Feeding Dysfunction

Feeding dysfunction is a common concern of children with Schizencephaly. Children who have Schizencephaly may display difficulties with feeding and swallowing secondary due to the abnormality of the brain (one or more clefts which are filled with cerebrospinal fluid. Patients with Schizencephaly have varying degrees of feeding difficulties due to hemiparesis(weakness or paralysis affecting one side of the body),developmental delays, quadriparesis (weakness or paralysis affecting all four extremities), and reduced muscle tone (hypotonia).

 

Difficulties can range from relatively minor difficulties in coordination of oral movements causing eating to be slow and with excessive spillage, to severe in coordination of the swallowing mechanism, causing upper respiratory infections or aspiration pneumonia. Failure to thrive is another diagnosis that can coexist with schizencephaly. Children with this diagnosis often take longer than 30 minutes for their mealtimes, which take away from the nourishment absorption. Other issues related to Schizencephaly include chewing/ movement and sensory problems.

 

Low muscle tone can affect the ability to chew and orally manage food. Children with low muscle tone will benefit from therapy that will work on gaining strength with tongue mobility. These children often have food fall out of their mouth or drool.

 

Children with Schizencephaly can be over sensitive or under sensitive to touch, texture and temperature. This can lead to children refusing to try new food items, turning their head in refusal or in some cases, gagging and vomiting. For example, advancing textures from smooth purees to meltable solids (cheeto) is very difficult. Other children have the opposite problem and under react to food items near their face. They are unable to know how large of a bite they took, where it is in their mouth, or how to move it around in their mouth. Often times they will take too large of bites spit food out or swallow items whole. A child who overreacts or under-reacts to touch around the face would benefit from a feeding program that desensitizes or sensitizes him to touch in and around the mouth. If your child is oversensitive to touch, it is best to begin touching him (with your food or spoon) outside the mouth and slowly work up to touching him inside the mouth. If your child is under-responsive to touch, you will want to bombard him with input from different types of touch and texture. For example, provide spicy or cold food items, or offer a variety of dips.

 

It is best to approach feeding difficulties in a multi-disciplinary approach. Often clinics include: physicians, dietians, speech pathologists and occupational therapists. Pending on the severity and degree of the feeding issue, therapy may be suggested to aid with progression.

 

Reference: Morris, S. & Dunn-Klein, M. (1987). Prefeeding Skills: A Comprehensive Guide to Feeding. Tucson, AZ: Therapy Skills Builders.

 

Holly E. Knotowicz, M.S., CCC-SLP | Speech Language Pathologist¬†|¬†Children’s Hospital Colorado

 

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