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>
Nasogastric or gastrostomy feedings in children with neurologic disabilities
Child; Female; Humans; Male; Enteral Nutrition; Preschool; infant; Nutrition Disorders/etiology/prevention & control; Nervous System Diseases/complications/therapy
Although pediatricians are increasingly aware of the problem of undernutrition in children with neurologic disabilities, many of these children remain poorly nourished despite prolonged attempts at oral feedings. We studied the effects of tube feeding on such children, using either nasogastric (NG) or gastrostomy (GT) feedings. Twenty-six patients (16 male, mean age at first visit 40.7 months) were followed while receiving tube feedings for a mean of 23 months. Thirteen children in the NG group were tube fed by nasogastric tube. The GT group consisted of two groups of children: 10 who began with nasogastric feedings and then changed to gastrostomy because of intolerance or need for reflux surgery, and three who were always tube fed via gastrostomy. Mean percent ideal body weight for height age (%IBWH) for the whole group improved from 73.2% to 94.2% (P < .0001), for the NG group from 72.1% to 89.3% (P < .002), and for the GT group from 74.2% to 98.8% (P < .0001). One patient died of unrelated severe upper airway obstruction. No patients reported hospitalization due to tube-feeding complications. Seventeen of the parents perceived that their child's mood was improved and that they spent less time in child care after NG or GT feedings were begun. We conclude that (1) both nasogastric and gastrostomy feedings safely improved nutrition in these children and (2) this objective improvement was often accompanied by subjective improvement. We suggest aggressive use of tube feedings in selected patients.
1994
Naureckas SM; Christoffel KK
Clinical Pediatrics
1994
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/10.1177/000992289403300608" target="_blank" rel="noreferrer">10.1177/000992289403300608</a>