Serebral Palsi’li Çocuklarda Çiğneme Bozuklukları ve İlişkili Beslenme Problemleri

Serebral palsi (SP) doğum öncesi, sırası veya sonrasında beyinde oluşan hasar sonucu meydana gelen klinik bir tablodur.Serebral palsi, çocukluk çağı engelliliğinin en yaygın nedenlerinden biridir. Serebral palside duyusal, motor ve zihinselproblemler tabloya eşlik etmektedir. Özellikle orofasiyal bölgedeki duyusal ve motor etkilenim beslenmenin önemli biraşamasını oluşturan çiğneme fonksiyonunda ciddi problemlere yol açmaktadır. Çiğneme, besinleri parçalayıp yutmaya hazırhale getirilmesi sürecini ifade etmektedir. Çiğneme bozukluğu ise besinin ağıza alınması, ağızda tutulması ve yutulabilir birkıvama getirilmesi sırasında görülen problemleri ifade etmektedir. Çiğneme fonksiyonu normal gelişim gösteren çocuklarda4-6 ay civarında gözlenmeye başlamakta, dil hareketlerinin artması, dişlerin çıkması ve katı besin deneyimleriyle birlikte8 yaşına kadar gelişim göstermektedir. Serebral palsili çocuklarda görülen oromotor disfonksiyonlar, anormal nörolojikgelişim, postüral bozukluklar ve kognitif etkilenim yaşa uygun besin dokularını yönetme ve besinleri yutulabilir kıvamagetirme becerilerini olumsuz etkilemekte ve çiğneme bozukluğuna neden olmaktadır. Çiğneme bozukluğu nedeniyleSP’li çocuklarda katı besinlerin alımı sınırlanabilmekte ve daha çok yarı katı veya sıvı besinler gibi çiğneme becerisigerektirmeyen besinler tercih edilmektedir. Bu durum gerekli enerji alımını sınırlandırabilmekte ve beslenme bozukluğunaneden olmaktadır. Aynı zamanda öğünlerin hazırlanması süreci de düşünüldüğünde hem çocuk, hem de aile için olumsuzsosyal etkileşim ve yaşam kalitesinde düşmeye neden olmaktadır. Bu nedenle çiğneme bozukluğu olan SP’li çocuklarınbeslenme durumları erken dönemde belirlenmeli ve uygun tedavi yaklaşımları planlanmalıdır.

Chewing Disorders and Related Nutritional Problems in Children with Cerebral Palsy

Cerebral palsy (CP) is a clinical picture that occurs as a result of brain damage before, during or after birth. Cerebral palsy is one of the most common causes of childhood disability. Sensory, motor and mental problems accompany the condition in CP. Sensory and motor involvement, especially in the orofacial region, causes serious problems in chewing function, which is an important stage of nutrition. Chewing refers to the process of breaking down food and making it ready for swallowing. Chewing disorder, on the other hand, refers to the problems seen during accepting food by mouth, keeping it in the mouth, and turning it to a swallowable consistency. Chewing function begins to be observed around 4-6 months in children with normal development, and it develops until the age of 8 years with increased tongue movements, teeth eruption and solid food experiences. Oromotor dysfunctions, abnormal neurological development, postural disorders and cognitive impairment which were seen in children with CP adversely affect their ability to manage age-appropriate food textures and turn foods into swallowable consistency, and cause chewing disorders. The solid food intake can be limited in children with CP due to chewing disorders, and mostly semi-solid or liquid foods that do not require chewing skills are preferred. This can restrict the necessary energy intake and cause malnutrition. At the same time, considering the process of preparing meals, it causes negative social interaction and a decrease in the quality of life for both the child and the family. Therefore, the nutritional status of children with CP with chewing disorder should be determined early and appropriate treatment approaches should be planned.

PDF

___

1. Bakarčić D, Lajnert V, Jokić N, Gržić R. Masticatory efficiency in children with cerebral palsy. Eur Arch Paediatr De. 2020:1-6.
2. Andrew MJ, Parr JR, Sullivan PB. Feeding difficulties in children with cerebral palsy. Archives of Disease in Childhood-Education and Practice. 2012;97(6):222-9.
3. Benfer KA, Weir KA, Bell KL, Ware RS, Davies PS, Boyd RN. Food and fluid texture consumption in a populationbased cohort of preschool children with cerebral palsy: relationship to dietary intake. Developmental Medicine & Child Neurology. 2015;57(11):1056-63.
4. Wilson EM, Hustad KC. Early feeding abilities in children with cerebral palsy: a parental report study. Journal of Medical Speech-Language Pathology. 2009:nihpa57357.
5. Del Giudice E, Staiano A, Capano G, Romano A, Florimonte L, Miele E, et al. Gastrointestinal manifestations in children with cerebral palsy. Brain and Development. 1999;21(5):307-11.
6. Weir KA, Bell KL, Caristo F, Ware RS, Davies PS, Fahey M, et al. Reported eating ability of young children with cerebral palsy: is there an association with gross motor function? Archives of Physical Medicine and Rehabilitation. 2013;94(3):495-502.
7. Reddihough DS, Collins KJ. The epidemiology and causes of cerebral palsy. Australian Journal of Physiotherapy. 2003;49(1):7-12.
8. Patel DR, Neelakantan M, Pandher K, Merrick J. Cerebral palsy in children: a clinical overview. Translational Pediatrics. 2020;9(Suppl 1):S125.
9. Serel Arslan S, Demir N, Karaduman A. Effect of a new treatment protocol called Functional Chewing Training on chewing function in children with cerebral palsy: a double-blind randomised controlled trial. Journal of Oral Rehabilitation. 2017;44(1):43-50.
10. Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing: normal and abnormal. Physical Medicine and Rehabilitation Clinics of North America. 2008;19(4):691-707.
11. Okada A, Honma M, Nomura S, Yamada Y. Oral behavior from food intake until terminal swallow. Physiology & Behavior. 2007;90(1):172-9.
12. Hiiemae KM, Palmer JB. Tongue movements in feeding and speech. Critical Reviews in Oral Biology & Medicine. 2003;14(6):413-29.
13. Mioche L, Hiiemae KM, Palmer JB. A postero-anterior videofluorographic study of the intra-oral management of food in man. Arch Oral Biol. 2002;47(4):267-80.
14. Matsuo K, Palmer JB. Coordination of mastication, swallowing and breathing. Japanese Dental Science Review. 2009;45(1):31-40.
15. Le Révérend BJ, Edelson LR, Loret C. Anatomical, functional, physiological and behavioural aspects of the development of mastication in early childhood. British Journal of Nutrition. 2014;111(3):403-14.
16. Delaney AL, Arvedson JC. Development of swallowing and feeding: prenatal through first year of life. Developmental Disabilities Research Reviews. 2008;14(2):105-17.
17. Stolovitz P, Gisel EG. Circumoral movements in response to three different food textures in children 6 months to 2 years of age. Dysphagia. 1991;6(1):17-25.
18. Green JR, Moore CA, Ruark JL, Rodda PR, Morvée WT, Vanwitzenburg MJ. Development of chewing in children from 12 to 48 months: Longitudinal study of EMG patterns. Journal of Neurophysiology. 1997;77(5):2704- 16.
19. Gisel EG. Effect of food texture on the development of chewing of children between six months and two years of age. Developmental Medicine & Child Neurology. 1991;33(1):69-79.
20. Arvedson JC, Rudolph CD. Feeding and Swallowing Issues. Pediatric Nutrition Support. 2007:149.
21. Le Révérend B, Hartmann C. Numerical modeling of human mastication, a simplistic view to design foods adapted to mastication abilities. Physiology & Behavior. 2014;124:61-4.
22. Foy T, Czyzewski D, Duggan C, Watkins J, Walker W. Chapter 42: Feeding difficulties. Nutrition in pediatrics: Basic Science & Clinical Applications. 2008:471-7.
23. Panteliadis CP, Strassburg H-M. Cerebral palsy: principles and management: Thieme Medical Publishers; 2004. 24. Erkin G, Culha C, Ozel S, Kirbiyik EG. Feeding and gastrointestinal problems in children with cerebral palsy. International Journal of Rehabilitation Research. 2010;33(3):218-24.
25. Redstone F, West JF. The importance of postural control for feeding. Pediatric Nursing. 2004;30(2):97-100.
26. Zafeiriou DI. Primitive reflexes and postural reactions in the neurodevelopmental examination. Pediatric Neurology. 2004;31(1):1-8.
27. Inal Ö, Serel Arslan S, Demir N, Tunca Yilmaz Ö, Karaduman A. Effect of functional chewing training on tongue thrust and drooling in children with cerebral palsy: a randomised controlled trial. Journal of Oral Rehabilitation. 2017;44(11):843-9.
28. Gavião MBD, Raymundo V, Sobrinho LC. Masticatory efficiency in children with primary dentition. Pediatric Dentistry. 2001;23(6):499-513.
29. Otapowicz D, Sobaniec W, Okurowska-Zawada B, Artemowicz B, Sendrowski K, Kułak W, et al. Dysphagia in children with infantile cerebral palsy. Advances in Medical Sciences. 2010;55(2):222-7.
30. Avivi-Arber L, Martin R, Lee J-C, Sessle BJ. Face sensorimotor cortex and its neuroplasticity related to orofacial sensorimotor functions. Arch Oral Biol. 2011;56(12):1440-65.
31. Laguna L, Chen J. The eating capability: Constituents and assessments. Food Quality and Preference. 2016;48:345- 58.
32. Du RY, McGrath C, Yiu CK, King NM. Health-and oral health-related quality of life among preschool children with cerebral palsy. Quality of Life Research. 2010;19(9):1367-71.
33. Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective. International Journal of Paediatric Dentistry. 2019;29(3):238-48.
34. Benfer KA, Weir KA, Bell KL, Ware RS, Davies PS, Boyd RN. Oropharyngeal dysphagia in preschool children with cerebral palsy: oral phase impairments. Research in Developmental Disabilities. 2014;35(12):3469-81.
35. Reilly S, Skuse D. Characteristics and management of feeding problems of young children with cerebral palsy. Developmental Medicine & Child Neurology. 1992;34(5):379-88.
36. Rogers B. Feeding method and health outcomes of children with cerebral palsy. The Journal of Pediatrics. 2004;145(2):S28-S32.
37. Morrow AM, Quine S, Loughlin EV, Craig JC. Different priorities: a comparison of parents’ and health professionals’ perceptions of quality of life in quadriplegic cerebral palsy. Archives of Disease in Childhood. 2008;93(2):119-25.
38. Gisel E, Patrick J. Identification of children with cerebral palsy unable to maintain a normal nutritional state. The Lancet. 1988;331(8580):283-6.
39. Grammatikopoulou MG, Daskalou E, Tsigga M. Diet, feeding practices, and anthropometry of children and adolescents with cerebral palsy and their siblings. Nutrition. 2009;25(6):620-6.
40. Arslan SS, Ilgaz F, Demir N, Karaduman AA. The effect of the inability to intake chewable food texture on growth, dietary intake and feeding behaviors of children with cerebral palsy. Journal of Developmental and Physical Disabilities. 2018;30(2):205-14.