Swallowing Muscle Ultrasonography in Children With Cerebral Palsy and Dysphagia: A Cross-Sectional Study

To determine whether the thickness of swallowing-related muscles measured by ultrasonography (US) differs according to dysphagia status in children with cerebral palsy (CP) and to identify muscle-specific associations between US measurements and swallowing symptoms.

In this cross-sectional study, 66 children with CP aged 2-18 years were evaluated at a tertiary outpatient rehabilitation clinic. B-mode US was used to measure the thickness of swallowing-related muscles. Symptom-defined dysphagia was defined as a Pediatric Eating Assessment Tool-10 (Pedi-EAT-10) score of ≥ 4. Muscle thicknesses were compared between children with and without dysphagia. Associations between individual Pedi-EAT-10 items and muscle thickness measurements were explored using Spearman correlation and univariate linear regression analyses.

Of the 66 children, 27 (40.9%) met the criteria for dysphagia. US-measured muscle thickness did not differ significantly between children with and without dysphagia for the masseter (0.66 ± 0.12 vs. 0.68 ± 0.10 cm; p = 0.520), genioglossus (0.69 ± 0.15 vs. 0.64 ± 0.13 cm; p = 0.166), geniohyoid (0.60 ± 0.14 vs. 0.64 ± 0.13 cm; p = 0.208), anterior digastric (0.50 ± 0.12 vs. 0.50 ± 0.12 cm; p = 0.887), or mylohyoid muscles (0.15 ± 0.03 vs. 0.15 ± 0.05 cm; p = 0.959). Symptom-level analyses demonstrated inverse associations between selected swallowing complaints and specific muscle measurements, with the strongest association observed between "coughs while eating" and genioglossus thickness.

Although swallowing-related muscle thickness did not differ between children with CP with and without dysphagia, US measurements were associated with specific caregiver-reported swallowing complaints. These findings suggest that US may provide complementary, symptom-oriented information in the clinical assessment of swallowing difficulties in children with CP.