Nineteen patients with severely handicapped children were divided into 3 groups; tube-fed patients (group 1, n=8), oral-fed patients with dysphagia (group 2, n=3) and oral-fed patients (group 3, n=8). Clinical symptoms, past history, cranical CT, EEG, blink reflex and auditory brainstem response were evaluated in these patients. All patients of group 1 and 2 could not control head or sit by themselves. They needed naso-oral suction. However, nasal airway, intubation and tracheostomy were necessary only in group 1 patients. Five out of 8 patients of group 3 could control head and sit by themselves. No one needed naso-oral suction. CT revealed ventricular dilatation or prominent destructive lesions in group 1. However, patients of group 2 and 3 showed the lesions of mild to moderate degree. EEGs showed poorly developed background activities or electrical status epilepticus in group 1, while they showed relatively well-developed background activities with less prominent paroxysmal discharges in group 2 and 3. R 2 component of blink reflex was absent bilaterally in 90% patients of group 1 and 2, while unilateral R 2 at least was present in group 3.
Feeding problems in severely handicapped children were affected by combination of cerebrum and brainstem involvements. Examination of cranial CT, EEG and blink reflex was useful to determine the method of feeding.
