Top

European Journal of Pediatrics

Published in:

Open Access 01-03-2012 | Review

Clinical practice

Swallowing problems in cerebral palsy

Authors: Corrie E. Erasmus, Karen van Hulst, Jan J. Rotteveel, Michel A. A. P. Willemsen, Peter H. Jongerius

Published in: European Journal of Pediatrics | Issue 3/2012

Abstract

Cerebral palsy (CP) is the most common physical disability in early childhood. The worldwide prevalence of CP is approximately 2–2.5 per 1,000 live births. It has been clinically defined as a group of motor, cognitive, and perceptive impairments secondary to a non-progressive defect or lesion of the developing brain. Children with CP can have swallowing problems with severe drooling as one of the consequences. Malnutrition and recurrent aspiration pneumonia can increase the risk of morbidity and mortality. Early attention should be given to dysphagia and excessive drooling and their substantial contribution to the burden of a child with CP and his/her family. This review displays the important functional and anatomical issues related to swallowing problems in children with CP based on relevant literature and expert opinion. Furthermore, based on our experience, we describe a plan for approach of investigation and treatment of swallowing problems in cerebral palsy.

Altaf MA, Sood MR (2008) The nervous system and gastrointestinal function. Dev Disabil Res Rev 14:87–95PubMedCrossRef

Arvedson JC (2008) Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Dev Disabil Res Rev 14:118–127PubMedCrossRef

Aziz Q, Andersson JL, Valind S, Sundin A, Hamdy S, Jones AK, Foster ER, Langstrom B, Thompson DG (1997) Identification of human brain loci processing esophageal sensation using positron emission tomography. Gastroenterology 113:50–59PubMedCrossRef

Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, Jacobsson B, Damiano D (2005) Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 47:571–576PubMedCrossRef

Bianchi AL, Gestreau C (2009) The brainstem respiratory network: an overview of a half century of research. Respir Physiol Neurobiol 168:4–12PubMedCrossRef

Casas MJ, Kenny DJ, McPherson KA (1994) Swallowing/ventilation interactions during oral swallow in normal children and children with cerebral palsy. Dysphagia 9:40–46PubMedCrossRef

Cooper-Brown L, Copeland S, Dailey S, Downey D, Petersen MC, Stimson C, Van Dyke DC (2008) Feeding and swallowing dysfunction in genetic syndromes. Dev Disabil Res Rev 14:147–157PubMedCrossRef

Daniels SK, Corey DM, Fraychinaud A, DePolo A, Foundas AL (2006) Swallowing lateralization: the effects of modified dual-task interference. Dysphagia 21:21–27PubMedCrossRef

Day SM, Strauss DJ, Vachon PJ, Rosenbloom L, Shavelle RM, Wu YW (2007) Growth patterns in a population of children and adolescents with cerebral palsy. Dev Med Child Neurol 49:167–171PubMedCrossRef

10.

Dziewas R, Soros P, Ishii R, Chau W, Henningsen H, Ringelstein EB, Knecht S, Pantev C (2003) Neuroimaging evidence for cortical involvement in the preparation and in the act of swallowing. Neuroimage 20:135–144PubMedCrossRef

11.

Ekedahl C, Mansson I, Sandberg N (1974) Swallowing dysfunction in the brain-damaged with drooling. Acta Otolaryngol 78:141–149PubMedCrossRef

12.

Fatemi A, Wilson MA, Johnston MV (2009) Hypoxic-ischemic encephalopathy in the term infant. Clin Perinatol 36:835–858, viiPubMedCrossRef

13.

Hamdy S, Mikulis DJ, Crawley A, Xue S, Lau H, Henry S, Diamant NE (1999) Cortical activation during human volitional swallowing: an event-related fMRI study. Am J Physiol 277:G219–G225PubMed

14.

Hemming K, Hutton JL, Pharoah PO (2006) Long-term survival for a cohort of adults with cerebral palsy. Dev Med Child Neurol 48:90–95PubMedCrossRef

15.

Humbert IA, Robbins J (2007) Normal swallowing and functional magnetic resonance imaging: a systematic review. Dysphagia 22:266–275PubMedCrossRef

16.

Jacobsson B, Hagberg G (2004) Antenatal risk factors for cerebral palsy. Best Pract Res Clin Obstet Gynaecol 18:425–436PubMedCrossRef

17.

Jean A (2001) Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev 81:929–969PubMed

18.

Jongerius PH, Joosten F, Hoogen FJ, Gabreels FJ, Rotteveel JJ (2003) The treatment of drooling by ultrasound-guided intraglandular injections of botulinum toxin type A into the salivary glands. Laryngoscope 113:107–111PubMedCrossRef

19.

Kern M, Birn R, Jaradeh S, Jesmanowicz A, Cox R, Hyde J, Shaker R (2001) Swallow-related cerebral cortical activity maps are not specific to deglutition. Am J Physiol Gastrointest Liver Physiol 280:G531–G538PubMed

20.

Kern M, Chai K, Lawal A, Shaker R (2009) Effect of esophageal acid exposure on the cortical swallowing network in healthy human subjects. Am J Physiol Gastrointest Liver Physiol 297:G152–G158PubMedCrossRef

21.

Kern MK, Jaradeh S, Arndorfer RC, Shaker R (2001) Cerebral cortical representation of reflexive and volitional swallowing in humans. Am J Physiol Gastrointest Liver Physiol 280:G354–G360PubMed

22.

Lefton-Greif MA, Carroll JL, Loughlin GM (2006) Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors. Pediatr Pulmonol 41:1040–1048PubMedCrossRef

23.

Malandraki GA, Sutton BP, Perlman AL, Karampinos DC, Conway C (2009) Neural activation of swallowing and swallowing-related tasks in healthy young adults: an attempt to separate the components of deglutition. Hum Brain Mapp 30:3209–3226PubMedCrossRef

24.

Martin RE, Goodyear BG, Gati JS, Menon RS (2001) Cerebral cortical representation of automatic and volitional swallowing in humans. J Neurophysiol 85:938–950PubMed

25.

Mirrett PL, Riski JE, Glascott J, Johnson V (1994) Videofluoroscopic assessment of dysphagia in children with severe spastic cerebral palsy. Dysphagia 9:174–179PubMedCrossRef

26.

Mosier K, Bereznaya I (2001) Parallel cortical networks for volitional control of swallowing in humans. Exp Brain Res 140:280–289PubMedCrossRef

27.

Odding E, Roebroeck ME, Stam HJ (2006) The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil 28:183–191PubMedCrossRef

28.

Owayed AF, Campbell DM, Wang EE (2000) Underlying causes of recurrent pneumonia in children. Arch Pediatr Adolesc Med 154:190–194PubMed

29.

Parkes J, Hill N, Platt MJ, Donnelly C (2010) Oromotor dysfunction and communication impairments in children with cerebral palsy: a register study. Dev Med Child Neurol 52:1113–1119PubMedCrossRef

30.

Ravelli AM, Milla PJ (1998) Vomiting and gastroesophageal motor activity in children with disorders of the central nervous system. J Pediatr Gastroenterol Nutr 26:56–63PubMedCrossRef

31.

Reddihough D, Erasmus CE, Johnson H, McKellar GM, Jongerius PH (2010) Botulinum toxin assessment, intervention and aftercare for paediatric and adult drooling: international consensus statement. Eur J Neurol 17(Suppl 2):109–121PubMedCrossRef

32.

Rogers B, Arvedson J, Buck G, Smart P, Msall M (1994) Characteristics of dysphagia in children with cerebral palsy. Dysphagia 9:69–73PubMedCrossRef

33.

Saito Y (2009) Reflections on the brainstem dysfunction in neurologically disabled children. Brain Dev 31:529–536PubMedCrossRef

34.

Saito Y, Kawashima Y, Kondo A, Chikumaru Y, Matsui A, Nagata I, Ohno K (2006) Dysphagia-gastroesophageal reflux complex: complications due to dysfunction of solitary tract nucleus-mediated vago-vagal reflex. Neuropediatrics 37:115–120PubMedCrossRef

35.

Sanger GJ, Lee K (2008) Hormones of the gut-brain axis as targets for the treatment of upper gastrointestinal disorders. Nat Rev Drug Discov 7:241–254PubMedCrossRef

36.

Scheffer AR, Erasmus C, Van Hulst K, Van Limbeek J, Jongerius PH, van den Hoogen FJ (2010) Efficacy and duration of botulinum toxin treatment for drooling in 131 children. Arch Otolaryngol Head Neck Surg 136:873–877PubMedCrossRef

37.

Scheffer AR, Erasmus C, Van Hulst K, Van Limbeek J, Rotteveel JJ, Jongerius PH, van den Hoogen FJ (2010) Botulinum toxin versus submandibular duct relocation for severe drooling. Dev Med Child Neurol 52:1038–1042PubMedCrossRef

38.

Smith HC (2008) Cough and aspiration of food and liquids due to oral pharyngeal dysphagia. Lung 186(Suppl 1):S35–S40CrossRef

39.

Soros P, Inamoto Y, Martin RE (2009) Functional brain imaging of swallowing: an activation likelihood estimation meta-analysis. Hum Brain Mapp 30:2426–2439PubMedCrossRef

40.

Spiroglou K, Xinias I, Karatzas N, Karatza E, Arsos G, Panteliadis C (2004) Gastric emptying in children with cerebral palsy and gastroesophageal reflux. Pediatr Neurol 31:177–182PubMedCrossRef

41.

Staiano A, Cucchiara S, Del GE, Andreotti MR, Minella R (1991) Disorders of oesophageal motility in children with psychomotor retardation and gastro-oesophageal reflux. Eur J Pediatr 150:638–641PubMedCrossRef

42.

Stern LM (1997) Preliminary study of glycoyrrolate in the management of drooling. J Paediatr Child Health 33:52–54PubMedCrossRef

43.

Sullivan PB (2008) Gastrointestinal disorders in children with neurodevelopmental disabilities. Dev Disabil Res Rev 14:128–136PubMedCrossRef

44.

Tahmassebi JF, Curzon ME (2003) The cause of drooling in children with cerebral palsy—hypersalivation or swallowing defect? Int J Paediatr Dent 13:106–111PubMedCrossRef

45.

Teismann IK, Dziewas R, Steinstraeter O, Pantev C (2009) Time-dependent hemispheric shift of the cortical control of volitional swallowing. Hum Brain Mapp 30:92–100PubMedCrossRef

46.

Van de Heyning PH, Marquet JF, Creten W (1980) Drooling in children with cerebral palsy. Acta Otorhinolaryngol Belg 34:691–705

47.

van der Burg JJ, Didden R, Engbers N, Jongerius PH, Rotteveel JJ (2009) Self-management treatment of drooling: a case series. J Behav Ther Exp Psychiatry 40:106–119PubMedCrossRef

48.

van der Burg JJ, Jongerius P, van Limbeek J, van Hulst K, Rotteveel J (2006) Drooling in children with cerebral palsy: a qualitative method to evaluate parental perceptions of its impact on daily life, social interaction, and self-esteem. Int J Rehabil Res 29:179–182PubMedCrossRef

49.

Vane DW, Shiffler M, Grosfeld JL, Hall P, Angelides A, Weber TR, Fitzgerald JF (1982) Reduced lower esophageal sphincter (LES) pressure after acute and chronic brain injury. J Pediatr Surg 17:960–964PubMedCrossRef

50.

Veugelers R, Benninga MA, Calis EA, Willemsen SP, Evenhuis H, Tibboel D, Penning C (2010) Prevalence and clinical presentation of constipation in children with severe generalized cerebral palsy. Dev Med Child Neurol 52:e216–e221PubMedCrossRef

51.

Volpe JJ (2006) Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances. Lancet Neurol 8:110–124CrossRef

52.

Watanabe Y, Abe S, Ishikawa T, Yamada Y, Yamane GY (2004) Cortical regulation during the early stage of initiation of voluntary swallowing in humans. Dysphagia 19:100–108PubMedCrossRef

53.

Weir K, McMahon S, Barry L, Ware R, Masters IB, Chang AB (2007) Oropharyngeal aspiration and pneumonia in children. Pediatr Pulmonol 42:1024–1031PubMedCrossRef

Title: Clinical practice
Swallowing problems in cerebral palsy
Authors: Corrie E. Erasmus
Karen van Hulst
Jan J. Rotteveel
Michel A. A. P. Willemsen
Peter H. Jongerius
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: European Journal of Pediatrics / Issue 3/2012
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-011-1570-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Clinical practice

Swallowing problems in cerebral palsy

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2012

Massive macroglossia after palatoplasty

European survey on the use of prophylactic fluconazole in neonatal intensive care units

Waist circumference percentiles for Portuguese children and adolescents aged 10 to 18 years

Acknowledgements

Tracheal agenesis: approach towards this severe diagnosis. Case report and review of the literature

Chest physiotherapy using passive expiratory techniques does not reduce bronchiolitis severity: a randomised controlled trial