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Naidoo L, Pillay M, Naidoo U. Who really decides? Feeding decisions 'made' by caregivers of children with cerebral palsy. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2024; 71:e1-e14. [PMID: 38572900 PMCID: PMC11019338 DOI: 10.4102/sajcd.v71i1.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND There are no definitive guidelines for clinical decisions for children with cerebral palsy (CP) requiring enteral feeds. Traditionally, medical doctors made enteral feeding decisions, while patients were essentially treated passively within a paternalistic 'doctor knows best' approach. Although a more collaborative approach to decision-making has been promoted globally as the favoured model among healthcare professionals, little is known about how these decisions are currently made practically. OBJECTIVES This study aimed to identify the significant individuals, factors and views involved in the enteral feeding decision-making process for caregivers of children with CP within the South African public healthcare sector. METHOD A single-case research design was used in this qualitative explorative study. Data were collected using semi-structured interviews and analysed using reflexive thematic analysis. RESULTS Four primary individuals were identified by the caregivers in the decision-making process: doctors, speech therapists, caregivers' families and God. Four factors were identified as extrinsically motivating: (1) physiological factors, (2) nutritional factors, (3) financial factors and (4) environmental factors. Two views were identified as intrinsically motivating: personal beliefs regarding enteral feeding tubes, and feelings of fear and isolation. CONCLUSION Enteral feeding decision-making within the South African public healthcare sector is currently still dominated by a paternalistic approach, endorsed by a lack of caregiver knowledge, distinct patient-healthcare provider power imbalances and prescriptive multidisciplinary healthcare dialogues.Contribution: This study has implications for clinical practice, curriculum development at higher education training facilities, and institutional policy changes and development, thereby contributing to the current knowledge and clinical gap(s) in the area.
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Affiliation(s)
- Lavanya Naidoo
- Discipline of Speech-Language Therapy, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and Department of Speech Language Pathology, Faculty of Humanities, University of the Witwatersrand, Johannesburg.
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Zambelli L, Aumar M, Ley D, Antoine M, Coopman S, Morcel J, Bequet E, Guimber D, Cailliau E, Peretti N, Gottrand F. Home enteral nutrition does not decrease oral feeding in children during the first year of nutritional support. Clin Nutr 2024; 43:781-786. [PMID: 38340410 DOI: 10.1016/j.clnu.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Enteral nutrition is necessary when nutritional status is poor and oral intake is insufficient or impossible. Although it has been suspected to reduce spontaneous oral feeding, no study has formally assessed the influence of enteral nutrition on pediatric oral intake. The present study aimed to evaluate variation in oral feeding intake after enteral nutrition initiation, and to identify factors influencing oral feeding. METHODS This retrospective cohort study included 149 pediatric patients from two French tertiary care hospitals, who received home enteral nutrition from 2009 to 2022. The patients were aged 2 months to 17 years (median age 3 years, interquartile range 1.3-9.2). Oral and enteral intakes were assessed when enteral nutrition was initiated (M0), and again at M3 (n = 123), M6 (n = 129), and M12 (n = 134) follow-ups, based on dieticians' and home services' reports. Oral feeding and body mass index z score variations during follow-ups were evaluated using a linear mixed regression model, including "time" as a fixed effect and "patient" as a random effect. Factors associated with oral feeding changes were assessed using a model interaction term. RESULTS Oral intake did not vary significantly (P = 0.99) over time and accounted for 47.4% ± 27.4%, 46.9% ± 27.4%, 48.4% ± 28.2%, and 46.6% ± 26.9% of the ideal recommended daily allowance (calculated for the ideal weight for height) at M0, M3, M6, and M12, respectively. Delivery method (nasogastric tube versus gastrostomy), prematurity, underlying disease, history of intrauterine growth retardation, and speech therapy intervention did not influence oral intake. Administration (i.e., exclusively continuous nocturnal infusion versus daytime bolus) led to different oral intake development, although oral intake also differed at M0. CONCLUSIONS Enteral nutrition, although increasing total energy intake, does not alter oral feeding during the first year of administration. Only the mode of administration might influence oral intake.
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Affiliation(s)
- L Zambelli
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France; Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Liège University Hospital, Liège, Belgium.
| | - M Aumar
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - D Ley
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - M Antoine
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - S Coopman
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - J Morcel
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - E Bequet
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Liège University Hospital, Liège, Belgium.
| | - D Guimber
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
| | - E Cailliau
- Biostatistics Department, CHU Lille, F-59000 Lille, France.
| | - N Peretti
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Hospices Civils de Lyon, Lyon, France.
| | - F Gottrand
- Univ. Lille, Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Inserm U1286 INFINITE, Lille, France.
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3
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Dickinson KM, Smith BM, Green DM, Nasr S, Sawicki GS, Schechter MS, Riekert KA. An emotional journey: caregiver experiences with gastrostomy tube decision-making for children with cystic fibrosis. J Cyst Fibros 2024:S1569-1993(24)00006-7. [PMID: 38320875 DOI: 10.1016/j.jcf.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/19/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Nutritional challenges are common in early CF care and stressful for caregivers of children with CF (cwCF) to navigate. Gastrostomy tube (G-tube) placement can improve weight gain, however the decision to proceed with placement is personalized and preference-sensitive. Little is known about the experiences of caregivers of cwCF and the G-tube decision-making process. OBJECTIVES The present study used a qualitative approach to explore the perceptions and experiences of caregivers of cwCF with G-tube introductions and recommendations, as well as factors influencing G-tube decision-making. METHODS Caregivers of cwCF aged ≤ 10 years completed audio-taped, semi-structured interviews describing their experiences with G-tube placement discussions. Interviews were transcribed and two independent researchers coded the transcripts and conducted content and thematic analysis using an inductive approach. RESULTS Participants included 43 caregivers, 84 % were mothers (36/43). CwCF had a mean age of 4 years (SD=2.6), 84 % were White (36/43), and 60 % reported weights below <50th percentile (26/43). All caregivers knew about G-tubes, 44 % (19/43) were recommended a G-tube and 35 % (15/43) had a G-tube placed. Major findings included descriptions of the stages of G-tube decision-making from a heads up, to the game plan, to making a first difficult decision and finally living with the decision to pursue G-tube placement. CONCLUSION G-tube decision-making is an emotional and personalized journey for caregivers of cwCF. Efforts to explore the values and priorities of caregivers is imperative to supporting families making difficult decisions in CF care.
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Affiliation(s)
- Kimberly M Dickinson
- Department of Pediatrics, Division of Pulmonary, Allergy/Immunology, Cystic Fibrosis and Sleep, Emory University, Atlanta, GA, USA.
| | - Brandon M Smith
- Department of Pediatrics, Division of General Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Deanna M Green
- Department of Pediatrics, Division of Pediatric Pulmonology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Samya Nasr
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, MI, USA
| | - Gregory S Sawicki
- Department of Pediatrics, Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Michael S Schechter
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Virginia Commonwealth University, Richmond VA, USA
| | - Kristin A Riekert
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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Pagnamenta E, Longhurst L, Breaks A, Chadd K, Kulkarni A, Bryant V, Tier K, Rogers V, Bangera S, Wallinger J, Leslie P, Palmer R, Joffe V. Research priorities to improve the health of children and adults with dysphagia: a National Institute of Health Research and Royal College of Speech and Language Therapists research priority setting partnership. BMJ Open 2022; 12:e049459. [PMID: 35078835 PMCID: PMC8796217 DOI: 10.1136/bmjopen-2021-049459] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To conduct the first UK-wide research priority setting project informing researchers and funders of critical knowledge gaps requiring investigation to improve the health and well-being of patients with eating, drinking and swallowing disorders (dysphagia) and their carers. DESIGN A priority setting partnership between the National Institute of Health Research (NIHR) and the Royal College of Speech and Language Therapists using a modified nominal group technique. A steering group and NIHR representatives oversaw four project phases: (1) survey gathering research suggestions, (2) verification and aggregation of suggestions with systematic review research recommendations, (3) multistakeholder workshop to develop research questions, (4) interim priority setting via an online ranking survey and (5) final priority setting. SETTING UK health services and community. PARTICIPANTS Patients with dysphagia, carers and professionals who work with children and adults with dysphagia from the UK. RESULTS One hundred and fifty-six speech and language therapists submitted 332 research suggestions related to dysphagia. These were mapped to 88 research recommendations from systematic reviews to form 24 'uncertainty topics' (knowledge gaps that are answerable by research). Four patients, 1 carer and 30 healthcare professionals collaboratively produced 77 research questions in relation to these topics. Thereafter, 387 patients, carers and professionals with experience of dysphagia prioritised 10 research questions using an interim prioritisation survey. Votes and feedback for each question were collated and reviewed by the steering and dysphagia reference groups. Nine further questions were added to the long-list and top 10 lists of priority questions were agreed. CONCLUSION Three top 10 lists of topics grouped as adults, neonates and children, and all ages, and a further long list of questions were identified by patients, carers and healthcare professionals as research priorities to improve the lives of those with dysphagia.
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Affiliation(s)
- Emma Pagnamenta
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Lauren Longhurst
- Child and Adolescent Mental Health Service, Whittington Health NHS Trust, London, UK
| | - Anne Breaks
- Acute Speech and Language Therapy Service, Evelina London Children's Hospital, London, UK
| | - Katie Chadd
- Research and Outcomes, Royal College of Speech and Language Therapists, London, UK
| | - Amit Kulkarni
- Research and Outcomes, Royal College of Speech and Language Therapists, London, UK
| | | | - Kathy Tier
- NIHR Evaluation, Trials and Studies Coordinating Centre, National Institute for Health Research, London, UK
| | | | - Sai Bangera
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Josephine Wallinger
- Division of Language and Communication Science, City University of London, London, UK
| | - Paula Leslie
- Center for Bioethics & Health Law, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca Palmer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Victoria Joffe
- School of Health and Social Care, University of Essex, Colchester, UK
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Taylor C, Kong AC, Foster J, Badawi N, Novak I. Caregivers' Feeding Experiences and Support of Their Child with Cerebral Palsy. JOURNAL OF CHILD AND FAMILY STUDIES 2021; 31:819-830. [PMID: 34629833 PMCID: PMC8489792 DOI: 10.1007/s10826-021-02123-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 06/13/2023]
Abstract
Feeding difficulties are often reported in children with cerebral palsy (CP) and are associated with caregiver stress. This study explored the feeding experiences and support of caregivers with children who have CP. A qualitative approach was used where semi-structured telephone interviews were conducted and audio recorded. Thematic analysis was used to code and analyse the transcribed interview data from the eleven mothers that participated. Four major themes were identified from the data: Child-centred world, Making decisions, Knowing their child, and Seeking and receiving support. Caregivers knew their child's unique needs and made daily decisions around feeding based upon the child's feedback and changing condition. Family support was viewed as important, although the caregivers still reported feeling stressed. Health professional support varied from "amazing" to "frustrating", which contributed to the caregivers' stress. However, no single support strategy was appropriate as their needs or preferences varied. It is recommended that health professionals take an individualised partnership approach with caregivers and their child, with particular attention to those caregivers who lack a friend or family support and those who are physically isolated.
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Affiliation(s)
- Christine Taylor
- School of Nursing and Midwifery, Western Sydney University, Building EB.LG, Parramatta South Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Ariana C. Kong
- Centre for Oral Health Outcomes & Research Translation (COHORT), School of Nursing & Midwifery, Western Sydney University, South-Western Sydney Local Health District, Ingham Institute Applied Medical Research, Level 3, Ingham Institute, Locked Bag 7103, Liverpool, BC NSW 1871 Australia
| | - Jann Foster
- School of Nursing and Midwifery, Western Sydney University, Building EB.LG, Parramatta South Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, The University of Sydney, Westmead campus, Hawkesbury Road, Westmead, NSW 2145 Australia
- The Grace Centre for Newborn Intensive Care, The Children’s Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, The University of Sydney, Westmead campus, Hawkesbury Road, Westmead, NSW 2145 Australia
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Suluhan D, Yildiz D, Surer I, Fidanci Eren B, Balamtekin N. Effect of Gastrostomy Tube Feeding Education on Parents of Children with Gastrostomy. Nutr Clin Pract 2020; 36:1220-1229. [DOI: 10.1002/ncp.10586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Derya Suluhan
- Gulhane Faculty of Nursing Department of Pediatric Nursing, University of Health Sciences Turkey Ankara Turkey
| | - Dilek Yildiz
- Gulhane Faculty of Nursing Department of Pediatric Nursing, University of Health Sciences Turkey Ankara Turkey
| | - Ilhami Surer
- Department of Pediatric Surgery Gulhane Research and Training Hospital Ankara Turkey
| | - Berna Fidanci Eren
- Gulhane Faculty of Nursing Department of Pediatric Nursing, University of Health Sciences Turkey Ankara Turkey
| | - Necati Balamtekin
- Department of Pediatric Gastroenterology Gulhane Research and Training Hospital Ankara Turkey
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Glasson EJ, Forbes D, Ravikumara M, Nagarajan L, Wilson A, Jacoby P, Wong K, Leonard H, Downs J. Gastrostomy and quality of life in children with intellectual disability: a qualitative study. Arch Dis Child 2020; 105:969-974. [PMID: 32269039 DOI: 10.1136/archdischild-2020-318796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Children with intellectual disability and marked feeding difficulties may undergo gastrostomy insertion to assist with their nutritional and medication needs. Use has increased recently for younger children, and it is intended to provide long-term support. This study explored the perceived value of gastrostomy for the quality of life (QOL) of children with intellectual disabilities and their families. METHODS Twenty-one primary caregivers of children with intellectual disability aged 2-18 years participated in semistructured telephone interviews. Data were analysed using directed content analysis, and data were coded to existing QOL domains relevant to children with intellectual disability and their families. RESULTS Benefits in each of the child and family QOL domains were represented in the interview data. For children, the impacts of gastrostomy for the physical health domain were predominant, supplemented by experiences of value for emotional well-being, social interactions, leisure activities and independence. For families, gastrostomy was integrated into multiple aspects of QOL relating to family interactions, parenting, resources and supports, health and safety, and advocacy support for disability. Shortcomings related to difficulties with equipment and complications. CONCLUSIONS Our comprehensive overview of the value of gastrostomy for children with intellectual disability and their families was classified within a QOL framework. Gastrostomy was mainly supportive over long time periods across many QOL domains. Findings will be of use to patient counselling and education and the development of family support resources.
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Affiliation(s)
- Emma J Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia
| | - David Forbes
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Madhur Ravikumara
- Department of Gastroenterology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Lakshmi Nagarajan
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia.,Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Paediatrics, The University of Western Australia, Perth, Australia, Perth, Western Australia, Australia
| | - Andrew Wilson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia.,School of Paediatrics, The University of Western Australia, Perth, Australia, Perth, Western Australia, Australia.,Department of Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Peter Jacoby
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia
| | - Helen Leonard
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia
| | - Jenny Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia .,School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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8
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Beyond Picky Eating. J Dev Behav Pediatr 2020; 41:656-658. [PMID: 32826694 DOI: 10.1097/dbp.0000000000000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Joseph is a 20-month-old boy who was thriving and developing well before a 4-day hospitalization for paralytic ileus at 11 months of age. Joseph is the first child born to parents who immigrated to the United States from Southeast Asia 3 years ago. Before the hospitalization, Joseph consumed 3 meals and 480 to 600 mL of milk daily. Oral feedings were restricted during the hospitalization with subsequent rejection of foods upon reintroduction of oral feeds. This resulted in 2 kg of weight loss by follow-up at 13 months. Joseph was referred to the multidisciplinary feeding and nutrition clinic at 16 months for failure to thrive, complicated by iron deficiency anemia and zinc deficiency. Joseph's feeding issues had negatively affected other aspects of his well-being; his development had stagnated, his sleep was fragmented (napping 5 times daily and frequent night waking attributed to hunger), and he had become withdrawn and irritable. By 16 months of age, Joseph was accepting only a couple of bites of solid foods by spoon or drinking small volumes (20-70 mL) of milk every 2 hours around the clock. Anthropometric z scores (World Health Organization) at 16 months: weight for age: < -3; length for age: -2.02; weight for length: -2.92; head circumference: -1.54. Physical examination revealed a cachectic and irritable child with loose skin folds. His skin was dry, and his hair was sparse. There were no perioral or perineal rashes, bruising, or features of rickets noted. Developmentally, parents reported that he was able to crawl and stand independently at the time of hospitalization, but by the time of evaluation at 16 months, he would no longer stand independently and tired quickly when crawling. He did not use any words but waved bye-bye, used gesture to indicate that he would like to be picked up, used a single-finger point to indicate his wants, and sought his parents for comfort. His fine motor skills were appropriate for chronological age. After extensive evaluation without findings of an organic cause for his failure to thrive, Joseph was diagnosed with avoidant restrictive food intake disorder (ARFID). Enteral nutrition was commenced using a nasogastric (NG) tube, and his micronutrient deficiencies were corrected. Joseph made significant gains within 2 weeks of beginning to receive enteral nutrition. Initial improvement in weight gain (25 g daily over 2 wk, resulting in weight for age z score improving to -1.85) was rapid. Joseph regained ability to stand and began taking a few independent steps. He also acquired the ability to use one word spontaneously and appropriately. His sleep improved, his previously cheerful disposition returned, and he became much easier to engage. Unfortunately, at 20 months, Joseph's parents chose to have the NG tube removed, and his growth began to falter. What would be your next steps in Joseph's care?
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Puia-Dumitrescu M, Benjamin DK, Smith PB, Greenberg RG, Abuzaid N, Andrews W, Chellani K, Gupta A, Price D, Williams C, Malcolm WF, Clark RH, Zimmerman KO. Impact of Gastrostomy Tube Placement on Short-Term Weight Gain in Hospitalized Premature Infants. JPEN J Parenter Enteral Nutr 2020; 44:355-360. [PMID: 30908714 PMCID: PMC7295029 DOI: 10.1002/jpen.1539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/25/2019] [Accepted: 03/08/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Gastrostomy tube (G-tube) placement is a long-term alternative to oral or nasogastric feeding for premature infants who cannot safely feed orally or need supplemental nutrition for adequate growth. METHODS We compared daily weight changes for G-tube infants 14 and 30 days preplacement and postplacement, excluding the first 7 days post-G-tube insertion. Infants <37 weeks of gestation without major congenital anomalies and discharged from 327 United States neonatal intensive care units (2004-2013) were included. Incidence of in-hospital outcomes including hypoxic ischemic encephalopathy, intraventricular hemorrhage grade 3 or 4, necrotizing enterocolitis, and patent ductus arteriosus ligation was examined. Additionally, we estimated a treatment effect model in which infants with a G-tube were matched 1:1 to untreated controls based on propensity scores; main outcome was the average treatment effect (weight gain) for treated infants during the 7, 14, or 30 days immediately prior to discharge. RESULTS Of 329,254 infants, 1393 (0.4%) received a G-tube, increasing from 0.2% in 2004 to 0.6% in 2013. Daily weight gain was significantly less during days 8-14 postplacement compared with 14 days preplacement but was similar between 30 days preplacement and 8-30 days postplacement. After matching, G-tube infant weight gain during the 7 days predischarge was less than among controls, but there was no difference in weight gain between treated and control patients for 14 days and 30 days predischarge. CONCLUSIONS The prevalence of G-tube placement has increased. G-tube use in infants was not associated with improved short-term daily weight gain.
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Affiliation(s)
- Mihai Puia-Dumitrescu
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel K Benjamin
- Department of Economics, Clemson University, Clemson, South Carolina, USA
| | - P Brian Smith
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Nada Abuzaid
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Winsome Andrews
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Kris Chellani
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Anjali Gupta
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Douglas Price
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Ciara Williams
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - William F Malcolm
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida, USA
| | - Kanecia O Zimmerman
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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10
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Backman E, Karlsson AK, Sjögreen L. Gastrostomy Tube Feeding in Children With Developmental or Acquired Disorders: A Longitudinal Comparison on Healthcare Provision and Eating Outcomes 4 Years After Gastrostomy. Nutr Clin Pract 2018; 33:576-583. [DOI: 10.1002/ncp.10056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ellen Backman
- School of Health and Welfare; Halmstad University; Sweden
- Regional Habilitation Center; Region Halland; Kungsbacka Sweden
| | | | - Lotta Sjögreen
- Mun-H-Center Orofacial Resource Center for Rare Diseases; Public Dental Service; Gothenburg Sweden
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11
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Taylor T, Kozlowski AM, Girolami PA. Comparing behavioral treatment of feeding difficulties and tube dependence in children with cerebral palsy and autism spectrum disorder. NeuroRehabilitation 2017; 41:395-402. [DOI: 10.3233/nre-162071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tessa Taylor
- Paediatric Feeding International, Sydney, NSW, Australia
| | - Alison M. Kozlowski
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Peter A. Girolami
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment. J Pediatr Gastroenterol Nutr 2017; 65:242-264. [PMID: 28737572 DOI: 10.1097/mpg.0000000000001646] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Feeding difficulties are frequent in children with neurological impairments and can be associated with undernutrition, growth failure, micronutrients deficiencies, osteopenia, and nutritional comorbidities. Gastrointestinal problems including gastroesophageal reflux disease, constipation, and dysphagia are also frequent in this population and affect quality of life and nutritional status. There is currently a lack of a systematic approach to the care of these patients. With this report, European Society of Gastroenterology, Hepatology and Nutrition aims to develop uniform guidelines for the management of the gastroenterological and nutritional problems in children with neurological impairment. METHODS Thirty-one clinical questions addressing the diagnosis, treatment, and prognosis of common gastrointestinal and nutritional problems in neurological impaired children were formulated. Questions aimed to assess the nutritional management including nutritional status, identifying undernutrition, monitoring nutritional status, and defining nutritional requirements; to classify gastrointestinal issues including oropharyngeal dysfunctions, motor and sensory function, gastroesophageal reflux disease, and constipation; to evaluate the indications for nutritional rehabilitation including enteral feeding and percutaneous gastrostomy/jejunostomy; to define indications for surgical interventions (eg, Nissen Fundoplication, esophagogastric disconnection); and finally to consider ethical issues related to digestive and nutritional problems in the severely neurologically impaired children. A systematic literature search was performed from 1980 to October 2015 using MEDLINE. The approach of the Grading of Recommendations Assessment, Development, and Evaluation was applied to evaluate the outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation using the nominal voting technique. Expert opinion was applied to support the recommendations where no randomized controlled trials were available.
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Kapadia MZ, Joachim KC, Balasingham C, Cohen E, Mahant S, Nelson K, Maguire JL, Guttmann A, Offringa M. A Core Outcome Set for Children With Feeding Tubes and Neurologic Impairment: A Systematic Review. Pediatrics 2016; 138:peds.2015-3967. [PMID: 27365302 DOI: 10.1542/peds.2015-3967] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Uncertainty exists about the impacts of feeding tubes on neurologically impaired children. Core outcome sets (COS) standardize outcome selection, definition, measurement, and reporting. OBJECTIVE To synthesize an evidence base of qualitative data on all outcomes selected and/or reported for neurologically impaired children 0 to 18 years living with gastrostomy/gastrojejunostomy tubes. DATA SOURCES Medline, Embase, and Cochrane Register databases searched from inception to March 2014. STUDY SELECTION Articles examining health outcomes of neurologically impaired children living with feeding tubes. DATA EXTRACTION Outcomes were extracted and assigned to modified Outcome Measures in Rheumatology 2.0 Filter core areas; death, life impact, resource use, pathophysiological manifestations, growth and development. RESULTS We identified 120 unique outcomes with substantial heterogeneity in definition, measurement, and frequency of selection and/or reporting: "pathophysiological manifestation" outcomes (n = 83) in 79% of articles; "growth and development" outcomes (n = 13) in 55% of articles; "death" outcomes (n = 3) and "life impact" outcomes (n = 17) in 39% and 37% of articles, respectively; "resource use" outcomes (n = 4) in 14%. Weight (50%), gastroesophageal reflux (35%), and site infection (25%) were the most frequently reported outcomes. LIMITATIONS We were unable to investigate effect size of outcomes because quantitative data were not collected. CONCLUSIONS The paucity of outcomes assessed for life impact, resource use and death hinders meaningful evidence synthesis. A COS could help overcome the current wide heterogeneity in selection and definition. These results will form the basis of a consensus process to produce a final COS.
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Affiliation(s)
- Mufiza Z Kapadia
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences,
| | - Kariym C Joachim
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
| | - Chrinna Balasingham
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
| | - Eyal Cohen
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; and
| | - Sanjay Mahant
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; and
| | - Katherine Nelson
- Division of Paediatric Medicine, Institute of Health Policy, Management and Evaluation, and Paediatric Advanced Care Team, Department of Paediatrics, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, and Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Martin Offringa
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
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Nelson KE, Lacombe-Duncan A, Cohen E, Nicholas DB, Rosella LC, Guttmann A, Mahant S. Family Experiences With Feeding Tubes in Neurologic Impairment: A Systematic Review. Pediatrics 2015; 136:e140-51. [PMID: 26122806 DOI: 10.1542/peds.2014-4162] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Gastrostomy tubes (G-tubes) are frequently used to provide enteral nutrition for children who have neurologic impairment. Understanding the impact of G-tubes from the family's perspective will inform decision-making and improve support from health care providers. This study explored the experiences of families after G-tube placement in children with neurologic impairment. METHODS We conducted a systematic review of English-language qualitative primary research studies describing family experiences after G-tube placement. Six electronic databases were searched from inception to June 2014. Two authors independently screened and identified relevant studies, evaluated quality of reporting by using the Consolidated Criteria for Reporting Qualitative Research tool, and extracted data. Overarching concepts were developed by using thematic analysis. RESULTS From 2674 screened abstracts, 84 texts were reviewed, and 13 studies met the inclusion criteria. G-tubes affect the lives of children, parents, and the family unit in many ways, both positive and negative. Improvements and challenges were described for children's health and happiness, for parental caregiving and stress, and for logistics and bonding within the family. G-tube feeding also changed relationships within the family, between the family and the medical system, and between the family and the outside world. Furthermore, experiences varied, with different families framing similar concepts as positive and negative. CONCLUSIONS G-tube placement has diverse effects on daily life for children with neurologic impairment and their families. Clinicians may use the themes identified in this study to guide conversations with families about their values, experiences, and expectations before and after G-tube placement.
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Affiliation(s)
- Katherine E Nelson
- Paediatric Advanced Care Team and Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation,
| | | | - Eyal Cohen
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada; and
| | - David B Nicholas
- Department of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada; and
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Harding C, Cockerill H. Managing eating and drinking difficulties (dysphagia) with children who have learning disabilities: What is effective? Clin Child Psychol Psychiatry 2015; 20:395-405. [PMID: 24414040 DOI: 10.1177/1359104513516650] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People who work with children who have neurological and learning disabilities frequently need to manage the health and emotional risks associated with eating, drinking and swallowing (dysphagia). Some approaches can support children to develop oral feeding competence or to maximise their ability to maintain some oral intake supplemented with tube feeding. However, some clinicians feel that oral-motor exercises can support eating and drinking skills as well as speech and language development, whereas there is little evidence to support this.The implied "beneficial" association between oral-motor exercises, speech and swallowing skills gives a false impression in terms of future outcomes for parents and carers of children with learning disabilities. This paper considers oral-motor approaches in the remediation of dysphagia and the need for a cultural shift away from this view. Realistic and useful outcomes for people with learning disabilities need to be an essential part of therapeutic intervention.
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Affiliation(s)
- Celia Harding
- City University, London and the Royal Free Hospital, London
| | - Helen Cockerill
- Evelina Children's Hospital, London, Guy's and St. Thomas's NHS Foundation Trust, London
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Abstract
The decision to initiate enteral feedings is multifaceted, involving medical, financial, cultural, and emotional considerations. Children who have developmental or acquired disabilities are at risk for having primary and secondary conditions that affect growth and nutritional well-being. This clinical report provides (1) an overview of clinical issues in children who have developmental or acquired disabilities that may prompt a need to consider nonoral feedings, (2) a systematic way to support the child and family in clinical decisions related to initiating nonoral feeding, (3) information on surgical options that the family may need to consider in that decision-making process, and (4) pediatric guidance for ongoing care after initiation of nonoral feeding intervention, including care of the gastrostomy tube and skin site. Ongoing medical and psychosocial support is needed after initiation of nonoral feedings and is best provided through the collaborative efforts of the family and a team of professionals that may include the pediatrician, dietitian, social worker, and/or therapists.
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Parents’ Perceptions of Gastrostomy Feeding for Children With Neurological Disabilities. J Hosp Palliat Nurs 2014. [DOI: 10.1097/njh.0000000000000113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Cowpe Jebson E, Hanson B, Smith CH. What do parents of children with dysphagia think about their MDT? A qualitative study. BMJ Open 2014; 4:e005934. [PMID: 25326210 PMCID: PMC4202020 DOI: 10.1136/bmjopen-2014-005934] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/10/2014] [Accepted: 09/25/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To seek the experiences and perspectives of parents caring for children with dysphagia, with emphasis on their experiences of working within their child's multidisciplinary team (MDT). SETTING This research was completed in community settings, within families' homes across the UK. PARTICIPANTS 14 families self-selected to participate in the study. Criteria specified that participants must care for a child under the age of 18 and to decrease ambiguity the term 'diagnosis of dysphagia' was defined as the need for modified (thickened) fluids. EXCLUSION CRITERIA caring for an adult over the age of 18; diet and fluid modifications for reasons other than dysphagia (eg, for symptomatic treatment of gastro-oesophageal reflux disease. Participants were interviewed within their homes using a semistructured questionnaire and data was analysed using a descriptive phenomenological approach through use of thematic coding and constant comparison. Themes and relationships were inductively generated from the data. RESULTS Participants universally expressed a desire to be involved with their child's MDT; this study identified the following facilitators and barriers to collaboration: accessing services, professional knowledge and professional skillset. Participants described three means of responding to these barriers: reacting emotionally, seeking solutions and making decisions. CONCLUSIONS This study recorded in-depth reports of participants' experiences of working with healthcare providers. Despite government-driven efforts towards person-centred healthcare and social care, participants shared accounts of times when this has not occurred, describing a negative impact on the well-being and quality of life of their child and family.
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Affiliation(s)
| | - Ben Hanson
- Department of Mechanical Engineering, University College London, London, UK
| | - Christina H Smith
- Department of Language and Communication, Division of Psychology and Language Sciences, University College London, London, UK
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Abstract
Shared decision-making is a process that helps frame conversations about value-sensitive decisions, such as introduction of assistive technology for children with neurologic impairment. In the shared decision-making model, the health care provider elicits family values relevant to the decision, provides applicable evidence in the context of those values, and collaborates with the family to identify the preferred option. This article outlines clinical, quality of life, and ethical considerations for shared decision-making discussions with families of children with neurologic impairment about gastrostomy tube and tracheostomy tube placement.
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Pedrón-Giner C, Calderón C, Martínez-Costa C, Borraz Gracia S, Gómez-López L. Factors predicting distress among parents/caregivers of children with neurological disease and home enteral nutrition. Child Care Health Dev 2014; 40:389-97. [PMID: 23461829 DOI: 10.1111/cch.12038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS Caregivers of children with chronic diseases included in a home enteral nutrition (HEN) programme are at risk of experiencing a feeling of burden, high level of anxiety and psychological distress. The aims of this study were: first, to examine the prevalence of symptoms of anxiety-depression in caregivers of children with neurological diseases requiring HEN by gastrostomy tube (GT); second, to compare the characteristics of caregivers with high or low risk of exhibiting symptoms of anxiety-depression; and third, to investigate possible associations to child disease severity and nutrition support mode. METHODS A cross-sectional observational study was performed in 58 caregivers of children (31 boys, aged 0.3-18 years) with neurological diseases and GT feeding. The characteristics of caregivers with high or low risk of presenting symptoms of anxiety-depression were compared regarding the following variables: socio-demographic characteristics, the primary caregiver's intrapsychic factors, anthropometric parameters of the child, length of HEN, type of nutrients delivered by GT and infusion regime. RESULTS All primary caregivers were mothers. Fifty-three per cent of them showed high risk of exhibiting symptoms of anxiety-depression. Mothers with high or low risk of presenting symptoms of anxiety-depression were comparable in age and family socio-economic status. They were also similar in terms of age, anthropometric conditions and length of HEN in their children.No differences were found between the two groups of mothers according to the level of the child's motor function impairment, type of nutrients delivered by GT and infusion regime. Higher levels of psychological distress and perception of burden overload were found in mothers with high risk of exhibiting symptoms of anxiety-depression. CONCLUSIONS This study found a high prevalence of symptoms of anxiety-depression, perception of burden overload and psychological distress in caregivers of children with HEN. Thus, greater practical and emotional support is required for these families.
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Affiliation(s)
- C Pedrón-Giner
- Division of Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Martínez-Biarge M, Blanco D, García-Alix A, Salas S. [Follow-up of newborns with hypoxic-ischaemic encephalopathy]. An Pediatr (Barc) 2013; 81:52.e1-14. [PMID: 24290154 DOI: 10.1016/j.anpedi.2013.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 06/27/2013] [Indexed: 11/19/2022] Open
Abstract
Hypothermia treatment for newborn infants with hypoxic-ischemic encephalopathy reduces the number of neonates who die or have permanent neurological deficits. Although this therapy is now standard of care, neonatal hypoxic-ischaemic encephalopathy still has a significant impact on the child's neurodevelopment and quality of life. Infants with hypoxic-ischaemic encephalopathy should be enrolled in multidisciplinary follow-up programs in order to detect impairments, to initiate early intervention, and to provide counselling and support for families. This article describes the main neurodevelopmental outcomes after term neonatal hypoxic-ischaemic encephalopathy. We offer recommendations for follow-up based on the infant's clinical condition and other prognostic indicators, mainly neonatal neuroimaging. Other aspects, such as palliative care and medico-legal issues, are also briefly discussed.
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Affiliation(s)
- M Martínez-Biarge
- Department of Paediatrics, Hammersmith Hospital, Imperial College, Londres, Reino Unido.
| | - D Blanco
- Servicio de Neonatología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - A García-Alix
- Servicio de Neonatología, Hospital Sant Joan de Déu, Barcelona, España
| | - S Salas
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España
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Carvalho APCD, Chiari BM, Goncalves MIR. Impact of an educational program on the feeding of neurologically impaired children. Codas 2013; 25:413-21. [DOI: 10.1590/s2317-17822013005000004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 06/26/2013] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: To verify the impact of an educative program focused on aspects related to feeding developed with a group of caregivers of children with chronic non-progressive encephalopathy. METHODS: Cross-sectional comparative study conducted with 30 children diagnosed with chronic non-progressive encephalopathy and their caregivers with the use of a questionnaire and video recordings of a meal conducted by the main caregiver. In order to verify the impact of an educational program in the knowledge and conduct of caregivers, patients were divided into two groups: study - consisting of caregivers submitted to a questionnaire and a video recording before and after the educational program; control - group in which caregivers underwent the procedures in two occasions, but without access to the educational program. RESULTS: Around 93.33% of caregivers were females, most had low educational level, and only 10% had a professional activity. Previous knowledge of caregivers concerning feeding was restricted, with 66% of caregivers not knowing what aspiration was, 60% being unfamiliar with the complications associated with such occurrence, and 86.66% stating that there is no relation between voice and swallowing. During feeding, only 26.66% of the caregivers used verbal commands related to feeding, and 50% did not realize the difficulties presented by their children. We observed a difference with regard to knowledge and conduct in the study group only. CONCLUSION: The educational program had a positive impact on the knowledge and conduct of caregivers concerning the feeding of their children with chronic non-progressive encephalopathy.
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Gantasala S, Sullivan PB, Thomas AG. Gastrostomy feeding versus oral feeding alone for children with cerebral palsy. Cochrane Database Syst Rev 2013; 2013:CD003943. [PMID: 23900969 PMCID: PMC7154382 DOI: 10.1002/14651858.cd003943.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Children with cerebral palsy can be significantly disabled in terms of their ability to suck, chew and swallow. This can lead to significant impairment in feeding and, eventually, to undernutrition. It can also result in aspiration of food into the lungs. Length of feeding time may be considerably increased and, instead of being an enjoyable experience, mealtimes may be distressing for both child and carer. For children unable to maintain a normal nutritional state feeding by mouth, gastrostomy or jejunostomy tubes are increasingly being used to provide the digestive system with nutrients. A gastrostomy tube is a feeding tube inserted surgically through the abdominal wall directly into the stomach. A jejunostomy feeding tube is inserted into the jejunum, part of the small intestine, either directly or via a previous gastrostomy. Although gastrostomy or jejunostomy placement may greatly facilitate the feeding of children with cerebral palsy, many carers find it very emotionally difficult to accept this intervention. Moreover, the intervention is costly and there is the possibility of complications. The effectiveness and safety of the treatment requires further assessment. This review is an update of one previously published in 2004. OBJECTIVES To assess the effects of nutritional supplementation given via gastrostomy or jejunostomy to children with feeding difficulties due to cerebral palsy. SEARCH METHODS For this update, we searched the following databases in July 2012: CENTRAL, MEDLINE , Embase, CINAHL, Science Citation Index, Conference Proceedings Citation Index, LILACS and Zetoc. We searched for trials in ICTRP and Clinicaltrials.gov, and for theses in WorldCat and Proquest Index to Theses. We also contacted other researchers and experts in this field. SELECTION CRITERIA We looked for randomised controlled trials that compared delivery of nutrition via a gastrostomy or jejunostomy tube compared with oral feeding alone for children up to the age of 16 years. DATA COLLECTION AND ANALYSIS Screening of search results was undertaken independently by two review authors. No data extraction was possible as there were no included studies. MAIN RESULTS No trials were identified that met the inclusion criteria for this review. AUTHORS' CONCLUSIONS Considerable uncertainty about the effects of gastrostomy for children with cerebral palsy remains. A well designed and conducted randomised controlled trial should be undertaken to resolve the current uncertainties about medical management for children with cerebral palsy and physical difficulties in eating.
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Åvitsland TL, Birketvedt K, Bjørnland K, Emblem R. Parent-Reported Effects of Gastrostomy Tube Placement. Nutr Clin Pract 2013; 28:493-8. [DOI: 10.1177/0884533613486484] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tone Lise Åvitsland
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjersti Birketvedt
- National Resource Center for Feeding and Nutritional Difficulties in Children, Section for Child Neurology, Oslo University Hospital, Oslo, Norway
| | - Kristin Bjørnland
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Emblem
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Martínez-Costa C, Calderón C, Pedrón-Giner C, Borraz S, Gómez-López L. Psychometric properties of the structured Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8) for caregivers of children with gastrostomy tube nutritional support. J Hum Nutr Diet 2012. [PMID: 23190211 DOI: 10.1111/jhn.12000] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND To analyse the psychometric properties of the structured Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8) in parents/caregivers of children with home enteral nutrition (HEN) by gastrostomy tube (GT). METHODS Eighty-six caregivers (mothers) of paediatric patients with HEN by GT were recruited. Patients suffered from neurological disease (61.6%) and other chronic diseases. The SAGA-8 scale, a structured questionnaire to explore satisfaction with HEN by GT, and the Caregiver Burden Inventory (Zarit) were completed. The discriminating power of each of the SAGA-8 items, internal consistency and external validity were evaluated. An exploratory factor analysis and Kaiser-Meyer-Olkin (KMO) was performed as well. RESULTS Eighty-four percent of the families expressed high satisfaction with GT feeding. All eight items of SAGA-8 gave additional information. The exploratory factor analysis revealed that a significant part of the items' variability could be explained by two independent factors: Factor 1 (direct benefit), which compiled the variables related to the perception of children's overall improvement by GT feeding; Factor 2 (indirect benefit), which grouped the variables related to a decrease in respiratory infections, feeding time and institutional support. Results from KMO (0.628) indicated the high adequacy of the items assessed in the factorial analysis. Moreover, the questionnaire presented high internal consistency (0.76), and the external validation analysis confirmed the correlation between SAGA-8 and Zarit, thereby emphasising the approptiate use of the SAGA-8 to detect carers' satisfaction. CONCLUSIONS The SAGA-8 questionnaire has a high discriminatory power to assess the degree of satisfaction experienced by parents/caregivers of children with HEN by GT and, subsequently, the patients' wellbeing.
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Affiliation(s)
- C Martínez-Costa
- Department of Pediatrics, School of Medicine, University of Valencia, Valencia, Spain.
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Maternal psychological distress and parenting stress after gastrostomy placement in children. J Pediatr Gastroenterol Nutr 2012; 55:562-6. [PMID: 22644463 DOI: 10.1097/mpg.0b013e31826078bd] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate stress in mothers of children with feeding problems before and after gastrostomy placement, and to identify changes in child health and variables affecting maternal stress. METHODS Psychological distress and parenting stress in 34 mothers of children referred for gastrostomy were assessed using general health questionnaire (GHQ) (overall psychological distress), impact of event scale (IES) (intrusive stress related to child's feeding problems), and parenting stress index (PSI) (stress related to parenting) before, 6, and 18 months after placement of a gastrostomy. Information of child health and long-term gastrostomy complications were recorded. A semistructured interview constructed for the present study explored maternal preoperative expectations and child's quality of life. RESULTS Insertion of a gastrostomy did not significantly influence vomiting or the number of children with a low weight-for-height percentile. All of the children experienced peristomal complications. Despite this, mothers' overall psychological distress was significantly reduced after 6 and 18 months, and the majority of mothers (85%) reported that their preoperative expectations were fulfilled and that the child's quality of life was improved after gastrostomy placement. Maternal concerns for the child's feeding problems, measured as intrusive stress, had effect on maternal overall psychological distress. CONCLUSIONS Despite frequent stomal complications the gastrostomy significantly reduced the mothers' psychological distress and improved the child's quality of life as reported by the mother.
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Feeding and communication impairments in infants with central grey matter lesions following perinatal hypoxic-ischaemic injury. Eur J Paediatr Neurol 2012; 16:688-96. [PMID: 22658307 DOI: 10.1016/j.ejpn.2012.05.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 04/25/2012] [Accepted: 05/01/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Basal ganglia and thalamic (BGT) injury is common after acute perinatal hypoxia-ischaemia. Cerebral palsy is the most obvious consequence of BGT injury affecting 70-75% of survivors and is predictable from neonatal magnetic resonance imaging (MRI). However there is no equivalent predictive data for other specific outcomes. Feeding and communication impairments are also common in children following hypoxic-ischaemic encephalopathy (HIE) and BGT injury. AIMS To describe, in infants with HIE and BGT injury, the prevalence of feeding and communication impairments; and to evaluate the accuracy of early MRI for predicting these outcomes. METHODS 175 term infants with HIE and BGT injury were studied. Brain lesions were classified by site and severity from the MRI scans. Motor, feeding and communication impairments were documented at 2 years. RESULTS Feeding and communication impairments occurred in 65% and 82% of 126 survivors respectively and related strongly to the severity of motor impairment. Forty-one children had a gastrostomy or long-term nasogastric tube. Injury severity in all brain regions was significantly associated with feeding and communication impairment on univariate analysis. On logistic regression analysis BGT (OR 10.9) and mesencephalic lesions (OR 3.7) were independently associated with feeding impairment; BGT (OR 10.5) and pontine lesions (OR 3.8) were associated with gastrostomy; the severity of BGT lesions (OR 20.1) was related to the severity of communication impairment. CONCLUSIONS Feeding and communication impairment are very common in children with BGT and brainstem injury of neonatal origin and can be well predicted from early MRI scans.
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Wilken M. The impact of child tube feeding on maternal emotional state and identity: a qualitative meta-analysis. J Pediatr Nurs 2012; 27:248-55. [PMID: 22525813 DOI: 10.1016/j.pedn.2011.01.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 01/27/2011] [Accepted: 01/28/2011] [Indexed: 11/18/2022]
Abstract
Literature on mothers' acceptance of their children's tube feeding is heterogeneous. When a child is fed via gastrostomy, parents may report higher quality of life and higher stress levels. Qualitative research suggests that tube feeding can conflict with fundamental expectations about the mothering role. In this qualitative meta-analysis, parental statements from various studies have been excerpted and theory-based analyzed. Data suggest that feeding a child orally is not only an important aspect of mothering but also a key element for the development of a motherhood identity. Nonoral feeding often results in psychological stress and a struggle to negotiate the motherhood identity successfully and may result in traumatization of the mother. Preventive psychological guidance is recommended to decrease the risk of posttraumatic stress disorder in mothers and disturbances in the mother-child relationship and to assist in maternal coping with a child's feeding disorder.
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Affiliation(s)
- Markus Wilken
- Institute for Psychology and Psychosomatics of Early Childhood, Siegburg, Germany.
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Mahant S, Jovcevska V, Cohen E. Decision-making around gastrostomy-feeding in children with neurologic disabilities. Pediatrics 2011; 127:e1471-81. [PMID: 21624876 DOI: 10.1542/peds.2010-3007] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to understand the decision-making experiences, perspectives, and beliefs of parents of children with a neurologic disability around gastrostomy tube-feeding. DESIGN AND METHODS We conducted a systematic review of qualitative studies to explore the experiences of parents of children with a neurologic disability around gastrostomy-feeding. We searched 5 electronic databases from inception to July 2010. Two authors independently selected articles and extracted data. Concepts and themes relevant to decision-making were constructed by using thematic analysis. RESULTS Eleven studies were selected in which experiences relevant to decision-making were reported. The decision-making process was characterized by decisional conflict. Concepts important to understanding conflict were categorized under 3 themes: values; context; and process. The value and meaning of feeding by mouth and, in contrast, with a gastrostomy tube was the dominant theme that led to internal distress for parents in decision. Feeding by mouth was seen as an enjoyable activity, an important social process, but also a struggle. Gastrostomy-feeding represented a loss of normality, a sign of disability, and a disruption of maternal nurturing and bonding. Context (child and family characteristics) and process (information sharing and support) modified the decision-making experience. CONCLUSIONS Values associated with gastrostomy-feeding and feeding by mouth, the context of child and family, and the process of decision-making facilitated by the health care system shape parental experiences and decisional conflict. This framework will help guide interventions, such as patient decision aids, that are aimed at improving parental decision-making.
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Affiliation(s)
- Sanjay Mahant
- Division of Pediatric Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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Abstract
Half of the most severe cases of cerebral palsy (CP) survive to adulthood, but because this longevity is relatively recent, there is no empirical experience of their life expectancy past middle age. The last 2 decades have seen significant developments in the management of persons with CP, involving specialist services from an increasing number of disciplines that require coordination to maximize their effectiveness. This article provides an overview of CP. The author discusses definitions of CP, its epidemiology, pathologies, and range of possible clinical descriptions, and briefly touches on management and prevention.
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Affiliation(s)
- Eve Blair
- Division of Population Sciences, Centre for Child Health Research, University of Western Australia at The Telethon Institute for Child Health Research, West Perth, WA 6872, Australia.
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Wilson M, Gosche J, Bishop P, Liu H, Moore T, Nowicki MJ. Critical analysis of caregiver perceptions regarding gastrostomy tube placement. Pediatr Int 2010; 52:20-5. [PMID: 19419510 DOI: 10.1111/j.1442-200x.2009.02851.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gastrostomy tubes (GT) are often required to safely provide nutrition in children with feeding disorders and aspiration risk. The need for a GT brings with it known risks, complications, and benefits, but caregivers may have unspoken concerns and expectations. The present study was done to assess caregiver concerns, expectations, and satisfaction with GT placement in children. METHODS A two-part retrospective and prospective study was conducted to assess caregiver concerns and expectations related to GT placement, to determine which concerns and expectations came to fruition, and to rate overall satisfaction with the GT. Questionnaires were used to collect data before and after GT placement. A visual analog scale (VAS) score was used to determine degree of concern and satisfaction. RESULTS Sixty-four children (19 retrospective, 45 prospective) completed the study. Concern score by VAS was evenly distributed with a mean value of 47.4 +/- 31.8. Concerns were realized in 25%; expectations were met in 93%. Feeding time decreased following GT placement. Satisfaction was reported as satisfied (23.6%), pleased (16.4%), or very pleased (60.0%). CONCLUSIONS Despite pre-placement concerns, most caregivers reported being pleased with the GT following placement. Concerns that occurred were of minor medical significance. Most expectations were met, in particular improved nutrition. The present study provides insight into caregiver concerns and expectations, and which are likely to occur. This information can be useful when counseling caregivers of children requiring GT.
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Affiliation(s)
- Melissa Wilson
- Divisions of Pediatric Gastroenterology and Nutrition, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA
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Gisel E. Interventions and outcomes for children with dysphagia. ACTA ACUST UNITED AC 2008; 14:165-73. [DOI: 10.1002/ddrr.21] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Brotherton A, Abbott J, Hurley M, Aggett PJ. Home enteral tube feeding in children following percutaneous endoscopic gastrostomy: perceptions of parents, paediatric dietitians and paediatric nurses. J Hum Nutr Diet 2007; 20:431-9. [PMID: 17845377 DOI: 10.1111/j.1365-277x.2007.00811.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The perceptions of parents and professionals are important in deciding to feed children by gastrostomy, yet there are few published studies in this field. This study explored and compared the perceptions of parents to those of paediatric outreach nurses and paediatric dietitians. METHODS A cross-sectional mixed-method study with purposive sampling was undertaken using structured interviews and questionnaires to explore perceptions of percutaneous endoscopic gastrostomy (PEG) placement and feeding. Binomial regression was used to investigate differences in perceptions across the groups of participants. RESULTS Parents, paediatric outreach nurses and dietitians shared similar perceptions regarding success of feeding, support for gastrostomy reinsertion and the acceptability of the child's quality of life. Much greater differences in perceptions were evident regarding the parents' involvement in the decision-making process for PEG placement and the adequacy of the support received from healthcare professionals. CONCLUSIONS A high level of support for feeding was demonstrated together with strong perceptions across all groups that feeding was successful. It is important for healthcare professionals to consider the perceptions of the parents throughout decision making and provision of care following PEG placement because it is highly likely there will be differences in the perceptions between parents and healthcare professionals.
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Affiliation(s)
- A Brotherton
- Department of Nursing, Faculty of Health, University of Central Lancashire, Preston, Lancashire, UK.
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Partrick DA. Gastrointestinal tract feeding access and the role of fundoplication in combination with gastrostomy. Curr Opin Pediatr 2007; 19:333-7. [PMID: 17505196 DOI: 10.1097/mop.0b013e32815745bd] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Feeding access and associated antireflux procedures continue to be some of the most common operations performed in pediatric patients. This review will discuss the various feeding access procedures available, including minimally invasive techniques, and further elaborate on appropriate indications for a concurrent antireflux procedure as well as alternatives to fundoplication. RECENT FINDINGS Gastrostomy and jejunostomy can be successfully placed using endoscopic or laparoscopic techniques with low complication rates. Nissen fundoplication is well described laparoscopically but failure with recurrent gastroesophageal reflux has resulted in the development of other operative alternatives. SUMMARY Decisions concerning appropriate long-term feeding access must be individualized, understanding the advantages and disadvantages of gastrostomy and jejunostomy techniques. Laparoscopic Nissen fundoplication is successful for treatment of patients who fail medical therapy of gastroesophageal reflux, but recurrent gastroesophageal reflux is a persistent problem that requires innovative solutions.
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Affiliation(s)
- David A Partrick
- University of Colorado Health Sciences Center, and Department of Pediatric Surgery, The Children's Hospital, 1056 East 19th Avenue, Denver, CO 80218, USA.
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