title: Food and fluid texture consumption in a population-based cohort of preschool children with cerebral palsy: relationship to dietary intake.
abstract: OBJECTIVE
  To determine the texture constitution of children's diets and its relationship to oropharyngeal dysphagia (OPD), dietary intake, and gross motor function in young children with cerebral palsy (CP).
  
  
  METHODS
  A cross-sectional, population-based cohort study comprising 99 young children with CP (65 males, 35 females) aged 18 to 36 months (mean age 27mo; Gross Motor Function Classification System [GMFCS] level I, n=45; II, n=13; III, n=14; IV, n=10; V, n=17). CP subtypes were classified as spastic unilateral (n=35), spastic bilateral (n=49), dyskinetic (n=5), and other (n=10), in accordance with the criteria of the Surveillance of Cerebral Palsy in Europe. Habitual dietary intake of food textures, energy, and water were determined from parent-completed 3-day weighed food records. Parent-reported feeding ability of food textures was reported on the Pediatric Evaluation of Disability Inventory and a feeding questionnaire. OPD was classified based on clinical feeding assessment using the Dysphagia Disorders Survey (rated by a certified assessor, KAB) and a subjective Swallowing Safety Recommendation (classified by a paediatric speech pathologist, KAB).
  
  
  RESULTS
  Food/fluid textures were modified for 39% of children. Children with poorer gross motor function tended to receive a greater proportion of energy from fluids (GMFCS levels IV-V: β=0.9, p=0.002) in their diets and fewer chewable foods (level III: β=-0.7, p=0.03; levels IV-V: β=-1.8, p<0.001) compared to level I to II participants. Fluids represented a texture for which children frequently had OPD and the texture most frequently identified as unsafe (or recommended for instrumental assessment).
  
  
  CONCLUSIONS
  These findings indicate that swallowing safety, feeding efficiency, and energy/water intake should be considered when providing feeding recommendations for children with CP.
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, The School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Benfer
authors.affiliation: Speech Pathology Department, Royal Children's Hospital, Brisbane, Qld, Australia.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Weir
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, The School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: Kristie L
authors.initials: KL
authors.lastname: Bell
authors.affiliation: Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia.|School of Population Health, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Ware
authors.affiliation: Children's Nutrition Research Centre, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: Peter S W
authors.initials: PS
authors.lastname: Davies
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, The School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: Roslyn N
authors.initials: RN
authors.lastname: Boyd
mesh_terms: D002547:Cerebral Palsy / Q000453:epidemiology* / Q000503:physiopathology*; D002675:Child, Preschool; D015331:Cohort Studies; D018672:Community Health Planning; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D004032:Diet; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009043:Motor Activity; D010290:Parents / Q000523:psychology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires