Ax2 β=5.5 p<0.001). OPD at 18-24 months was related to health outcomes at 36 months: low Z-scores for weight (adj β=1.2, p=0.03) and BMI (adj β=1.1, p=0.048), increased parent stress (adj OR=1.1, p=0.049). Classification and severity of OPD remained relatively stable between 18-24 months and 36 months. Gross motor function was the best predictor of OPD. These findings contribute to developing more effective screening processes which consider critical developmental transitions which are anticipated to present challenges for children from each of the GMFCS levels.