Article

AIM: To determine the most accurate parent-reported indicators for detecting (1)
feeding/swallowing difficulties and (2) undernutrition in preschool-aged children
with cerebral palsy (CP). METHOD: This was a longitudinal, population-based
study, involving 179 children with CP, aged 18 to 60 months (mean 34.1mo [SD
11.9] at entry, 111 males, 68 females [Gross Motor Function Classification System
level I, 84; II, 23; III, 28; IV, 18; V, 26], 423 data points).
Feeding/swallowing difficulties were determined by the Dysphagia Disorders Survey
and 16 signs suggestive of pharyngeal phase impairment. Undernutrition was
indicated by height-weight and skinfold composite z-scores less than -2. Primary
parent-reported indicators included mealtime duration, mealtime stress, concern
about growth, and respiratory problems. Other indicators were derived from a
parent feeding questionnaire, including 'significant difficulty eating and
drinking'. Data were analysed using multilevel mixed-effects regression and
diagnostic statistics. RESULTS: Primary parent-reported indicators associated
with feeding/swallowing were 'moderate-severe parent stress' (odds ratio [OR]=3.2
[95% confidence interval {CI} 1.3-7.8]; p<0.01), 'moderate-severe concern
regarding growth' (OR=4.5 [95% CI 1.7-11.9]; p<0.01), and 'any respiratory
condition' (OR=1.8 [95% CI 1.4-5.8]; p<0.01). The indicator associated with
undernutrition was 'moderate-severe concern regarding growth' (height-weight
OR=13.5 [95% CI 3.0-61.3]; p<0.01; skinfold OR=19.1 [95% CI 3.7-98.9]; p<0.01).
'Significant difficulty eating and drinking' was most sensitive/specific for
feeding outcome (sensitivity=58.6%, specificity=100.0%), and 'parent concern
regarding growth' for undernutrition (sensitivity=77.8%, specificity=77.0%).
INTERPRETATION: Parent-reported indicators are feasible for detecting feeding and
swallowing difficulties and undernutrition in children with CP, but need formal
validation. WHAT THIS PAPER ADDS: Parent-reported indicators can detect
feeding/swallowing difficulties and undernutrition in children with cerebral
palsy. Most accurate screening questions were 0-10 scales for 'difficulty eating'
and 'difficulty drinking'. Supplementation of these scales with additional
indicators would improve detection.
CI - (c) 2017 Mac Keith Press.

Langue : ANGLAIS