Clinical Relevance of the Eating and Drinking Ability Classification System in Young Children with Cerebral Palsy: Associations with Child and Family Outcomes Relevant to Rehabilitation

BACKGROUND: The Eating and Drinking Ability Classification System (EDACS) is a validated functional classification system for assessing feeding ability in individuals with cerebral palsy (CP). Its clinical relevance in relation to broader child and family outcomes has received limited attention, particularly in young children. This study evaluated associations between EDACS and motor function, communication ability, nutritional status, behavioral profile and caregiver quality of life in young children with CP. METHODS: This cross-sectional study included 100 children aged 18-60 months with CP attending a tertiary Child Development Center in North India. Of these, 49 (49%) were aged 18-35 months and 51 (51%) were aged 36-60 months; 49 (49%) were classified as GMFCS Levels IV-V. Feeding ability was classified using age-appropriate EDACS descriptors. Gross motor function and communication were assessed using GMFCS and CFCS, respectively. Nutritional status was assessed using weight-for-length/height Z scores, mid-upper arm circumference and clinical pallor. Behavioral problems and caregiver quality of life were evaluated using the Child Behavior Checklist and WHOQOL-BREF, respectively. Associations were assessed using Kruskal-Wallis and Fisher's exact tests, Spearman's rank correlation, cumulative ordinal logistic regression and linear regression. RESULTS: < .001). Higher EDACS levels were also associated with poorer caregiver quality of life in the physical, social and environmental domains. On multivariable analysis, communication and gross motor function remained associated with feeding severity after adjustment for MUAC. CONCLUSION: EDACS demonstrated associations with motor function, communication ability, nutritional status and caregiver quality of life, suggesting that feeding severity co-occurs with impairments across multiple child and caregiver domains. EDACS may provide clinically relevant information alongside existing functional classifications and help inform multidisciplinary assessment and planning, particularly in resource-constrained settings. Prospective studies are warranted to evaluate its role in rehabilitation planning and longitudinal outcomes.