Assessment of feeding problems in neurodevelopmental handicap: a team approach.

Many children with cerebral palsy and other neurodevelopmental disorders are unable to swallow and eat normally. ' 2 As a result they do not receive adequate nutritionl4 and they suffer from recurrent respiratory illness.' 5 6 Instead of being an enjoyable family event, meals are stressful and time consuming for the child and those caring for them. Feeding may take the parents four to six hours day, and it is punctuated by repeated spillage of food, coughing, choking, or regurgitation. For many parents of handicapped children feeding represents the major difficulty in the daily management of their child.1 2 Because of our increasing awareness of these problems, in 1989 we established a specialist clinic to assess and to give advice on severe feeding and swallowing problems in children with neurological or developmental handicap. Given the complexity of such problems it was clear that a team drawn from several paediatric disciplines was needed. The original core team consisted of a neurologist, a specialist speech therapist, a respiratory paediatrician, and a radiologist. A gastroenterologist has since joined the team. Other specialists, including clinical psychologists, surgeons, and dietitians are also involved, depending on the individual child's needs. The clinic is held in the hospital's assessment unit. Children are referred by paediatricians from throughout the region. Referral letters are reviewed by the neurologist and speech therapist, and parents are sent a letter explaining what the assessment entails. Because of the duration of the assessment we see only two or three children in each session. Each child sees all members of the team, and at the end of the session the results of the assessments, and suggestions on future management, are discussed with the family and accompanying carers (figure). We send a report of our findings and recommendations to all the professionals involved in the child's care, and a letter summarising our views is sent to the parents.