Development and validation of a screening tool for feeding/swallowing difficulties and undernutrition in children with cerebral palsy.
Kristie L Bell, Katherine A Benfer, Robert S Ware and 6 others
PMID 30937885WHAT IT FOUND
A four-question parent questionnaire identified 48% of children with cerebral palsy at risk for feeding issues or undernutrition.
It caught all severe cases. Use these questions to decide who needs a full speech pathology or dietetic assessment.
Key findings
01A final screening tool consisting of four questions identified 48% of children as being at risk of feeding/swallowing difficulties and undernutrition requiring further assessment.
02The tool demonstrated 81% sensitivity and 79% specificity for feeding safety issues (EDACS) and 72% sensitivity and 75% specificity for undernutrition (SGNA).
03The screening tool successfully identified 100% of children with severe undernutrition and 100% of children classified as EDACS level IV or V.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study did not reach its recruitment target of 100 children, analyzing 89 instead. The sample excluded children with feeding tubes and those who were acutely unwell or hospitalized, so the tool's performance in those groups is unknown. The validation was conducted in an outpatient setting with a high prevalence of chronic undernutrition, which may not reflect other clinical populations. The reference standard for nutrition (SGNA) relies on clinical judgment and is not an objective laboratory measurement. The tool was not tested against a gold-standard instrumental assessment for all participants; only 6 children underwent a videofluoroscopic swallow study (VFSS).
Declared interests
The study was supported by Non-U.S. Government funding. The text does not report any specific financial conflicts of interest or industry sponsorship.
The easy way to misread this
Do not use this tool to diagnose aspiration or undernutrition. It is a screening instrument to identify who needs a formal assessment. A low score does not rule out problems in children with feeding tubes or acute illness, as these groups were excluded from the study.