Feeding and Swallowing Problems in Brain Damage Motory Handicapped ( BDMH) Children

Abstract

BDMH children take up to IS times longer than neurologically intact children of the same weight to eat a mouthful of food. Mothers of children with BDMH report spending up to 7 hours a day feeding them. Problems in feeding may be due to movement or sensory problems. Movement problems such as jaw control, tongue, lip and cheek mobility can usually be traced back to problems with either too much or too little muscle tone. Children with BDMH may also be overly sensitive to touch in and around the face and mouth (oral tactile defensiveness) due to inadequate sensory awareness around the mouth. They may react to touch around the mouth by betting down, tuning away, and refusing to open their mouths or by remitting. Introduction of different textures into a child's diet may become a problem if there are sensory problems. They may not tolerate solid foods or hot/cold foods due to a sensory problem. Children with BDMH may also under react to stimulus around the mouth. Any child may dislike a particular food but these children can find feeding unpleasant or even terrifying. The sight or smell of food being prepared may cause extensor spasms before feeding begins. It can be difficult to know whether tongue protrusion, turning the head away, excessive food loss, gagging, choking or coughing is reflexive or the expression of aversive behavior. Children with BDMH often retain the primitive reflexes for months or years longer than normal. When these reflexes persist in the face or mouth, children with BDMH cim have trouble in chewing, sucking or swallowing.