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Feeding development and difficulties

Lyla

  • Managing potential feeding problems associated with Cerebral Palsy

    • Feeding problems are common in children with Cerebral Palsy and other significant developmental delays. The nature and extent of the problems varies according to the degree of impairment in each of the domains in the Feeding Development Framework.   Link to reference on Cerebral Palsy – table already used in feeding difficulties section
    • As children grow and develop the nature and impact of their feeding difficulties is likely to change and specialised support may be required.
      • Specialised seating providing postural support and stability is essential for promoting feeding development and enabling children to achieve their full feeding potential.
      • Meeting nutritional requirements and maintaining adequate growth may become a challenge as mealtimes become prolonged and food variety and textures are limited.
    • Use of anticipatory guidance may help to avoid potential problems and minimize the impact of feeding difficulties.
    • Recognising and responding to a child’s feeding cues is fundamental to managing feeding difficulties and ensuring that mealtimes are enjoyable for both parent and child.

    Case scenario

    Lyla is aged 9 months. She has a recent diagnosis of quadriplegic dystonic cerebral palsy with mild spasticity.  At this stage Lyla’s parents do not have any specific concerns with her feeding.  They have identified some difficulties with feeding but have adapted to Lyla’s needs minimizing their impact.  Lyla has been referred for a developmental assessment including a feeding assessment with a view to providing services to support Lyla and her family.  She is now attending her first review.

    Remember to consider your own response before viewing suggested answers.

    Question 1

    What are the key elements of your assessment of  Lyla’s feeding?

    Answer Question 1

    Key elements of your assessment include:

    • Parent’s perception of Lyla’s feeding.
    • Medical, developmental, growth and social history.
    • Dietary assessment.
    • Observation of feeding.

    Your assessment reveals the following details:

    Parent’s perception of feeding

    • Mum recognises that Lyla has some difficulties with feeding but at this stage does not consider this to be a significant problem.
    • Lyla had some early feeding difficulties.  “She struggled with breast feeding. I then tried several different teats before finding one that suited Lyla.  She has always been good at letting me know when she is hungry.  Her hungry cry is different to her other cries.” 
    • Solids were introduced at around 6 months. “I had planned for Lyla to wean herself onto soft pieces of food rather than use puree foods but due to her difficulties in bringing her hands to her mouth I had to change my mind.  She really enjoys her food and knows when it is mealtime.” 
    • Lyla has a strong tongue thrust so she spits out a lot of food.  “I know that she is not doing this to tell me that she has enough or that she dislikes the food being offered but it does take longer to feed her compared to her brother at a similar stage.  I have tried her on lumpier foods that children of her age are supposed to manage but she gags and spits out the lumps.”
    • A standard high chair is not suitable for feeding due to Lyla’s dystonia and need for additional supports with seating.   “Before the developmental assessment I was feeding Lyla on my lap.  I have now started using the chair that was recommended at our last visit but Lyla is still getting used to it.  So I start the feed in the chair and finish with Lyla on my lap.”

    Medical, Developmental, Growth and Social History

    • Lyla was born at term and has been generally healthy since birth. She was difficult to settle as a baby and was prescribed medication for reflux which she continues.
    • Lyla presented at 7 months of age to a Paediatrician with concerns regarding her motor skills. She was subsequently diagnosed with   quadriplegic dystonic cerebral palsy with mild spasticity and referred for an Allied Health Developmental Assessment.  Assessment was conducted by an Occupational Therapist, Physiotherapist and Speech Pathologist and based on observation and parent reporting.   She has been provided with some advice on positioning for play and feeding and is now attending for follow-up.
    • Lyla’s Development video
    • In the first few weeks of life growth was reportedly slow before finding a suitable teat for feeding however since then growth has been tracking 10th-25th percentile on the WHO charts without concern.    
    • Lyla lives with both parents and her 3 year old brother who is typically developing.  Mum is currently on maternity leave but plans to return to work in around 15 months.  Dad works full time.  

    Dietary assessment

    • Lyla is currently having around 5 small bottles (Total volume approx. 600-700mls) of infant formula /day. 
    • She also has around ½ a cup of puree solids 3 times per day. 
    • The length of time Lyla takes to have solid meals is longer than expected for this amount of food.  It can take up to 30 minutes for her to finish.

    Mealtime Observation

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