Dealing with Dysphagia in Kids with Cerebral Palsy

अच्छे स्वास्थ्य के लिए पर्याप्त मात्रा में पोषक आहार लेने के साथ ही उसे सही प्रकार से चबाना भी जरुरी होता है, पर कभी-कभी कुछ बच्चो को भोजन चबाने या निगलने में दिक्कत का सामना करना पड़ता है.. Children having Neurological Disorders are more prone for such feeding related problems.. 

Dysphagia makes feeding a tough task 

Cerebral palsy can affect the muscles which controls opening and closing of mouth,moves lips and tongue and jaw movement. The muscle coordination and movements in face and neck allows a person to breath,swallow and talk. 

Some children may face difficulties in chewing and swallowing food and liquid items, the condition is known as Dysphagia. 

सेरिब्रल पाल्सी से ग्रसित अनेक बच्चों को डिसफैजिया अर्थात खाद्य पदार्थों को निगलने में दिक्कत होना एक आम समस्या है जो की अनेक प्रकार के गंभीर कॉम्प्लीकेशन्स को जन्म दे सकती है. सही मात्रा में भोजन नहीं चबा पाने के कारन प्रायः इन बच्चों में कुपोषण, पोषक तत्वों की कमी होना, बार-बार सांस अटकना, हिचकियाँ आना, chronic aspiration, oesophagitis,and respiratory infections आदि अनेक प्रॉब्लम्स भी होती हैं..

क्यों होता है Dysphagia?? 

Well, this condition arises when the esophagus cannot move food and liquids from the back of a child’s mouth to the stomach. The muscle coordination in the face and neck is a complex and intricate set of movements that allow a person to breath, swallow and talk. A person with Cerebral Palsy is prone to muscle impairment, even in the face and neck region.  चूँकि CP  से ग्रसित बच्चों का सेंट्रल नर्वस सिस्टम एवं  मांसपेशियों अफेक्टेड रहती हैं, उनका हेड-नैक कण्ट्रोल भी प्रॉपर नहीं होता, साथ ही पुअर पोस्चर and poor Oro-Motor skills acts as contributing factor for developing Dysphagia.. 

Signs and Symptoms of  Dysphagia

• - apnea during feeding खाते खाते ही सो जाना 

• - aspiration

• - delayed swallowing reflex

• - esophageal spasm

• - difficulty in feeding

• - oral apraxia

• - pain during feeding गले में भारीपन/दर्द 

• - delayed or absent swallowing reflex 

• - difficulty in or an unwillingness to feed.

• - esophageal spasms – squeezing of the esophagus

अन्य लक्षण जिन पर अभिभावकों को नज़र रखना चाहिए वे हैं 

Choking 

Constant cough  लगातार खांसी 

Drooling  मुँह से लार गिरना 

Dry mouth

Nasal regurgitation  नाक बंद रहना 

Resistance to feeding

Sluggishness, lack of energy

Sore throat

Taking a long time to eat  बहुत धीरे-धीरे भोजन चबाना-निगलना 

Tongue thrust

Unexplained weight loss

Speech-related signs of dysphagia include: ( resource from cerebralpalsy. org)

• Ataxic dysarthria – A slow and erratic pattern of speech 
• Flaccid dysarthria – A nasal speech 
• Inability to voice – The muscles that control vocal chords are not properly coordinated.
• Lack of vocal articulation – The muscles of the face, jaw, mouth and tongue do not work in concert to provide the proper conventional speech coordination.
• Mixed dysarthria 
• Spastic dysarthria – A monotone speech with difficulty pronouncing individual syllables.
• Verbal apraxia 

Dysphagia can be classified into 2 types:


1. Oropharyngeal Dysphagia : occurs due to nerve and muscle malfunction leading to weaken the throat muscles, thereby making it difficult to move the food from mouth to the throat


2. Esophageal Dysphagia: occurs due to malformation or malfunction of the lower esophageal sphincter, as if the food gets stuck in the esophagus

Dysphagia Management 

Make Feeding a pleasurable experience 

A number of feeding and oral motor intervention strategies has been developed to address the difficulties with sucking,chewing,swallowing. These include oral sensorimotor stimulation,positioning,food appliances,and neuromuscular stimulation. 

Occupational Therapy plays an integral role by guiding oro-motor training, Face n Jaw Muscles exercises, proper Head n Neck positioning, Chin Tucking, Co-ordination Exercises that will assist the child to feed properly and stay healthy...

Take Care..!!

Dr. Pooja Pathak

Occupational Therapist n Founder

www.swavalambanrehab.com