Tube Feeding In Children Research Articles

Exploring parental thoughts and clinical experiences on blended food in a paediatric population, a qualitative study.

There's a growing interest in blended food (BF) as an alternative to commercial food (CF) for tube-fed children. Thus, we investigated parental and medical experiences with BF as an option for tube feeding in children. In this cross-sectional study, all patients were already using BF, chosen by parents. In March 2022, all patients using BF provided consent and completed a questionnaire assessing their experiences. Medical data were collected retrospectively from patient charts, including biometric changes, dietary adjustments, and nutritional status. A non-validated parent satisfaction score was computed from 17 questions, rated on a scale from one to five. A score of ≥ 51 points, indicating an average score of > 3 per question, was deemed indicative of a positive parental experience with BF. Nine children receiving BF were identified (median age: 4.7 years; weight: 14.9 kg; 66% male). All parents were satisfied with BF, reflected in the parent satisfaction score. Parents cited reduced feeding-related discomforts as the main reason for switching to BF. Weight (+0.3 SD) and length (+0.5 SD) showed positive changes. None discontinued BF, though modifications were made for five patients by the dietician. Nutritional deficiencies, mainly iron with or without zinc deficiency, were observed in four patients, with uncertain onset due to lack of pre-BF laboratory testing. In this small BF cohort overseen by an experienced multidisciplinary team, BF was well tolerated, resulting in high parental satisfaction and maintaining good nutritional status.

A clinical consensus paper on jejunal tube feeding in children.

Feeding problems are common in children with complex medical problems or acute critical illness and enteral nutrition may be required. In certain situations, gastric tube feeding is poorly tolerated or may not be feasible. When feed intolerance persists despite appropriate adjustments to oral and gastric enteral regimens, jejunal tube feeding can be considered as an option for nutrition support. A multidisciplinary expert working group of the Australasian Society of Parenteral and Enteral Nutrition was convened. They identified topic questions and five key areas of jejunal tube feeding in children. Literatures searches were undertaken on Pubmed, Embase, and Medline for all relevant studies, between January 2000 and September 2022 (n = 103). Studies were assessed using National Health and Medical Research Council guidelines to generate statements, which were discussed as a group, followed by voting on statements using a modified Delphi process to determine consensus. A total of 24 consensus statements were created for five key areas: patient selection, type and selection of feeding tube, complications, clinical use of jejunal tubes, follow-up, and reassessment. Jejunal tube feeding is a safe and effective means of providing nutrition in a select group of pediatric patients with complex medical needs, who are unable to be fed by gastric tube feeding. Appropriate patient selection is important as complications associated with jejunal tube feeding are not uncommon, and although mostly minor, can be significant or require tube reinsertion. All children receiving jejunal tube feeding should have multidisciplinary team assessment and follow-up.

Experiences and perceptions of multidisciplinary paediatric teams of blended tube feeding in children.

Background: Blended tube feeding (BTF) is the administration of pureed whole foods via gastric feeding tubes. There is some evidence to suggest that BTF may have clinical and psychosocial benefits when compared to commercial formula, but further investigation of how BTF is understood and recommended by health professionals is needed. This study aims to investigate awareness and knowledge of BTF among multi-disciplinary paediatric staff in Ireland. Methods: A cross-sectional observational study was conducted among paediatric staff in Children's Health Ireland (CHI). The 16-item anonymous online survey gathered information on awareness of BTF, willingness to recommend BTF, confidence in BTF knowledge, and self-assessed competence in managing BTF. Results: Of the 207 responses, doctors (n68), nurses (n66), and dietitians (n32) provided 80.3% of responses. Two-thirds (n136, 66%) of the total group were aware of BTF. Of these, 68.1% had cared for a child on BTF and 70% (n = 63/90) were willing to recommend BTF. Three in five (n = 39/63, 61.9%) stated they were somewhat confident in their BTF knowledge and one in five (n = 12/56, 21.4%) were not yet competent in managing children on BTF. The most common reasons for recommending BTF were parental desire (n17, 39.5%) and commercial formula intolerance (n15, 34.9%). The most common barrier to recommending BTF was family logistics (n18, 41.9%). The most valuable sources of information on BTF for two-thirds (68.3%) of participants were other healthcare professionals (HCPs) and patients/caregivers. Conclusion: Healthcare settings should provide evidence-based training to HCPs on BTF to optimise the treatment and safety of children under their care.

Laparoscopic Roux-en-Y feeding jejunostomy as a long-term solution for severe feeding problems in children

Enteral feeding is a common problem in children with gastric emptying disorders. Traditional feeding methods in these patients often show a high rate of complications and maintenance issues. Laparoscopic Roux-en-Y feeding jejunostomy (LRFJ) has been described in a few patients as a minimal invasive option for enteral access in these children. The aim of this study is to evaluate the outcomes of the LRFJ procedure in our tertiary referral center. We conducted a retrospective case-series including all patients, aged 0–18 years old, that underwent a LFRJ procedure between August 2011 and December 2020 for the indication of oral feeding intolerance due to delayed gastric emptying. Outcomes evaluated were complications (short and long term) and parenteral satisfaction. In total, 12 children were identified that underwent LRFJ for the indication of oral feeding intolerance due to delayed gastric emptying. A total of 16 complications were noted in 8/12 patients (67%). Severity classified by Clavien-Dindo were grade I (n = 13), grade II (n = 1), and grade IIIB (n = 2). In 11/12 patients, parents were satisfied with the results. Conclusions: Although minor complications after LRFJ are common in our patients, this technique is a safe solution in patients with gastric emptying disorders leading to a definitive method of enteral feeding and high parenteral satisfaction.What is Known:• Traditional tube feeding in children (duodenal, PEG-J-tubes) with severe delayed gastric emptying can be challenging with a high rate of complications and maintenance issues.• Open loop jejunostomy and Roux-en-Y jejunostomy are alternative, permanent methods of feeding but either invasive or are accompanied by severe complications. Little is known in the literature about laparoscopic Roux-en-Y feeding jejunostomy.What is New:• Laparoscopic Roux-en-Y feeding jejunostomy is a permanent, safe and minimal invasive alternative option for enteral feeding in children with severe delayed gastric emptying..

Nutrition and preparation of blenderized tube feeding in children and adolescents with neurological impairment: A scoping review.

BackgroundThe use of homemade tube feeding formula has become increasingly popular for children requiring enteral nutrition. This project aimed to investigate nutrition and preparation of blenderized tube feeding in the field of children and adolescents with neurological impairment.MethodsA scoping review was performed using established methodologies. In January 2021, we searched PubMed, Embase, CINAHL Complete, the Cochrane Central Register of Controlled Trials, and gray literature to identify relevant articles.Major findingsTwenty‐two papers were included describing the composition of food items, preparation procedures, and food safety. No randomized controlled trials and only a few prospective studies were included. A broad variety of food items from all food groups and many examples of recipes were presented. Most recipes provided 1.0 kcal/ml but tended to contain less energy and nutrients than expected, which could be due to preparation issues, such as sieving and the high viscosity of the blend. Preparation requires a commercial‐grade household blender and diligence to ensure thorough household hygiene for adequate food safety.ConclusionsThis review revealed practical experience in the nutrition and preparation aspects of blenderized tube feeding but minimal empirical evidence. Multiple examples of the composition of food items and preparation procedures for blenderized tube feeding were found, but uncertainty regarding the ideal composition or preparation was also exposed. The future of blenderized tube feeding would benefit from clinically tested recipes that include an evaluation of nutrients, viscosity, and microbial contamination, as well as the effect of the food's appearance and scent on the target group.

Blenderized tube feeding for children: an integrative review.

ABSTRACTObjective:To analyze scientific evidence on the use of blenderized tube feeding in children regarding nutritional composition, family satisfaction, and health outcomes.Data source:Survey was conducted in the PubMed, Scopus, Embase, and Virtual Health Library (VHL) databases using the following search terms: blenderized tube feeding OR blended tube feeding OR homemade OR pureed AND enteral nutrition AND enteral tube. The methodological quality of the selected articles was evaluated using the Critical Appraisal Skill Programme and Hierarchical Classification of Evidence.Data synthesis:After analysis, 11 articles were included in the present review. Most studies demonstrated improvements in health outcomes and greater family satisfaction after replacing the commercial enteral feeding with blenderized tube feeding.Conclusions:When guided and monitored by the healthcare team, a blenderized tube feeding ensures an adequate nutritional composition. The use of this method is also associated with positive health outcomes such as reductions in gastrointestinal symptoms and hospitalizations. Moreover, a high frequency of family satisfaction was verified.%

How to support parents and healthcare professionals in the decision-making process of tube feeding in children?

BackgroundTube feeding in children has a severe psychosocial impact on children and their families. Parents also feel that they have limited communication with healthcare professionals (HCPs) about decision-making and the implications of tube feeding. ObjectiveThis study focussed on the parents’ experiences and expectations about tube feeding of children and a solution to improve the management and communication of it. MethodsWe applied a design thinking method in two parts. First, focus groups and individual interviews were conducted with parents of children aged 0–10 years who are or had been tube fed and HCPs. Thereafter, two sounding boards with HCPs and parents were convened to discuss improvements in the management of tube feeding. ResultsIn total, 17 parents participated in the study. Two main topics derived from the focus groups and interviews: psychosocial impact and communication with HCPs. The sounding boards (five HCPs and two parents) divided the challenges of tube feeding into three stages: the moment tube feeding is considered, the insertion of the tube in the hospital, and transfer to the domestic environment and follow-up. Interview topics were used to develop a communication sheet to support the decision process of tube feeding. ConclusionsThe empowerment of parents in the process of tube feeding is important. More attention should be paid to alternatives, consequences, and planning for the long term. The developed communication sheet offers suggestions for issues to discuss and could support communication between parents and HCPs about tube feeding.

Utility of a specialized peptide-based enteral formula containing medium-chain triglycerides in provision of enteral tube feeding in children with cerebral palsy: data from prospective observational tolerup study

Rationale: The study aimed to evaluate the utility of enteral tube feeding (ETF) with specialized peptide-based formula (SPBEF) containing medium chain triglycerides (MTCs) in children with cerebral palsy (CP).

Evaluating the use of laparoscopic-assisted gastrostomy tube feeding in children with epidermolysis bullosa: A single-center retrospective study

BackgroundNutritional management of children with epidermolysis bullosa (EB) presents multiple challenges including reduced oral intake compounded by mucosal fragility. Gastrostomy tube feeding is effective in improving nutritional status however there is limited data on the safety and tolerance of this technique in EB children. We aim to review the effectiveness and morbidity of our minimally invasive two-port laparoscopic-assisted gastrostomy (LAG) approach using Seldinger techniques with serial dilatations in children with EB. MethodsA retrospective, observational cohort study was conducted on all consecutive EB patients who underwent LAG tube insertion between 2009 and 2019. Patient demographics, admission details and 12-month clinical outcomes were reported. Results32 EB patients underwent LAG placement. Median age at insertion was 7.3 (IQR ± 6.3) years, with 8 (25.0%) and 3 (9.4%) of patients also undergoing oesophageal dilatation and fundoplication, respectively. Minor complications arose in 58.1% of patients including: peri-stomal overgranulation (25.8%), gastrostomy infection (22.6%), pain (22.6%), mild gastrostomy leakage (16.1%), blockage (9.7%) and device failure (3.2%). 2 patients (6.5%) developed major complications with extensive gastrostomy site leakage. Improvements in growth were reflected in mean height Z-scores (-1.99 to -1.71). Mean weight Z-scores improved in patients aged 0–10 years (-2.30 to -1.61) and mean BMI Z-scores increased in patients more than 10 years (-2.71 to -1.46). No cases of gastrostomy-related mortality were reported. ConclusionLAG is well-tolerated in EB patients with improvements in growth and minimal morbidity 12-months post-gastrostomy insertion. An extended follow-up period is required to ascertain the long-term implications of gastrostomy feeding.

Организация диетического питания путем энтерального кормления через зонд у детей с хроническими заболеваниями почек 2-5-й стадии и на диализе: рекомендации по клинической практике от Рабочей группы по вопросам детского нефрологического питания

No abstract

Current trends in paediatric enteral tube feeding

Abstract The demand for enteral tube feeding in children is increasing globally. As our ability to manage complex medical conditions improves, so too does our understanding of the benefits of good enteral nutrition on health outcomes for these children. If oral feeding is not possible, an enteral tube can provide a viable alternative by delivering nutrition directly into the stomach or jejunum. The decision to recommend a child for long term tube feeding is complex and needs to be balanced against the potential risks. It is therefore essential that healthcare professionals keep up to date with the indications for referral, understand the current options available to children, and are able to identify common and serious problems that can arise following tube insertion. Healthcare professionals should also be aware of the debate surrounding the administration of blended feeds via the enteral tube. While some children may benefit from this practice, there are important considerations to be made for children receiving home blended feeds versus enteral formula. In this article, we review the indications for enteral tube insertion, device selection, complications and subsequent management. In addition, we review the logistics and implications for families and healthcare teams aiming to start blended tube feeding.

Therapeutic Efficacy of Nasoenteric Tube Feeding in Children Needing Enteral Nutrition.

Background: There is limited information on therapeutic benefits and tube-related complications of pediatric nasoenteric (NE) tube feeding. We viewed, from different clinical aspects, NE tube feeding in children who are under intolerable conditions.Methods: A 10-years retrospective study enrolled 77 pediatric patients who underwent an endoscopic-guided placement of the NE tube for enteral nutrition. The evaluated data, including growth parameters, feeding volume, parenteral nutrition (PN) dependence, and nutritional markers [serum hemoglobin (Hb) and albumin] before and after NE tube feeding were compared. Tube-related complications and major adverse events were also recorded.Results: A total of 77 patients (including 50 males) underwent 176 endoscopic-guided placements of the NE tube with an average duration of 133.7 (6.0–1,847.3) days. The gastroesophageal reflux disease-related symptoms (vomiting, desaturations, and aspiration pneumonia) improved in 71.4% of patients. Feeding volume increased significantly after intervention, especially in patients with delayed gastric emptying, from 144.8 ± 28.5 to 1,103.1 ± 524.7 ml/days (p < 0.001). Weaning from PN was successfully achieved in 84.3% of patients with an average of 9.33 ± 7.30 days. About 16 patients (20.8%) were subsequently highly compatible with oral feeding after NE tube placement for an average of 24.7 ± 14.1 days. Patients either without neurologic dysfunction or with no ventilator-dependent status had a higher chance of shifting to oral feeding. Weight-for-age z-scores increased by 0.15 ± 1.33 after NE tube intervention. One NE tube-related adverse event, which caused bowel perforation at 6 days post-insertion, was recorded. No direct tube-related mortality was observed.Conclusions: Endoscopic-guided NE tube placement is a relatively safe, non-invasive procedure for pediatric patients who require enteral nutrition. Feeding via NE tube showed beneficial effects such as improvement in symptoms, PN weaning, and maintenance of body growth without major tube-related complications.

Parental Perspectives on Family Mealtimes Related to Gastrostomy Tube Feeding in Children.

Built on the important functions daily routines serve families and child health, this study aimed to explore parents’ descriptions of mealtimes and food-related challenges when living with a child using a gastrostomy feeding tube. The study was informed by ecocultural theory and based on in-depth interviews combined with stimulated recall. The interviews of 10 parents were inductively analyzed by means of qualitative content analysis. Four main categories comprised the parents’ descriptions: “One situation, different functions,” “On the child’s terms,” “Doing something to me,” and “An unpredictable pattern,” with one overarching theme. The analyses showed that the parents strived to establish mealtimes in line with their cultural context, although they struggled to reach a point of satisfaction. The study highlights the importance of health care professionals to address the medical aspects of caring for a child with a G-tube, but also the potential psychological and social consequences for ordinary family life.

Long-term use of tube feeding in children with cystic fibrosis: results from two Belgian CF centers.

Enteral tube feeding (ETF) is often used in an attempt to optimize the nutritional status. The aim of this study was to observe the long term effect of ETF and to compare the start of ETF with the current European guidelines on nutrition care in CF. From all patients who received ETF (ETFp) between February 2000 and September 2016 in the Ghent University Hospital (GUH) or Brussels University Hospital (BUH), z-scores for body weight (W), height (H), growth velocity (GV) and BMI, FEV1%, and FVC% were retrospectively collected from the patients' medical record, 3 years before and 5 years after the year of ETF initiation. Gender, age, and pancreatic status matched controls were selected from the GUH database. All baseline (T0) measurements in ETFp were worse compared to controls. Only 11% of the controls had a Hz < -1.6 compared 58% of the ETFp. After the initiation of ETF a rapid weight gain was noted until the second year (T + 2:-1.9 (-2.8; -1.0) vs. T0:-2.7 (-3.2; -2.1) (p = 0.01) with a stabilization afterwards. A rapid GVz increase was noted at T + 1:1.0 (-0.8; 1.9) vs. T0:-1.5 (-2.0;-0.3). After the start of ETF until T + 3, a stabilization of FEV1% was noted. However, compared to controls, it remained significantly lower (p < 0.05). ETF as a nutritional intervention has its effect on weight, height, GV, and BMI. To our knowledge this is the first study that describes the evolution of growth in ETFp. The effect on GV argues for a faster introduction of ETF in malnourished children with CF.

Nasojejunal tube feeding in children: knowledge and practice

Nasojejunal tubes (NJ) are used in small numbers of children outside of neonatal and paediatric intensive care units. There is limited evidence on which to base practice aside from insertion techniques. Ongoing care and management is largely based on historical practice and extrapolation from nasogastric tube practice. This paper presents the historical caseload data for 36 babies and children over a five year period. The children ranged from 0 to 13 years of age, and 95% were less than 2 years old. They had a median of 4 tubes each (range 1 - 46). The paper presents data from two surveys of health professionals that demonstrate a lack of consistency in practice. There are concerns about ongoing position checks and about the radiation burden in these children. Local practice is described that aims to reduce dependence on x-ray procedures and to stimulate debate. Finally, an argument is made for a better evidence base for future practice.

Decision-making around gastrostomy tube feeding in children with neurologic impairment: Engaging effectively with families.

Children with neurologic impairment may not be able to feed safely or sufficiently by mouth to maintain an adequate nutritional state. Gastrostomy tube (G-tube) feeding is an important, often essential, intervention in such situations. However, many parents and families struggle with the decision to proceed with G-tube feeding. This practice point reviews common reasons for decisional conflict in parents and explores key aspects of life with G-tube feeding. A framework for shared decision-making and the International Classification of Functioning, Disability and Health (ICF) approach are highlighted. Practical recommendations for clinicians on engaging with families for decision-making around this life-changing intervention are provided.

280 Single centre long-term experience with tube feeding in children with cystic fibrosis

280 Single centre long-term experience with tube feeding in children with cystic fibrosis

WS05.6 The impact of tube feeding in children and adults with cystic fibrosis

WS05.6 The impact of tube feeding in children and adults with cystic fibrosis

Tube Feeding in Children.

1. Sarita Singhal, MD*,† 2. Susan S. Baker, MD, PhD*,† 3. Georgina A. Bojczuk, RD, CSP† 4. Robert D. Baker, MD, PhD*,† 1. *Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 2. †Digestive Diseases and Nutrition Center, Women and Children’s Hospital of Buffalo, Kaleida Health, Buffalo, NY Enteral tube feeding (TF) is an important part of the care of acutely ill children as well as an essential technique to deliver nutrition to children who have chronic conditions. However, the techniques of TF are neither a part of medical school courses nor specifically taught in pediatric residency programs. Thus, learning how to initiate, monitor, moderate, and transition TF is often learned by trial and error. After completing this article, readers should be able to: 1. Understand the need for nutritional assessment and nutrition support. 2. Recognize indications and contraindications for tube feeding (TF). 3. Plan the evaluation of a patient who requires TF. 4. Recognize the factors that are important to make the proper selection of enteral access for TF. 5. Plan the initiation and administration of TF. 6. Recognize the potential complications of TF and learn troubleshooting methods. 7. Coordinate care for home nutrition support and assist in the transition to oral feedings. 8. Understand the social needs of patients who have TF. Tube feeding (TF) is a mode of providing enteral nutrition when oral feeding is not possible or not sufficient. TF is delivered through a medical device that can be placed into the stomach, duodenum, or jejunum via either the nose, mouth, or the percutaneous route. This review focuses on TF in children beyond the neonatal period. Nutritional support can be either enteral or parenteral. Enteral nutrition (EN) refers to any method of feeding that uses the gastrointestinal (GI) tract to deliver part or all of a child's nutritional requirements. …

USING THE STOMACH IN SURGICAL CORRECTION OF ESOPHAGEAL ATRESIA WITH VACTER-ASSOCIATED MALFORMATIONS IN CHILDREN

Surgical treatment of diseases and congenital esophageal defects in children is one of the most difficult parts of pediatric surgery. The vast majority of orthotopic and heterotopic esophageal reconstructions in children falls on atresia or complications of chemical destruction.The present case illustrates the construction and implementation of a treatment plan for a child with esophageal atresia combined with microcephaly and VACTER-associated anomalies. In this case, the transposition of stomach into the thoracic cavity was used for esophageal atresia correction with a good result. Conclusion:1. Realization of esophageal shift by transposition of the stomach is one of the possible solutions to the complex problem of esophageal atresia correction associated with multiple malformations.2. Use of this technique creates optimal conditions for tube feeding in children with central nervous system disorders and violations of swallowing.