This blog post provides a recap of a My CP Guide webinar on the topic of dysphagia with Dr Amanda Khamis
Eating and drinking are everyday experiences that many people take for granted. But for people with cerebral palsy, these tasks can be complex, challenging, and sometimes risky. In a Mycpguide webinar, speech pathologist and researcher Dr Amanda Khamis shares insights into dysphagia—difficulty with eating, drinking, and swallowing—and explains what can go wrong, how to spot the signs, and practical ways to support safer and more enjoyable mealtimes across the lifespan.
“Swallowing is incredibly complex,” Dr Khamis says. “It requires perfect coordination of 31 pairs of muscles and six cranial nerves. Because people with cerebral palsy often have difficulty controlling their muscles, it’s not surprising that dysphagia is so common.”
She explains that between 30% and 100% of children with cerebral palsy experience dysphagia, depending on the severity of their condition, and similar rates apply for adults. This can lead to malnutrition, developmental delays, social withdrawal, and serious health risks like aspiration pneumonia. “Aspiration pneumonia is actually the second most common cause of death for people with cerebral palsy,” she notes.
The signs of dysphagia aren’t always obvious. “Coughing is the sign we most look for—but the majority of children with cerebral palsy don’t cough when they aspirate,” Dr Khamis explains. Other red flags include wet or gurgly voice, wheezing, watery eyes, fatigue during meals, and food residue left in the mouth long after eating.
Rather than relying only on compensatory strategies like thickeners and modified diets, Dr Khamis advocates for direct skill-building approaches where possible. “The best treatment for swallowing is swallowing,” she says. “Just like learning to play the piano, you need to practise the real task. Swallowing practice with real food, when it’s safe, is the best way to improve.”
She encourages families to work closely with speech pathologists to set up the right positioning and environment for meals. “If you’re uncomfortable, your body’s in extension and you’re struggling to stay stable, it’s so much harder to focus on what’s happening in your mouth and throat,” she says. “We aim for a 90–90–90 position—hips, knees, and ankles all at right angles—and feet supported. Comfort supports safety.”
Dr Khamis also emphasises that feeding tubes, when required, don’t mean a person must miss out on social or oral eating experiences. “Most of the time, even with a feeding tube, people can continue to work on eating skills and be part of mealtimes,” she says. “It’s not an either-or.”
One of her key messages is about the importance of recognising informed risk. “People have the right to choose what they eat and drink, even if it involves some risk,” she says. “It’s about informed decisions and being supported to live the life you choose.”
For anyone supporting a person with cerebral palsy, this webinar provides a valuable and practical overview. From understanding red flags to setting up for safer meals, Dr Khamis shares advice that blends clinical knowledge with compassion.