Mini-symposium Feeding problems in children with cerebral palsy S. Reilly ‘The feeding process from bolus gathering in the mouth to transport through the pharynx and oesophagus, involves several different anatomic and physiological systems of the body which may become involved in a wide spectrum of functional or organic abnormalities. Although the structures relating to swallowing are located at the intersec- tion of various medical disciplines, they have not been adequately addressed by any of them.” This quotation accurately summarises the current state of paediatric feeding in the UK. Despite the fact that feeding problems are relatively common in young children, the subject has been a neglected aspect of paediatric care. In 1989 Martin Bax’ wrote an editorial entitled ‘Eating is important’. He asked why ‘feeding’, in particular how to get food into young children, had received such scant attention in the paediatric literature. One reason he suggested which might account for this apparent neglect was that the topic was adequately covered in general child-care books and was therefore not seen as a ‘respectable’ one worthy of much attention in paediatric textbooks. As a result serious feeding difficulties which ultimately affect the health and well being of young children frequently go undetected and in the long term may be associated with a significant degree of morbidity and mortality. The consequences of feeding difficulties for both individuals with CP and their caretakers are wide- spread: the child’s physical growth, well being, and general development may suffer. Overt feeding diffi- culties may also affect the parent-child relationship which in turn may have consequences for the quality of care a child is receiving. This paper will focus on the specific feeding difficulties that occur in young S. Reilly, Research Speech Therapist, Behavioural Sciences Unit, Institute of Child Health, 30 Guilford Street, London WClN 1EH. Correspondence and requests for offprints to SR. children with cerebral palsy and review the problem from three perspectives: l the child l the caretaker l the professionals. The child Purpose of eating Whilst the main purpose of eating is to achieve an adequate intake of food in order to sustain growth, the process of eating is not just one of sustaining life: in human societies it is a social event. Infants undergo their earliest communication experiences during feeding. Their responses to events surrounding feeding are expressed through physiologic and/or motoric behaviours. Feeding is a highly communicat- ive and interactive experience for the child and the caretaker. Prevalence of d@culties Approximately 40-50% of children with cerebral palsy are thought to have feeding problems. In specific types of CP such as spastic quadriplegia the prevalence is thought to be as high as 85%.3 It is clear that the feeding problems of infancy and early childhood do not disappear; a survey of young disabled adults showed that 56% of the sample had major feeding problems.4 Causes and symptoms Feeding problems occur in children with CP for many reasons (Table 1) . Communication difficulties are rarely considered as a cause, yet a significant proportion of severely disabled children have limited means of expressing themselves. To compensate for Current Paediazrics (1993) 3, 209-213 0 1993 Longman Group UK Ltd 209