Table 1

Prevalence of oropharyngeal dysphagia in children with cerebral palsy and its relationship to gross motor function

Author and yearParticipantsOPD measureGross motor measureMajor findings
Santoro et al (2012)n=40 children with CP and feeding problems aged 4 months–11 years, GMFCS III–VParent questionnaire and mealtime observation by SPGMFCS
CP motor type
Children from GMFCS III showed best feeding performance (hemi/diplegic CP)
Erkin et al (2010)n=120 children with CP, 2–18 yearsInformal observations of feeding behavioursGMFCS (collapsed to two groups)
CP motor type
22% feeding dysfunction (12% mild, 8% moderate and 2% severe)
Feeding dysfunction in 4% of GMFCS I–III, and 22% of GMFCS IV–V (p<0.001)
Parkes et al (2010)n=1357 children with CP, median 5;11 years, GMFCS I–VQuestion on standardised assessment for register (‘absent’ or ‘present’)GMFCS
CP motor type (Surveillance of CP in Europe Project)
19% chewing and swallowing problems
GMFCS significantly related to swallowing/chewing difficulties and excessive drooling: GMFCS IV—OR 4.8
GMFCS V—OR 15.7
Wilson and Hustad (2009)n=37 children with CP, 11–58 months (mean 41 months)Parent report on feeding and swallowing Questionnaire
Clinical evaluation of OPD (no formal tools)
No analysis of motor severity56% had difficulty feeding from a bottle
78% had oral motor involvement (including motor speech)
No analysis with gross motor
Ortega et al (2009)n=53 children with CP, 3–13 years, GMFCS I–V (with 75% of sample from IV–V)Oral Motor Assessment ScaleGMFCS83% did not have functional feeding skills
No analysis with gross motor
Calis et al (2008)n=166 children with severe CP and ID, 2–19 years (mean 9;4 years). GMFCS IV–V, IQ<55DDS and DSS
Parent report
GMFCS99% clinically apparent dysphagia
Oral motor severity positively associated with motor functional severity (p<0.001)
Postural stability positive association to DDS score, but not postural alignment for eating
Yilmaz, et al (2004)n=23 children with spastic CP, 4–25 years GMFCS I–VFFAmAmbulatory status50–74% normal–mild feeding difficulties; 30–51% moderate–severe feeding difficulties
Field et al (2003)n=44 children with CP, 1 month–12 years (median age range 13–36 months)Record reviewNo analysis of motor severity68% oral motor delay
32% dysphagia
Fung et al (2002)n=230 children with CP, 2–18 years (mean 9.7 years), GMFCS III–VParent reported on feeding questionnaire—rated as none, mild, mod and severeGMFCS48% feeding problems
GMFCS level was highly associated with the degree of feeding dysfunction (p<0.001)
Sullivan et al (2000)n=271 parents of children with childhood impairments (96% CP), 4–13 years, mild–severe gross motorRegister question to determine ‘articulation/swallowing problems’
Parent questionnaire to investigate specific feeding problems
Parent rated severity of motor function, relating to aids needed (mild, mod and severe)79% articulation or swallowing problems
Significant correlation between severity of gross motor impairment and range of specific feeding problems (eg, choking with food p<0.001; prolonged mealtime p<0.001)
Reilly et al (1996)n=49 children with CP, 12–72 months, mild-profound (70% with severe-profound imp)SOMA
Early feeding histories
Standard Recording of Central Motor Deficit—classified as no disorder/mild; severe/profoundPositive relationship between OPD severity and gross motor severity (p=0.000)
Mod and severe OPD more common in tetraplegia, whereas diplegia was associated with mild OPD (p=0.001)
Dahl et al (1996)n=35 children with CP, 2.4–15.2 years (mean 7.7 years), profound motor handicaps (moderate and severe CP)Parent interview (retrospective data of 4 weeks) triangulated with medical file reviewMotor severity differentiated by level of dependence60% reported as having daily feeding problems
No analysis of gross motor
Stallings et al (1993)n=142 children with quadriplegic CP, 2–18 yearsParent interview (0–5; 0=no problems, 5=all (5) oral motor problems)Diagnostic criteria (for quadriplegic CP) not defined in paper86% impaired oral motor ability
No analysis of gross motor
Waterman et al (1992)n=56 children with CP, 5–21 years (median 14 years), mild–severeChart review (clinical or radiographical dysphagia)
Interviews with SP
Severity defined based on ambulatory status from chart review27% had evidence of swallowing disorders
More severe CP in dysphagic group (‘consistent but non-significant trend’—no statistics reported)
Thommessen et al (1991)n=42 children with CP, 1–16 yearsOPD evaluated by 3 OTs/PTs (based on child's age)No analysis of motor severity33% had OPD
No analysis of gross motor
Love et al (1980)n=60 children with CP, 3–23 years (mean 12.5 years), spastic, athetoid and mixed; mild–non-ambulatoryNon-standardised oral-motor tasks (biting, sucking, swallowing, chewing soft and firm food)No analysis of motor severity40% with inadequate feeding
  • CP, cerebral palsy; DDS, Dysphagia Disorders Survey; DSS, Dysphagia Severity Scale; FFAm, Functional Feeding Assessment modified; GMFCS, Gross Motor Function Classification System; ID, intellectual disability; imp, impairment; mod, moderate; OPD, oropharyngeal dysphagia; OT, occupational therapist; PT, physiotherapist; SOMA, Schedule for Oral Motor Assessment; SP, speech pathologist.