Snowdrop

Breathing is something we all take for granted because it is an automatic function, to which we do not have to pay attention. Only when something interferes with the smooth function of our respiration, such as exercising, or an adverse reaction to an allergen, or if we develop a respiratory disorder do we become all too aware of it!

Many children who have cerebral palsy, have difficulties with their breathing. Not many people are aware that the rate and depth of our breathing is subject to the forces of development and that consequently the rate and depth of a babies breathing is simply not comparable to that of an adult. For instance, the breathing rate of a newborn baby is around 40 breaths per minute, but by the time the child reaches his first birthday, this has dropped to around 35. By his second birthday the average rate has dropped to 30 and by the time he is 5 years old, it has dropped to around 25. We then see a slower decline and by the time he is 12 years old it has dropped to around 20, until finally it reaches its adult rate of around 15.

What implications does this have for a child with cerebral palsy? Well, the brain injury which adversely affects the development of the child in other areas, can also affect the development of the rate of respiration and this can have negative effects. If a child is growing physically, but his rate of respiration remains stuck at the level of a baby at around 40 shallow breaths per minute, it will create obvious consequences for the ability of that child in terms of his eating, drinking and the development of spoken language. (To test this out, try running up and down stairs until you are out of breath and then try to eat a biscuit or cake or try reciting your favourite poem. – Its difficult isn’t it)? This is the situation many of our children are faced with constantly. – Imagine the nightmare of trying to coordinate chewing, swallowing and breathing at such a rate!

Another factor which can be a worry as the child’s growing musculature demands more oxygen from a system which simply cannot provide it, is the creation of a poor physiological environment for the brain. The brain uses up 25% of all the oxygen we take in and as it develops, it not only demands more oxygen from a respiratory system which cannot deliver it, - with the consequences of brain development being slowed, but the increasing demands being made from a growing physical body provide stiff competition for the limited oxygen which is available. This can not only have the effects of limiting physical and neurological development, but can cause a child to have seizures.

So what can be done about this situation? The obvious answer seems to be the direct delivery of Oxygen, such as is seen in hyperbaric oxygen chambers, but this in turn throws up additional problems. There are sensors in the base of the brain, which are sensitive to the levels of oxygen and carbon dioxide in the bloodstream. They help regulate the rate of delivery of oxygen to the brain by widening and narrowing the arteries as is necessary. When they detect higher than normal levels of oxygen in the bloodstream, they act to constrict the arteries so that the brain is not flooded with oxygen. So in directly delivering extra oxygen, we may actually be depriving the brain of it! In the more extreme cases this has led to people experiencing a form of stroke known as an ischaemic attack!

So what do we do? At Snowdrop I find that when a child embarks on a programme of neurological rehabilitation and when we begin to make progress in developmental terms, very often the respiration makes improvements too.