Gastrostomy feeding versus oral feeding alone for children with cerebral palsy
Child; Humans; adolescent; Preschool; infant; Cerebral Palsy/complications; Eating; Gastrostomy/adverse effects; Nutrition Disorders/etiology/prevention & control
BACKGROUND: Children with cerebral palsy (CP) can be significantly disabled in terms of their ability to suck, chew and swallow. This can lead to significant impairment in feeding ability and, eventually, to under-nutrition. It can also result in aspiration of food into the lungs. Feeding time may be considerably increased and, instead of being an enjoyable experience, mealtimes may be distressing for both the child and carer. Increasingly for children unable to maintain a normal nutritional state feeding by mouth, gastrostomy or jejunostomy tubes are 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 feeding of children with CP, many carers find it very difficult to accept this intervention emotionally. The treatment is also relatively costly. For all of these reasons, its effectiveness requires assessment. OBJECTIVES: To assess the effects of nutritional supplementation given via gastrostomy or jejunostomy in children with feeding difficulties due to cerebral palsy. SEARCH STRATEGY: We searched the Cochrane Library's register of controlled trials (CENTRAL) up to Issue 4, 2003, MEDLINE 1977 - December 2003, EMBASE 1980 - December 2003, CINAHL 1982 - December 2003, LILACS 1980 - end 2003, ASLIB 1983 - 2003 and Dissertation Abstracts 1980 - 2003. SELECTION CRITERIA: Only randomised controlled trials which compared delivery of nutrition via a gastrostomy or jejunostomy tube compared with oral feeding alone for children up to the age of 16 were considered for this review. DATA COLLECTION AND ANALYSIS: Selection of trials, data extraction and assessment of trial quality were undertaken independently by two reviewers. MAIN RESULTS: No trials were identified that met the inclusion criteria for this review. REVIEWERS' CONCLUSIONS: On the basis of this systematic review, 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.
2004
Sleigh G; Sullivan P; Thomas AG
Cochrane Database Of Systematic Reviews
2004
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1002/14651858.CD003943.pub2" target="_blank" rel="noreferrer">10.1002/14651858.CD003943.pub2</a>
Effects of gastrostomy feeding in children with cerebral palsy: an AACPDM evidence report
Child; Humans; Enteral Nutrition; Gastrostomy; adolescent; Preschool; infant; Nutritional Failure; Cerebral Palsy/complications; Nutrition Disorders/etiology/prevention & control; Growth Disorders/etiology/prevention & control
2003
Samson-Fang L; Butler C; O'Donnell ME; AACPDM
Developmental Medicine And Child Neurology
2003
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1111/j.1469-8749.2003.tb00421.x" target="_blank" rel="noreferrer">10.1111/j.1469-8749.2003.tb00421.x</a>
Functional duodenal obstruction (superior mesenteric artery or cast syndrome) in cerebral palsy
Child; Female; Humans; Enteral Nutrition/methods; Cerebral Palsy/complications; Duodenal Obstruction/complications/physiopathology; Nutrition Disorders/diet therapy/etiology
An 8-yr-old girl with cerebral palsy who was chronically malnourished presented with functional duodenal obstruction (superior mesenteric artery or cast syndrome) proven by barium meal. Six months of feeding through a fluoroscopically positioned gastrojejunal tube generated sufficient weight gain and increase in body bulk to cure the functional obstruction.
1989
Vaisman N; Stringer DA; Pencharz P
Journal Of Parenteral And Enteral Nutrition
1989
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1177/0148607189013003326" target="_blank" rel="noreferrer">10.1177/0148607189013003326</a>
Gastrointestinal problems in the neurologically impaired child
Child; Humans; Preschool; Q3 Literature Search; Enteral Nutrition/methods; Cerebral Palsy/complications; Gastrostomy/adverse effects; Constipation/etiology; Gastroesophageal Reflux/etiology/physiopathology/surgery; Gastrointestinal Diseases/etiology/physiopathology; Gastrointestinal Motility; Nervous System Diseases/complications/physiopathology; Nutrition Physiology
Damage to the developing central nervous system may result in significant dysfunction in the gastrointestinal tract and is reflected in impairment in oral-motor function, rumination, gastro-oesophageal reflux, with or without aspiration, delayed gastric emptying and constipation. These problems can all potentially contribute to feeding difficulty in disabled children. Early recognition of an infant with neurological impairment that is compromising the normal feeding process is crucial. Detailed assessment of the nature of the feeding difficulties will help to predict the anticipated future nutritional needs and will allow decisions to be made about the appropriateness of input from different professionals (speech therapy, dietitians, gastroenterologists). Only when such information has been carefully assembled will rational and directed medical and surgical therapy be possible. Nutritional rehabilitation of disabled children can be associated with increased mortality and morbidity secondary to gastro-oesophageal reflux, retching, dumping syndrome or aspiration. It may also entail an increased work for care givers and increase costs of care. It is therefore necessary to document the impact of such rehabilitation on growth and quality of life for both patient and care giver.
1997
Sullivan P
Bailliere's Clinical Gastroenterology
1997
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0950-3528(97)90030-0" target="_blank" rel="noreferrer">10.1016/s0950-3528(97)90030-0</a>
Pain in Children with Significant Neurological Impairment
Child; Humans; Pain Measurement; Communication; Nervous System Diseases/complications; RDF Project; Cerebral Palsy/complications; Analgesics/therapeutic use; Pain/complications/diagnosis/drug therapy/etiology
1999
Oberlander T; O'Donnell M; Montgomery C
Developmental And Behavioral Pediatrics
1999
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/00004703-199908000-00006" target="_blank" rel="noreferrer">10.1097/00004703-199908000-00006</a>
Nutrition-related growth failure of children with quadriplegic cerebral palsy
Child; Female; Humans; Male; Sex Factors; adolescent; Preschool; Non-U.S. Gov't; P.H.S.; Research Support; U.S. Gov't; Comparative Study; Nutritional Status; Cerebral Palsy/complications; Nutrition Assessment; Anthropometry; Growth Disorders/diagnosis/etiology; Nutrition Disorders/complications; Quadriplegia/complications
Growth failure and nutritional status were evaluated in 142 children with quadriplegic cerebral palsy, aged between two and 18 years. Linear growth was assessed by upper-arm and lower-leg lengths: both means were significantly reduced. Mean bodyweight and triceps skinfold thickness fat stores were reduced to 65 per cent medians and subcapsular skinfold fat stores to 81 per cent median. Muscle stores were the most preserved and reduced to 88 per cent median. Examination of the sample by age-group showed significant reductions in growth and nutrition status indicators, even at two to four years, except for muscle area. To determine the degree to which nutritional status affected linear growth, a set of two-step regression analyses was conducted. The linear growth measures were significantly correlated with the measures of nutritional status.
1993
Stallings VA; Charney EB; Davies JC; Cronk CE
Developmental Medicine And Child Neurology
1993
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1111/j.1469-8749.1993.tb11614.x" target="_blank" rel="noreferrer">10.1111/j.1469-8749.1993.tb11614.x</a>
Feeding and nutritional characteristics in children with moderate or severe cerebral palsy
Child; Female; Humans; Male; Prevalence; Questionnaires; Disabled Persons; Risk Factors; Activities of Daily Living; Case-Control Studies; Non-U.S. Gov't; Research Support; Nutritional Status; Cerebral Palsy/complications; Age Distribution; Nutrition Assessment; Anthropometry; Child Nutrition Disorders/etiology; Eating Disorders/etiology
This study was undertaken to characterize the current feeding situation and nutritional status of moderately or severely disabled children with cerebral palsy (CP). Thirty-five children with CP (17 with diplegia, 11 with dystonia, 6 with tetraplegia and one child with ataxia) were investigated at a median age of 8 years. Information was obtained from parental interviews, medical records and clinical and anthropometric examinations. Twenty-one of the 35 children (60%), most of whom were severely disabled, were reported by the parents to have current feeding problems. Anthropometric indicators of undernutrition were found in 15 children (43%) and of overnutrition in 3 children (9%), compared with reference values of healthy children. Severely disabled children in the youngest age group were most at risk for poor nutritional status. Early identification of children at nutritional risk requires regular assessments of feeding skills and nutritional status.
1996
Dahl M; Thommessen M; Rasmussen M; Selberg T
Acta Paediatrica
1996
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1111/j.1651-2227.1996.tb14129.x" target="_blank" rel="noreferrer">10.1111/j.1651-2227.1996.tb14129.x</a>