Background:
Stroke is becoming increasingly recognized in children and is among the top 10 causes of mortality and lifelong morbidity. Perinatal stroke is the leading cause of hemiplegic cerebral palsy (HCP). Children with stroke and cerebral palsy often have dysphagia (feeding and swallowing problems); however, little is known about their incidence. A systematic review was conducted to determine the reported frequency of dysphagia, dysphagia-related health outcomes, and caregiver burden in children diagnosed with stroke or HCP. 

Methods:
Six electronic databases were searched to November 2017 and a manual search of eight relevant journals was conducted. Two blinded raters assessed abstracts and full articles for eligibility. Discrepancies were resolved by consensus. Reasons for exclusion included pre-term infants (<36wks), adults (>18yrs), and few eligible patients (n<10). Accepted articles were evaluated for quality using Cochrane’s risk of bias. Data was extracted and analyzed descriptively. 

Results: 
Of 1660 abstracts, five studies met inclusion criteria, of which three included patients with stroke and two HCP. Across studies, operational definitions of feeding and swallowing varied. Insufficient details were provided on assessment methods and timing. Thus, reported frequencies of dysphagia ranged from 24.0 to 88.6%. Only one study clearly separated feeding and swallowing impairment, with a combined frequency of 48.8%. Only one study reported dysphagia-related health outcomes and none reported caregiver burden. 

Discussion: 
These results suggest that dysphagia is common in pediatric patients with stroke and HCP; however, accurate frequency estimates remain unknown. Also unknown is its impact on health and caregivers. Therefore, there is a need for more high-level evidence.

DYSPHAGIA FOLLOWING STROKE OR HEMIPLEGIC CEREBRAL PALSY IN CHILDREN: A SYSTEMATIC REVIEW