Understanding What Are the Feeding Difficulties for CP?

October 23, 2025 •

3 min read

According to research, feeding difficulties occur in up to 90% of children with cerebral palsy (CP) in some populations, with the severity often linked to the level of motor impairment. Understanding what are the feeding difficulties for CP is crucial for ensuring proper nutrition, growth, and overall health for these individuals. This guide explores the diverse challenges, their underlying causes, and practical management strategies.

Quick Summary

This article details the complex feeding challenges associated with cerebral palsy, exploring issues like dysphagia, aspiration, and inadequate oral motor control. It discusses medical and behavioral factors, nutritional consequences, and the importance of multidisciplinary interventions. The content provides a structured overview of the problem, management options, and resources for affected individuals and their caregivers.

Key Points

Dysphagia is a core issue: Swallowing difficulties (dysphagia) are a major problem for many with cerebral palsy, especially in moderate to severe cases, leading to oral and pharyngeal phase complications.
Aspiration is a critical risk: The danger of food or liquid entering the lungs (aspiration) is a serious feeding difficulty that can cause recurrent respiratory infections and other pulmonary issues.
Oromotor skills are often impaired: Poor muscle control of the lips, cheeks, jaw, and tongue impairs chewing, bolus formation, and prevents adequate food intake.
Gastrointestinal issues are common: Complications like GER, chronic constipation, and motility disorders frequently accompany and exacerbate feeding challenges.
Growth and nutrition are at risk: Inadequate calorie and nutrient intake is a widespread concern, often resulting in poor weight gain, growth failure, and malnutrition.
A multidisciplinary team is necessary: Effective management requires a team of specialists including an SLP, dietitian, and OT to address the various medical, oral motor, and nutritional aspects.
Intervention strategies are diverse: Treatments range from oral motor therapy and positioning techniques to thickened liquids, modified diets, and, in severe cases, enteral (tube) feeding.

The Core Challenges: Oromotor Dysfunction and Dysphagia

Feeding difficulties in cerebral palsy stem from central nervous system damage impacting muscles used for eating and swallowing. Dysphagia, or difficulty swallowing, affects many individuals with CP across all swallowing phases.

Oral Phase Dysfunction

Challenges in the oral phase include poor lip and cheek control leading to drooling, abnormal tongue movements like thrusting, an exaggerated bite reflex, weak chewing and biting, and oral hypersensitivity.

Pharyngeal Phase Dysfunction

This involuntary phase involves moving food to the esophagus while protecting the airway. Difficulties include delayed swallow initiation, which increases the risk of aspiration (food or liquid entering the lungs). Aspiration can lead to recurrent respiratory infections and pneumonia and may be silent. Reduced pharyngeal motility can also leave food residue, raising aspiration risk.

Associated Medical and Behavioral Complications

Beyond motor issues, related medical and behavioral problems can worsen feeding difficulties for individuals with CP.

Gastrointestinal (GI) Issues

Common GI problems include Gastroesophageal Reflux (GER), chronic constipation due to factors like reduced mobility and low fiber, and abdominal pain or bloating. These issues can decrease appetite and feeding willingness.

Nutritional and Growth Concerns

Inadequate food and nutrient intake can lead to poor weight gain, growth failure (often tracked using CP-specific charts), malnutrition, dehydration, and specific nutrient deficiencies like calcium and vitamin D.

Behavioral Feeding Problems

Mealtime stress can cause food refusal, prolonged mealtimes (over 30 minutes), and tension that negatively affects the caregiver-child relationship.

Comparison of Oral vs. Enteral Feeding Interventions

Decisions on feeding methods are personalized and involve assessing risks and benefits with a medical team.


Feature	Oral Feeding Support	Enteral (Tube) Feeding
Primary Goal	Maximize safe, efficient oral intake; maintain oral motor skills for speech/pleasure	Ensure adequate, reliable calorie/hydration intake; bypass unsafe swallowing
Techniques	Positioning adjustments, thickened liquids, specialized utensils, oral motor exercises, sensory exposure	Nasogastric (NG) tube (short-term), gastrostomy (G-tube) or gastro-jejunostomy (GJ-tube) for long-term
Level of Severity	Mild to moderate oromotor dysfunction where oral intake is safe, though potentially slow	Severe dysphagia, high aspiration risk, or failure to thrive despite oral interventions
Safety Risk	Potential for aspiration, choking, dehydration, and malnutrition if not closely monitored	Potential for infection, tube complications, worsening GER, overfeeding, and social/psychosocial impact
Caregiver Effort	Can be highly demanding and stressful, with prolonged feeding times	Requires training and management of equipment, but often reduces mealtime stress
Social Impact	Allows for traditional mealtime social engagement and food exploration for pleasure	May limit social aspects of eating, but often improves quality of life by reducing mealtime stress and ensuring nourishment

A Multidisciplinary Approach is Essential

A team of specialists is needed to address the diverse feeding challenges in CP. This includes pediatricians/gastroenterologists for medical and GI management, Speech and Language Pathologists (SLPs) for oral motor and swallowing therapy, dietitians for nutritional needs and monitoring, Occupational Therapists (OTs) for positioning and adaptive equipment, and physiotherapists for postural control.

Conclusion

Feeding difficulties in CP are complex, affecting health, development, and quality of life. Challenges range from poor oral motor skills and dysphagia to GI and nutritional problems. Effective management requires a personalized, multidisciplinary approach. Strategies include oral motor therapy, dietary changes, and sometimes enteral feeding. Caregiver education and creating positive mealtimes are vital. Addressing these issues comprehensively can improve outcomes and well-being. CerebralPalsy.org is a useful resource.

Frequently Asked Questions

Dysphagia, or difficulty swallowing, is one of the most common and significant feeding problems experienced by individuals with cerebral palsy. It can affect all stages of the swallowing process, from preparing food in the mouth to moving it safely down the throat.

Signs of a swallowing problem can include coughing, choking, or gagging during meals, a wet or gurgly voice after eating or drinking, spitting out food, resistance to feeding, very long mealtimes, and a history of recurrent chest infections.

Aspiration occurs when food or liquid accidentally enters the lungs instead of the stomach. For people with CP and dysphagia, this is a significant risk that can lead to serious and repeated respiratory infections, including pneumonia.

Yes, proper positioning is a fundamental strategy for managing feeding difficulties. Maintaining a stable, upright posture with the head in a slightly tucked position can improve oral control and promote a safer swallow.

A feeding tube (enteral feeding) is recommended in cases of severe dysphagia, high risk of aspiration, or when oral feeding is insufficient to maintain adequate nutrition and growth. It ensures the person receives the necessary calories and hydration reliably.

A speech-language pathologist (SLP) assesses and treats feeding and swallowing disorders (dysphagia). They develop strategies to improve oral motor skills, address sensory issues related to food, and ensure safe and effective swallowing.

Caregivers can make mealtimes less stressful by creating a calm environment, allowing ample time for feeding, providing food choices when possible, using adapted utensils, and focusing on positive interactions rather than pressure to finish a meal.