Tube Feeding In Children Research Articles

Prolonged Nasoenteral Tube Feeding in Children Contradicts Best Practice Guidelines

Abstract BACKGROUND: Expert consensus guidelines from the Canadian Pediatric Society and the American Academy of Pediatrics state that naso-enteral tube feeding is not appropriate for long term home nutrition support. Therefore, gastrostomy tubes are recommended for nutrition support predicted to last 2-3 months or more. A 2010 survey of pediatric health care providers at our institution demonstrated that 73% were unaware of these guidelines and 47% would consider a G tube only after 3-6 months. OBJECTIVES: The objective of this study is to determine whether the duration of nasoenteral tube feeding in children at our centre is consistent with expert consensus guidelines. DESIGN/METHODS: Prospectivechart review of all patients younger than 17 years of age referred for home nutrition support from January 2014 - July 2015 was conducted, with data collection until the present. RESULTS: 310 children were referred for nutrition support. Excluding patients out of province, lost to follow-up or deceased within a year from referral, 237 children were included. 88% were initially fed with a nasoen-teral tube; 76% of them were predicted to require tube feeding for months to years. 70% were fed with a nasoenteral tube for more than 3 months, with a mean duration of 4.8 months (range 0.07-20.3 months). 10% eventually underwent gastrostomy tube insertion, with a mean time to insertion of 9.7 months (0.07-20.3 months). CONCLUSION: The duration of nasoenteral tube feeding in a significant proportion of children is longer than recommended by expert consensus guidelines. An important contributing factor is lack of knowledge amongst pediatric health care practitioners about existing best practice guidelines.

Genes determining the severity of cerebral palsy: the role of single nucleotide polymorphisms on the amount and structure of apolipoprotein E.

Apolipoprotein E (apoE) influences repair and other processes in the brain, and the apoE4 variant is a risk factor for Alzheimer's disease and for prolonged recovery following traumatic brain injury. We previously reported that specific single nucleotide polymorphisms in the APOE or TOMM40 genes affecting the structure and production of apoE were associated with epilepsy, more impaired hand function and gastrostomy tube feeding in children with cerebral palsy (CP). This study explored how various combinations of the same polymorphisms may affect these clinical manifestations. Successful DNA analyses of APOE and TOMM40 were carried out on 227 children. The CP Register of Norway provided details of gross and fine motor function, epilepsy and gastrostomy tube feeding. Possible associations between these clinical manifestations and various combinations of the APOEε2, ε3 or ε4 alleles and of the rs59007384 polymorphism in the TOMM40 gene were explored. Epilepsy, impaired fine motor function and gastrostomy tube feeding were less common in children carrying the combination of rs59007384 GG and APOEε2 or ε3 than in children with other combinations. Our findings suggest that specific combinations of genes influence the structure and production of apoE differently and affect the clinical manifestations of CP.

The effect of 3% and 6% hypertonic saline in viral bronchiolitis: a randomised controlled trial.

Bronchiolitis is a common disorder in young children that often results in hospitalisation. Except for a possible effect of nebulised hypertonic saline (sodium chloride), no evidence-based therapy is available. This study investigated the efficacy of nebulised 3% and 6% hypertonic saline compared with 0.9% hypertonic saline in children hospitalised with viral bronchiolitis. In this multicentre, double-blind, randomised, controlled trial, children hospitalised with acute viral bronchiolitis were randomised to receive either nebulised 3%, 6% hypertonic saline or 0.9% normal saline during their entire hospital stay. Salbutamol was added to counteract possible bronchial constriction. The primary endpoint was the length of hospital stay. Secondary outcomes were need for supplemental oxygen and tube feeding. From the 292 children included in the study (median age 3.4 months), 247 completed the study. The median length of hospital stay did not differ between the groups: 69 h (interquartile range 57), 70 h (IQR 69) and 53 h (IQR 52), for 3% (n=84) and 6% (n=83) hypertonic saline and 0.9% (n=80) normal saline, respectively, (p=0.29). The need for supplemental oxygen or tube feeding did not differ significantly. Adverse effects were similar in the three groups. Nebulisation with hypertonic saline (3% or 6% sodium chloride) although safe, did not reduce the length of stay in hospital, duration of supplemental oxygen or tube feeding in children hospitalised with moderate-to-severe viral bronchiolitis.

Home enteral tube feeding in children with inherited metabolic disorders: a review of long‐term carer knowledge and technique

Home enteral tube feeding (HETF) is commonly used in children with inherited metabolic disorders (IMD). It is unclear how caregiver knowledge and their safety in using tube feeding techniques changes over time. Caregivers of children with IMD on HETF from one UK IMD centre had annual interviews over 3 years using a structured questionnaire and observation to assess HETF knowledge and safety techniques. Thirty-two caregivers of IMD children (median age 5.3 years; range 0.3-13.6 years) were studied. Seventy-eight percent (n = 25) of subjects had been on HETF for >5 years. Over 3 years, many caregivers' HETF techniques deteriorated: accurate feed ingredient measurement decreased from 36% to 11%; correct flushing of tubes decreased from 56% to 44%; checking tube position as recommended decreased from 72% to 56%; and correct hand washing decreased from 38% to 25%. Despite improvements, knowledge of some aspects remained poorly understood: dangers of incorrect tube placement increased from 41% to 56%; correct position for night feeding increased from 38% to 56%; and feed ingredient storage decreased from 87% to 38%. The HETF techniques of caregivers of children with IMD declined over time. Caregivers need to understand that HETF, particularly in IMD, is a serious procedure associated with life-threatening risks. Poor HETF practices may cause feed contamination, incorrect feed concentration, feed intolerance, aspiration, peritonitis and even metabolic decompensation. HETF skills should be reassessed annually, with compulsory retraining if basic 'core' HETF competencies are not demonstrated.

Gastrostomy Tube Feeding in Children with Epidermolysis Bullosa: Consideration of Key Issues

Complications of severe forms of epidermolysis bullosa (EB) almost invariably lead to chronic malnutrition, jeopardizing immune status, growth, iron status, bone health, wound healing, and quality of life. Although gastrostomy tube (G-tube) feeding has successfully addressed the difficulties of providing nutrition and medications in some children attending our center, others have developed problems such as abdominal distension, poor feed tolerance, and leakage of gastric contents with persistent localized skin ulceration, posing enormous challenges to skin management and nutritional maintenance. Suspicions that G-tube placement and feeding cause or exacerbate these problems has led to a decline in placements at our center over the last 10 years. We therefore recognized that it should not be rejected without due consideration of why some patients seem more prone to complications than others. Thus, information on selected issues and outcomes of G-tube placement was obtained from records of 66 patients undergoing surgery between 1989 and 2008. The complex interrelationships of the sequelae of severe EB, changes in practice over 20 years and lack of data for patients treated early in the series make it impossible to draw firm conclusions at this stage, however, our scrutiny provides valuable information on which to base debate and future studies. It also offers well as useful insights for fellow professionals involved in nutrition support in children with severe EB.

Percutaneous Endoscopic Gastrojejunostomy Tube Feeding in Children

Managing infants and children with difficult feeding problems, such as intractable vomiting and dysmotility, can be challenging. Maintaining sufficient enteral feeding is the ultimate goal. However, the options for establishing this goal may be limited. One option is gastrojejunostomy tube feeding, a technique developed in 1984. This review discusses indications and limitations of gastrojejunostomy tube feeding in children. It also discusses alternative options for gastrojejunostomy tube feeding in view of the available evidence.

Inpatient tube weaning in children with long-term feeding tube dependency: A retrospective analysis.

This study investigates the outcome of an intervention program to establish oral feeding after prolonged tube feeding in children. The intervention is based on supervised reduction of enteral formula within a few days supported by a 3-week program of speech therapy, occupational therapy, psychoanalytically based eating therapy, physical therapy, psychodynamic coaching, and nutritional counseling of the infant and his or her parents. Two hundred twenty-one cases were included in this study. All patients had been severely ill or were handicapped and had been exclusively fed by tube for most of their lives. The major outcome variable was complete discontinuation of tube feeding with sufficient oral feeding after treatment, defined as the child's ability to sustain stable body weight by self-motivated oral feeding. Two hundred three patients (92%) were completely fed orally after treatment. Tube feeding was discontinued completely within 8 days in mean, and mean in-patient treatment time was 21.6 days. The current method can be used by a trained and experienced team to wean tube-dependent children from prolonged tube feeding. Tube weaning should be addressed from the beginning of tube feeding in all children who are expected to restore oral feeding after the phase of nutritional stabilization. Since successful programs are rare, we were motivated to present our results of this elaborate program in this article.

Tube feeding in children with chronic kidney disease: technical and practical issues

This review discusses the indications for enteral feeding in children with chronic kidney disease, the types of feeding tubes that can be used, methods of insertion and their benefits and complications.

Home enteral tube feeding in children following percutaneous endoscopic gastrostomy: perceptions of parents, paediatric dietitians and paediatric nurses

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. 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. 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. 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.

A review of nasogastric tube management in children 1: Enteral feeding

This first article of two identifies the primary themes in the literature regarding nasogastric tube management in children. The principal focus is a critical evaluation of the methods, effects, experiences and outcomes of the primary theme, nasogastric tube feeding in children. This article concludes with the implications and recommendations for future nursing practice. The in-depth critical review encompassed a systematic and rigorous search of appropriate healthcare databases using appropriate search terms in conjunction with preset inclusion and exclusion criteria. The review divided the harvested primary papers into three key themes: enteral feeding via the nasogastric tube (considered here); confirmation of tube position and associated incidence of tube placement error; hydration via the nasogastric tube for acute gastroenteritis in children. Valid and reliable methods were used to grade and appraise the culled papers so that conclusions could be drawn and recommendations made. Three primary literary themes are identified from this investigation. The primary theme, enteral feeding using the nasogastric tube is contraindicated for a selection of children. In spite of these findings empirical evidence suggests the nasogastric tube as a safe and effective method for short term feeding in children with a variety of chronic conditions that can be regularly used at home and in hospital. Health professionals need to review their practice in relation to nasogastric tube management in children, and ensure their practice reflects the best available evidence.

Gastrostomy tube feeding in children with cerebral palsy: a prospective, longitudinal study

We report a longitudinal, prospective, multicentre cohort study designed to measure the outcomes of gastrostomy tube feeding in children with cerebral palsy (CP). Fifty-seven children with CP (28 females, 29 males; median age 4y 4mo, range 5mo to 17y 3mo) were assessed before gastrostomy placement, and at 6 and 12 months afterwards. Three-quarters of the children enrolled (43 of 57) had spastic quadriplegia; other diagnoses included mixed CP (6 of 57), hemiplegia (3 of 57), undiagnosed severe neurological impairment (3 of 57), ataxia (1 of 57), and extrapyramidal disorder (1 of 57). Only 7 of 57 (12%) could sit independently, and only 3 of 57 (5%) could walk unaided. Outcome measures included growth/anthropometry, nutritional intake, general health, and complications of gastrostomy feeding. At baseline, half of the children were more than 3SD below the average weight for their age and sex when compared with the standards for typically-developing children. Weight increased substantially over the study period; the median weight z score increased from -3 before gastrostomy placement to -2.2 at 6 months and -1.6 at 12 months. Almost all parents reported a significant improvement in their child's health after this intervention and a significant reduction in time spent feeding. Statistically significant and clinically important increases in weight gain and subcutaneous fat deposition were noted. Serious complications were rare, with no evidence of an increase in respiratory complications.

‘Striving officiously to keep alive’?

Developmental Medicine & Child NeurologyVolume 49, Issue 2 p. 83-83 Free Access ‘Striving officiously to keep alive’? Peter Baxter, Peter BaxterSearch for more papers by this author Peter Baxter, Peter BaxterSearch for more papers by this author First published: 25 January 2007 https://doi.org/10.1111/j.1469-8749.2007.00083.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 Sullivan PB, Juszczak E, Bachlet AM, Lambert B, Vernon-Roberts A, Grant HW, Eltumi M, McLean L, Alder N, Thomas AG. (2005) Gastrostomy tube feeding in children with cerebral palsy: a prospective, longitudinal study. Dev Med Child Neurol 47: 77 – 85. 2 Raina P, O'Donnell M, Rosenbaum P, Brehaut J, Walter SD, Russell D, Swinton M, Zhu B, Wood E. (2005) The health and well-being of caregivers of children with cerebral palsy. Pediatrics 115: e626 – 36. 3 Clough AH. (1869) The Poems and Prose Remains of Arthur Hugh Clough, with a Selection from His Letters and a Memoir; Edited by His Wife. Volume 2. London : Macmillan and Co. Citing Literature Volume49, Issue2February 2007Pages 83-83 ReferencesRelatedInformation

Gastrostomy feeding in cerebral palsy: too much of a good thing?

Developmental Medicine & Child NeurologyVolume 48, Issue 11 p. 869-869 Free Access Gastrostomy feeding in cerebral palsy: too much of a good thing? Erika Gisel, Erika GiselSearch for more papers by this author Erika Gisel, Erika GiselSearch for more papers by this author First published: 13 February 2007 https://doi.org/10.1111/j.1469-8749.2006.01903a.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Patrick J, Boland M, Stoski D, Murray GE. (1986) Rapid correction of wasting in children with cerebral palsy. Dev Med Child Neurol 28: 734 – 739. 2 Reilly S, Skuse D. (1992) Characteristics and management of feeding problems of young children with cerebral palsy. Dev Med Child Neurol 34: 379 – 388. 3 Rempel GR, Colwell SO, Nelson R P. (1988) Growth in children with cerebral palsy fed via gastrostomy. Pediatrics 82: 857 – 862. 4 Sanders KD, Cox K, Cannon R, Blanchard D, Pitcher J, Papathakis P, Varella L, Maughan R. (1990) Growth response to enteral feeding by children with cerebral palsy. J Parent and Ent Nutr 14: 23 – 26. 5 Stanley FJ, Blair E, Hockey A, Petterson B, Watson L. (1993) Spastic quadriplegia in Western Australia: a genetic epidemiological study. I. Case population and perinatal risk factors. Dev Med Child Neurol 35: 191 – 201. 6 Stevenson RD, Roberts CD, Vogtle L. (1995) The effects of non-nutritional factors on growth in cerebral palsy. Dev Med Child Neurol 37: 124 – 130. 7 Sullivan PB, Juszczak E, Bachlet AME, Lambert B, Vernon-Roberts A, Grant H W, Eltumi M, McLean L, Alder N, Thomas AG. (2005) Gastrostomy tube feeding in children with cerebral palsy: a prospective, longitudinal study. Dev Med Child Neurol 47: 77 – 85. Citing Literature Volume48, Issue11November 2006Pages 869-869 ReferencesRelatedInformation

Does gastrostomy tube feeding in children with cerebral palsy increase the risk of respiratory morbidity?

Background: Children with severe neurological impairment may have significant oral motor dysfunction and are at increased risk of nutritional deficiencies, poor growth, and aspiration pneumonia. Gastrostomy tube feeding is increasingly...

Gastrostomy tube feeding in children with cerebral palsy: a prospective, longitudinal study

Gastrostomy tube feeding in children with cerebral palsy: a prospective, longitudinal study

Gastrostomy tube feeding in children with cerebral palsy: a prospective, longitudinal study

We report a longitudinal, prospective, multicentre cohort study designed to measure the outcomes of gastrostomy tube feeding in children with cerebral palsy (CP). Fifty-seven children with CP (28 females, 29 males; median age 4y 4mo, range 5mo to 17y 3mo) were assessed before gastrostomy placement, and at 6 and 12 months afterwards. Three-quarters of the children enrolled (43 of 57) had spastic quadriplegia; other diagnoses included mixed CP (6 of 57), hemiplegia (3 of 57), undiagnosed severe neurological impairment (3 of 57), ataxia (1 of 57), and extrapyramidal disorder (1 of 57). Only 7 of 57 (12%) could sit independently, and only 3 of 57 (5%) could walk unaided. Outcome measures included growth/anthropometry, nutritional intake, general health, and complications of gastrostomy feeding. At baseline, half of the children were more than 38D below the average weight for their age and sex when compared with the standards for typically-developing children. Weight increased substantially over the study period; the median weight z score increased from -3 before gastrostomy placement to -2.2 at 6 months and -1.6 at 12 months. Almost all parents reported a significant improvement in their child's health after this intervention and a significant reduction in time spent feeding. Statistically significant and clinically important increases in weight gain and subcutaneous fat deposition were noted. Serious complications were rare, with no evidence of an increase in respiratory complications.

A Multicomponent Behavioral Program for Oral Aversion in Children Dependent on Gastrostomy Feedings

ABSTRACTObjectivesDescribe outcomes in nine children with Nissen fundoplication and feeding gastrostomy treated in a multicomponent feeding program. The importance of comprehensive evaluation, appetite regulation, and family‐focused intervention within a behavioral feeding program are discussed.MethodsProspective clinical intervention with dependent measures evaluated before treatment, after treatment, and at follow‐up.ResultsNine children (4 girls; mean age, 3.1 ± 1.2 years; range, 1.8–5.5 years) and their mothers were admitted for intensive treatment (mean duration, 11.4 ± 1.7 days; range, 5–16 days). At discharge, 4 of 9 (44%) children were weaned completely from gastrostomy feedings. The mean oral intake of all patients increased 50% from pretreatment to posttreatment assessment. At a mean of 3.1 ± 0.5 months (range, 2.4–3.6 months) after treatment, six of nine children were weaned completely from gastrostomy feedings. The percent of daily nutritional needs consumed orally increased from a pretreatment mean of 14.6% ± 21.2% (range, 0%–67%) to a posttreatment mean of 63.4% ± 18.3% (range, 34%–85%) and a follow‐up mean of 88.1% ± 25.1% (range, 30%–100%). The mean percent ideal body weight for height was not compromised during intensive treatment.ConclusionsShort‐term intensive biobehavioral treatment was successful in improving oral intake and weaning from gastrostomy tube feeding in children with Nissen fundoplication and feeding gastrostomy.

A multicomponent behavioral program for oral aversion in children dependent on gastrostomy feedings.

Describe outcomes in nine children with Nissen fundoplication and feeding gastrostomy treated in a multicomponent feeding program. The importance of comprehensive evaluation, appetite regulation, and family-focused intervention within a behavioral feeding program are discussed. Prospective clinical intervention with dependent measures evaluated before treatment, after treatment, and at follow-up. Nine children (4 girls; mean age, 3.1 +/- 1.2 years; range, 1.8-5.5 years) and their mothers were admitted for intensive treatment (mean duration, 11.4 +/- 1.7 days; range, 5-16 days). At discharge, 4 of 9 (44%) children were weaned completely from gastrostomy feedings. The mean oral intake of all patients increased 50% from pretreatment to posttreatment assessment. At a mean of 3.1 +/- 0.5 months (range, 2.4-3.6 months) after treatment, six of nine children were weaned completely from gastrostomy feedings. The percent of daily nutritional needs consumed orally increased from a pretreatment mean of 14.6% +/- 21.2% (range, 0%-67%) to a posttreatment mean of 63.4% +/- 18.3% (range, 34%-85%) and a follow-up mean of 88.1% +/- 25.1% (range, 30%-100%). The mean percent ideal body weight for height was not compromised during intensive treatment. Short-term intensive biobehavioral treatment was successful in improving oral intake and weaning from gastrostomy tube feeding in children with Nissen fundoplication and feeding gastrostomy.

Percutaneous endoscopic gastrostomy in children: 15 cases experience.

For long-term tube feeding in children, percutaneous endoscopic gastrostomy (PEG) has the advantages of a short surgical time, early feeding following surgery, and lower rate of complications. From July 2000 to September 2002, we enrolled fifteen children (mean age: 8.2 years old) who underwent PEG placement for long-term nutritional support. Their underlying diseases included mucopolysaccharidosis (MPS) type II severe form, mitochondrial disease, Ehlers-Danlos syndrome associated with Robin sequence, spinal muscular atrophy (SMA) type II, nesidioblastosis, neurofibromatosis and other neurological disorders. We assessed the complications and outcome in these patients after PEG placement. There were no difficulties in PEG tube-feeding after procedure. One patient had a wound infection at the insertion site which required parenteral antibiotic therapy. Symptomatic gastroesophageal reflux (GER) occurred in two patients and was controlled with medication. One patient developed a gastrocutaneous fistula, requiring surgical removal of the PEG tube. One patient underwent laparoscopic gastrojejunostomy and Nissen fundoplication for persistent vomiting. Two patients with mitochondrial disease expired. The other eleven devices have continued to function on follow-up. Placement of a PEG is a simple, feasible procedure for children with swallowing difficulty who require long-term nutritional support. Although complications may sometimes occur, in our experience many can be managed conservatively.

Home Enteral Tube Feeding in Children After Chemotherapy or Bone Marrow Transplantation

Total parenteral nutrition (TPN) has been the standard method of nutrition support for children with cancer receiving intensive chemotherapy or bone marrow transplantation who are taking inadequate calories at the time of hospital discharge. In an effort to reduce costs and improve outcome, we have been using enteral tube feedings in these children, both in hospital and at home. Between 1995 and 1997, 10 children with cancer and 1 child receiving intensive chemotherapy for disseminated Langerhan's cell histiocytosis received home enteral tube feedings. Small (6F or 8F) nasogastric (NG) tubes were used in 9 (82%) children, and 2 (18%) children were fed via percutaneous gastrostomies (G‐tube). Home enteral tube feedings were administered for a total of 512 days (NG = 188 and G‐tube = 324). The tubes were well tolerated, and the children had minimal complications despite neutropenia and thrombocytopenia. The cost of the home enteral tube feedings in these 11 children was $31,315 less than the cost of TPN.