A unique finding of the present study was that parent report of coughing and choking during meals did not differ among children in any of the different severity groups when averaged over time. This was surprising, since we expected children in the WNL group to have few or no problems on feeding-related behavior and children in the severe group to have extensive problems. There are several possible explanations for this finding. First, there was considerable variability in parent report of choking and coughing from time to time, both within and between severity groups (see Figures 6 and 7). Because children in this study were between the ages of 4 and 7 years, choking and coughing may be a reflection of food preference and defiant behavior rather than oral-motor pathology, particularly for the children who had oral-motor skills that were judged clinically to be WNL. However, because children were separated into severity groups based on observation of oral motor and speech motor behavior, which did not include a feeding observation, it is possible that children in the WNL group experienced choking and coughing because of oral-motor impairment that was not evident clinically until the child engaged in actual feeding. Such a finding would provide support for the notion that the same structures (i.e. speech musculature) can show differential involvement depending on the specific task at hand (speech vs. feeding), and that the most valid way to assess problems with a particular function is to observe that function directly rather than making inferences regarding one behavior based on observations of another [17]. Additional research is necessary to determine whether the choking and coughing reported by parents is a reflection of impairment or a reflection of food preference behavior. Data from a control group of typically developing children without CP would help to address this question.

Results showing change over time by severity group for each of the seven variables are presented graphically in Figures 1–7. Note that the same children comprised each group at each time point. Statistical results showed that for the WNL group, only one variable, coughing, showed significant change (X² = 12.62; p = .03). For the mild-moderate group, none of the variable showed significant change over time. For the severe group, none of the variable showed significant change over time.

Results showing change over time by severity group for each of the seven variables are presented graphically in Figures 1–7. Note that the same children comprised each group at each time point. Statistical results showed that for the WNL group, only one variable, coughing, showed significant change (X² = 12.62; p = .03). For the mild-moderate group, none of the variable showed significant change over time. For the severe group, none of the variable showed significant change over time.