Online first
Review paper
Published online: 2024-05-27

open access

Page views 40
Article views/downloads 35
Get Citation

Connect on Social Media

Connect on Social Media

Feeding problems and temporomandibular dysfunction in children with cerebral palsy

Roksana Malak12, Ewa Mojs3, Włodzimierz Samborski12


Children with cerebral palsy encounter many problems in everyday life. One of them is feeding difficulties. These are some crucial problems which cause feeding disfunction in children with cerebral palsy. The first problem is structural abnormalities such as abnormal muscle tone and dysfunction of the temporomandibular articulation. Non-progressive brain injury manifests in uncoordinated mandibular movements, reduced biting force and alterations in muscular tone. Main muscles which are engaged in the process of eating are: masseter, suprahyoid or temporal muscles. Another issue which may be associated with feeding problem is excessive drooling and its variable consequences. The next dysfunction refers to breathing problem, which may be the primary or secondary reason of feeding difficulties. To summarize, the therapy of feeding dysfunction should contains harmonization of muscle tone, especially tone of muscles directly connected to the temporomandibular joint and stomatognathic system, reducing sialorrhea and regulating breathing.

Article available in PDF format

View PDF Download PDF file


  1. Barton C, Bickell M, Fucile S. Pediatric oral motor feeding assessments: a systematic review. Phys Occup Ther Pediatr. 2018; 38(2): 190–209.
  2. Speyer R, Cordier R, Kim JH, et al. Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta-analyses. Dev Med Child Neurol. 2019; 61(11): 1249–1258.
  3. Bell KL, Benfer KA, Ware RS, et al. Development and validation of a screening tool for feeding/swallowing difficulties and undernutrition in children with cerebral palsy. Dev Med Child Neurol. 2019; 61(10): 1175–1181.
  4. Schwemmle C, Arens C. Feeding, eating, and swallowing disorders in infants and children: An overview [article in German]. HNO. 2018; 66(7): 515–526.
  5. Introduction — Interventions for Feeding and Nutrition in Cerebral Palsy - NCBI Bookshelf [Internet]. (3.04.2020).
  6. Erasmus CE, van Hulst K, Rotteveel JJ, et al. Clinical practice: swallowing problems in cerebral palsy. Eur J Pediatr. 2011; 171(3): 409–414.
  7. Arvedson JC. Feeding children with cerebral palsy and swallowing difficulties. Eur J Clin Nutr. 2013; 67(Suppl 2): S9–S12.
  8. Michalska A, Panasiuk J, Pogorzelska J, et al. Eating and drinking ability classification system in cerebral palsy. Child Neurol. 2017; 26(52): 63–67.
  9. Burr S, Harding S, Wren Y, et al. The relationship between feeding and non-nutritive sucking behaviours and speech sound development: a systematic review. Folia Phoniatr Logop. 2021; 73(2): 75–88.
  10. Nguyen T, Stewart D, Rosenbaum P, et al. Using the ICF in transition research and practice? Lessons from a scoping review. Res Dev Disabil. 2018; 72: 225–239.
  11. Richards CL, Malouin F. Cerebral palsy: definition, assessment and rehabilitation. Handb Clin Neurol. 2013; 111: 183–195.
  12. Ortega AOL, Guimarães AS, Ciamponi AL, et al. Frequency of temporomandibular disorder signs in individuals with cerebral palsy. J Oral Rehabil. 2008; 35(3): 191–195.
  13. Mishra A, Sheppard J, Kantarcigil C, et al. Novel mealtime duration measures: reliability and preliminary associations with clinical feeding and swallowing performance in self-feeding children with cerebral palsy. Am J Speech-Language Pathol. 2018; 27(1): 99–107.
  14. Lacerda DC, Manhães-de-Castro R, Gouveia HJ, et al. Treatment with the essential amino acid L-tryptophan reduces masticatory impairments in experimental cerebral palsy. Nutr Neurosci. 2021; 24(12): 927–939.
  15. Ertekin C, Keskin A, Kiylioglu N, et al. The effect of head and neck positions on oropharyngeal swallowing: a clinical and electrophysiologic study. Arch Phys Med Rehabil. 2001; 82(9): 1255–1260.
  16. Russo EF, Calabrò RS, Sale P, et al. Can muscle vibration be the future in the treatment of cerebral palsy-related drooling? A feasibility study. Int J Med Sci. 2019; 16(11): 1447–1452.
  17. Chang SC, Lin CK, Tung LC, et al. The association of drooling and health-related quality of life in children with cerebral palsy. Neuropsychiatr Dis Treat. 2012; 8: 599–604.
  18. Dias BL, Fernandes AR, Maia Filho Hd. Sialorrhea in children with cerebral palsy. J Pediatr (Rio J). 2016; 92(6): 549–558.
  19. Marpole R, Blackmore AM, Gibson N, et al. Evaluation and management of respiratory illness in children with cerebral palsy. Front Pediatr. 2020; 8: 333.
  20. Bennett S, Siritaratiwat W, Tanrangka N, et al. Effectiveness of the manual diaphragmatic stretching technique on respiratory function in cerebral palsy: A randomised controlled trial. Respir Med. 2021; 184: 106443.