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Mårtensson U, Jenholt Nolbris M, Mellgren K, Wijk H, Nilsson S. Meals are more than nutrition for children with a malignant or non-malignant disorder with a gastrostomy tube: A qualitative study. Eur J Oncol Nurs 2024; 72:102663. [PMID: 39068866 DOI: 10.1016/j.ejon.2024.102663] [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: 11/29/2023] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE To elucidate mealtime experiences of children hospitalized with a malignant or severe non-malignant disorder -and their parents-after a gastrostomy tube insertion. METHODS A qualitative design involving a child-centred care approach was used. Parents of children aged 1-18 years old who had received a gastrostomy tube during treatment for a malignant or non-malignant disorder were included, as were the children themselves when aged 5-18 years old. Semi-structured interviews with 21 families were carried out and a thematic analysis performed. RESULTS The findings were presented in four themes: changed meal conditions, a troublesome sensory dimension, aggravating obstacles and solving the unmanageable. Hospitalization involves challenges regarding environmental aspects, hospital food and side effects, contributing to impaired nutritional intake and aggravated mealtime situations. CONCLUSIONS Hospital environment and hospital food have a profound impact on children's nutritional intake and mealtime situations. In addition, sensory aspects and side effects aggravate the child's motivation to eat, resulting in demanding meals. The families described a gastrostomy tube as a valuable strategy for improving mealtime situations.
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Affiliation(s)
- Ulrika Mårtensson
- Faculty of Care Science, Work Life and Social Welfare, University of Borås, SE - 501 90, Borås, Sweden.
| | - Margaretha Jenholt Nolbris
- The Queen Silvia Children's Hospital, SE- 416 50, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, SE- 405 30, Gothenburg, Sweden.
| | - Karin Mellgren
- The Queen Silvia Children's Hospital, SE- 416 50, Gothenburg, Sweden; Department of Paediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE- 416 85 Gothenburg, Sweden.
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, SE- 405 30, Gothenburg, Sweden; Chalmers Technology University/Centre for Health Care Architecture, SE- 412 96, Gothenburg, Sweden.
| | - Stefan Nilsson
- The Queen Silvia Children's Hospital, SE- 416 50, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, SE- 405 30, Gothenburg, Sweden; Centre for Person-Centred Care, University of Gothenburg, SE- 405 30, Gothenburg, Sweden.
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2
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Kaskie S, Horsley M, Marcuccio E. Experiences in Tube Weaning Children with Congenital Heart Disease and Oral Feeding Aversion. Pediatr Cardiol 2024:10.1007/s00246-024-03515-8. [PMID: 38744695 DOI: 10.1007/s00246-024-03515-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
Infants and children with congenital heart disease (CHD) often require supplemental nutrition via tube feeding before and after surgery. Tube feeding may be required due to poor weight gain, inadequate oral-motor skills, and/or reduced endurance for oral feeding. Our team has described a successful approach to weaning this population (Horsley et al. (2022) Pediatr Cardiol 43:1429-1437). A subgroup of tube-fed patients with CHD who demonstrate oral feeding aversion (OA) presents unique challenges to the tube weaning process. We discuss our team's experience with tube weaning orally averse children with CHD. Of 36 patients enrolled in the Cincinnati Children's Heart Institute Cardiology Feeding Tube Wean Clinic, 11 (31%) were determined to have oral feeding aversion (OA) by a speech-language pathologist (SLP). Descriptive data comparing the OA group to the non-averse group was gathered prior to and during the wean. Both groups had the ability to tube wean successfully, although the OA group had lower median oral intake (9 vs 24%) and higher age at start of the wean (9 vs 4 months). Those with OA also had a longer median duration of wean in days (17 vs 12 days) and higher likelihood of return to tube feeds within six-month post-wean (22 vs 0%). Additionally, the OA group had a higher percentage of genetic syndromes (36 vs 16%), although this was not found to be statistically significant in this study. Children with OA present with unique challenges for tube weaning. The results of this study show that weaning children with CHD and OA is possible with a multidisciplinary team who is knowledgeable about this population.
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Affiliation(s)
- Sarah Kaskie
- Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
| | - Megan Horsley
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elisa Marcuccio
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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3
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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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Clancy O, McCormack S, Graham M, O'Sullivan K, Bennett AE. Experiences and perceptions of multidisciplinary paediatric teams of blended tube feeding in children. Nutr Health 2024:2601060231218049. [PMID: 38281935 DOI: 10.1177/02601060231218049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
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.
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Affiliation(s)
- Orlaith Clancy
- Department of Clinical Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, Dublin, Ireland
| | | | - Meave Graham
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | | | - Annemarie E Bennett
- Department of Clinical Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, Dublin, Ireland
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Killian HJ, Bakula DM, Wallisch A, Swinburn Romine R, Fleming K, Edwards ST, Bruce AS, Chang CN, Mousa H, Davis AM. Pediatric Tube Weaning: A Meta-Analysis of Factors Contributing to Success. J Clin Psychol Med Settings 2023; 30:753-769. [PMID: 36856955 PMCID: PMC10989027 DOI: 10.1007/s10880-023-09948-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 03/02/2023]
Abstract
Approximately 3-10% of children have severe feeding issues, and some require enteral/tube nutrition to grow and thrive. For many children, tube feeding is temporary, making efficacious interventions for tube weaning essential. We conducted a systematic review and meta-analysis of tube weaning treatments. Outcomes included percentage of participants completely weaned from the tube, and mean percentage of kilocalories consumed orally following treatment. Data were extracted from 42 studies, including cohort studies and single-subject research design studies. We evaluated moderators of treatment success, including treatment setting, use of behavioral approaches, use of hunger provocation, and use of a multidisciplinary approach. Results indicated that, after treatment, children received significantly more calories orally, and 67-69% of children were fully weaned. These analyses suggest that current interventions are generally effective; however, variability within treatments exist. Prospective randomized clinical trials are needed to understand effective components of weaning interventions.
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Affiliation(s)
- Haley J Killian
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry St, Kansas City, MO, USA.
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO, USA.
| | - Dana M Bakula
- Division of Pediatric Gastroenterology, University of Missouri-Kansas City, 2411 Holmes, Kansas City, MO, 64108, USA
- School of Medicine, University of Missouri-Kansas City, 2411 Holmes, Kansas City, MO, 64108, USA
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO, USA
| | - Anna Wallisch
- Juniper Gardens Children's Project, University of Kansas, 444 Minnesota Ave #300, Kansas City, KS, USA
| | - Rebecca Swinburn Romine
- Life Span Institute, Dole Human Development Center, University of Kansas, 1000 Sunnyside Ave, Lawrence, KS, USA
| | - Kandace Fleming
- Life Span Institute, Dole Human Development Center, University of Kansas, 1000 Sunnyside Ave, Lawrence, KS, USA
| | - Sarah T Edwards
- Division of Pediatric Gastroenterology, University of Missouri-Kansas City, 2411 Holmes, Kansas City, MO, 64108, USA
- School of Medicine, University of Missouri-Kansas City, 2411 Holmes, Kansas City, MO, 64108, USA
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO, USA
| | - Amanda S Bruce
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO, USA
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, USA
| | - Chi-Ning Chang
- Department of Foundations of Education, School of Education, Virginia Commonwealth University, 1015 W. Main Street, PO Box 842020, Richmond, VA, USA
| | - Hayat Mousa
- Division of Gastroenterology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
| | - Ann M Davis
- Center for Children's Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO, USA
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, USA
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6
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Pahsini K, Marinschek S, Reininghaus EZ, Dalkner N, Bengesser SA, Mörkl S, Russell M, Russell AN, Scheer PJ, Dunitz-Scheer M. The Association of Tube Weaning and Oral Skill Development in Infants With Tube Dependency: A Prospective Study. J Pediatr Gastroenterol Nutr 2023; 77:e54-e60. [PMID: 37307357 DOI: 10.1097/mpg.0000000000003856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study was the first of its kind by assessing oral skills development during and after applying the "Graz Model" of tube weaning. METHODS This prospective case series study included data of 67 (35 females, 32 males, treated from March 2018 to April 2019) tube dependent children, who participated in the effective "Graz Model" of tube weaning. Parents filled out the standardized Pediatric Assessment Scale for Severe Feeding Problems (PASSFP) prior to and immediately after completion of the program. Paired sample t tests were conducted to examine pre-to-post changes in the children's oral skills. RESULTS The study showed that oral skills increased significantly during tube weaning PASSFP score of 24.76 (standard deviation, SD = 12.38) prior to versus 47.97 (SD = 6.98) after completion of the program. Furthermore, significant changes in their sensory and tactile perception and in their general eating behavior were observed. Children also showed reduced oral aversion symptoms and food pocketing, could enjoy their meals, and increased their food repertoire. Mealtime duration could be decreased, and parents were less anxious about their infants' intake and less frustrated because of their children's eating behavior. CONCLUSION The results of this study demonstrated for the first time that tube dependent children can improve their oral skills significantly during and after their participation in the child-led approach of the "Graz model" of tube weaning.
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Affiliation(s)
- Karoline Pahsini
- From the Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sabine Marinschek
- From the Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Eva Z Reininghaus
- From the Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Nina Dalkner
- From the Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne A Bengesser
- From the Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- From the Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Marion Russell
- the Department of Occupational Therapy, Creighton University, Omaha, NE
| | | | - Peter J Scheer
- the Department of Pediatric and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Marguerite Dunitz-Scheer
- the Department of Pediatric and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
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Grunewald W, Smith AR, Brown TA. Treatment of avoidant-restrictive food intake disorder in an older adult: A proof-of-concept case study. Int J Eat Disord 2023; 56:1795-1800. [PMID: 37097823 DOI: 10.1002/eat.23973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE Cognitive behavioral therapy for Avoidant Restrictive Food Intake Disorder (ARFID; CBT-AR) is an emerging treatment for ARFID. However, this treatment modality has yet to be examined among older adults (e.g., older than 50 years) or with adults presenting with feeding tubes. To inform future versions of CBT-AR, we present the results of a singular case study (G) of an older male with the sensory sensitivity phenotype of ARFID who presented for treatment with a gastrostomy tube. METHODS G was a 71-year-old male who completed eight sessions of CBT-AR in a doctoral training clinic. ARFID symptom severity and comorbid eating pathology changes were examined pre- and post-treatment. RESULTS Posttreatment, G reported significant decreases in ARFID symptom severity and no longer met diagnostic criteria for ARFID. Furthermore, throughout treatment, G reported significant increases in his oral food consumption (vs. calories being pushed through the feeding tube), solid food consumption, and the feeding tube was ultimately removed. DISCUSSION This study provides proof of concept that CBT-AR is potentially effective for older adults and/or those presenting for treatment with feeding tubes. Validation of patient efforts and severity of ARFID symptoms emerged as core to treatment success and should be emphasized when training clinicians in CBT-AR. PUBLIC SIGNIFICANCE Cognitive behavior therapy for ARFID (CBT-AR) is the leading treatment for this disorder; however, it has yet to be tested among older adults or those with feeding tubes. This single-patient case study demonstrates that CBT-AR may be efficacious in reducing ARFID symptom severity among older adults with a feeding tube.
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Affiliation(s)
- William Grunewald
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - April R Smith
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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8
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Eseonu D, Dongarwar D, Salihu H, Chumpitazi BP, Shulman RJ. Many pediatric patients with gastroparesis do not receive dietary education. BMC Gastroenterol 2023; 23:240. [PMID: 37460973 DOI: 10.1186/s12876-023-02865-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Gastroparesis is delayed gastric emptying in the absence of obstruction; dietary modifications are first-line treatment. However, we do not know the factors related to provision of dietary recommendations. METHODS We sought to determine how often pediatric patients with gastroparesis receive dietary education (from a gastroenterology provider vs dietitian), the recommendations given, and factors related to these outcomes. We performed a retrospective chart review of children 2- to 18-years-old managed by pediatric gastroenterology providers at our institution. Patient demographics and clinical data, dietary advice given (if any), and dietitian consultation (if any), practice location, and prokinetic use were captured. An adjusted binomial regression model identified factors associated with dietary education provision, dietitian consultation, and diet(s) recommended. RESULTS Of 161 patients who met criteria, 98 (60.8%) received dietary education and 42 (26.1%) met with a dietitian. The most common recommendation by gastroenterology providers and dietitians was diet composition adjustment (26.5% and 47.6%, respectively). Patients with nausea/vomiting were less likely to receive dietary education or be recommended to adjust diet composition. Patients with weight loss/failure to thrive were more likely to receive dietitian support. Patients seen in the community vs medical center outpatient setting were more likely to be recommended a low-fat diet. CONCLUSIONS Only a little over half of children with gastroparesis receive dietary education and use of a dietitian's expertise is much less frequent. Symptoms and clinical setting appear related to what, where, and by whom guidance is provided.
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Affiliation(s)
- Debra Eseonu
- Baylor Scott and White Medical Center, 1901 SW H K Dodgen Loop, Temple, TX, 76502, USA
| | - Deepa Dongarwar
- University of Texas Medical School at Houston, 6431 Fannin St, Houston, TX, 77030, USA
| | - Hamisu Salihu
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Bruno P Chumpitazi
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
- USDA/ARS Children's Nutrition Research Center, 1100 Bates Ave, Houston, TX, 77030, USA
| | - Robert J Shulman
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
- USDA/ARS Children's Nutrition Research Center, 1100 Bates Ave, Houston, TX, 77030, USA.
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9
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Waddle C, Gillespie SE. Examination of pediatric tube feeding schedules and oral intake: A retrospective cross-sectional study. Nutr Clin Pract 2023; 38:458-464. [PMID: 36172890 DOI: 10.1002/ncp.10912] [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: 03/08/2022] [Revised: 08/09/2022] [Accepted: 08/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A common treatment goal for children dependent on enteral feeding is to advance oral nutrition intake and decrease enteral feeding dependence. The purpose of this study was to investigate the relationship between tube feeding schedule and oral intake in feeding tube-dependent children diagnosed with avoidant restrictive food intake disorder (ARFID). METHODS A retrospective chart review was completed including 76 tube-dependent children with ARFID between the ages of 1 and 14 years who were evaluated by a registered dietitian, in conjunction with a multidisciplinary feeding team, during January 1, 2018, to May 31, 2019. Eligible participants were diagnosed with ARFID and receiving enteral nutrition via nasogastric or gastrostomy tube during the time of evaluation. The participants were categorized into groups according to tube feeding schedule type (bolus vs. overnight continuous) and further stratified by severity of oral motor deficit, as documented by the speech language pathologist or occupational therapist: none/mild and moderate/severe. The exclusion criteria included children aged <1 year, appetite stimulant listed as an active medication, overnight enteral feeding infusion of >12 h, or calculated percentage of calories from oral intake not specified. The primary study outcome was dichotomized percentage of oral intake, >0% vs 0%. RESULTS Following adjustment for confounders, this retrospective chart review showed statistically higher odds of percentage of oral intake >0% in ARFID patients receiving overnight continuous enteral feeding schedules (odds ratio = 0.20, 95% CI: 0.05-0.83, P = 0.027). CONCLUSION A bolus feeding schedule may not promote oral intake in feeding tube-dependent children diagnosed with ARFID.
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Affiliation(s)
- Caitlin Waddle
- Multidisciplinary Feeding Program, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Scott E Gillespie
- Department of Pediatrics, Pediatric Statistics Core, Emory University School of Medicine, Atlanta, Georgia, USA
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10
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Nucci AM, Samela K, Bobo E, Wessel J. Complementary food introduction practices in infants with intestinal failure. Nutr Clin Pract 2023; 38:177-186. [PMID: 35762260 DOI: 10.1002/ncp.10883] [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: 02/17/2022] [Revised: 04/08/2022] [Accepted: 05/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Oral intake in infants with intestinal failure (IF) may be limited due to intolerance or feeding difficulties. Guidelines for the introduction of semisolid or solid complementary foods (CFs) to infants with IF do not exist. CF intake and caloric contribution from CF is difficult to assess due to malabsorption and incomplete recording. The aim of this study was to identify institutional approaches to introducing CF to infants with IF. METHODS The American Society for Parenteral and Enteral Nutriton (ASPEN) Pediatric Intestinal Failure Section Registered Dietitian/Nutritionist (RDN) working group designed a 10-question online cloud-based survey to assess group member practice related to the introduction of CF to infants with IF. RESULTS Twenty-six surveys were completed. Thirteen (50%) RDNs recommend introduction of CF between 4 and 6 months of age. Nineteen (76%) recommend adding pureed foods to gastrostomy tube feedings. Seventeen (65%) follow standard infant feeding practice guidelines with half citing the American Academy of Pediatrics. Approximately half (44%) recommend introducing vegetables first and the majority (80%) recommend delaying the introduction of fruits. The vast majority (92%) recommend specific foods to minimize stool output including green beans, bananas, infant cereals, and meats/protein. CONCLUSION Institutional practices related to the introduction of CF to infants with IF vary. Similarities with first food choice and foods to avoid were observed. Evidenced-based practice guidelines for the introduction of CF to infants with IF need to be established to determine best practices for reducing stool output, encouraging weaning from parenteral nutrition, and achieving enteral autonomy.
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Affiliation(s)
- Anita M Nucci
- Department of Nutrition, Georgia State University, Atlanta, Georgia, USA
| | - Kate Samela
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Connecticut Children's, Hartford, Connecticut, USA
| | - Elizabeth Bobo
- Department of Gastroenterology and Nutrition, Nemours Children's Health, Jacksonville, Florida, USA
| | - Jacqueline Wessel
- Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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11
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Miranda PP, Levy DS, Kieling RR. Aspiration in the First Year of Life and Later Tube Feeding: A Retrospective Cohort from a Low-Income Country. Dysphagia 2023; 38:192-199. [PMID: 35476230 DOI: 10.1007/s00455-022-10450-4] [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: 09/17/2021] [Accepted: 04/04/2022] [Indexed: 01/27/2023]
Abstract
The objective of this study is to investigate in infants submitted to videofluoroscopic swallowing study (VFSS) during the first year of life, the association between aspiration and later tube feeding, and to identify potential risk factors related to feeding route outcome. Retrospective cohort study with data from electronic health records was performed. Data were collected from infants < 12 months of age who underwent VFSS during inpatient hospital stay in the period between 2013 and 2018. Patient charts after 24 months of age were reviewed to ascertain the outcome and study factors, including VFSS findings, neonatal data, clinical comorbidities, nutritional status, ICU admissions, and hospital readmissions. Relative risk (RR) for tube feeding was calculated, and a Poisson regression with robust variance was used to identify potential risk factors. VFSS data from 164 patients < 1 year old were retrieved, of whom 112 (68%) contributed with data about feeding route after 2 years of age. Most infants were preterm < 37 weeks (66%), with a median age of 9.28 weeks at the time of the exam. Aspiration occurred in 33% of the patients, with no statistically significant difference between full-term or premature infants (p = 0.173). The relative risk of tube feeding after the age of 2 among infants who aspirated in VFSS was 0.74 (CI 0.25-2.16, p = 0.573). Poisson regression analysis showed that number of hospital readmissions (RR 1.04, 95%CI 1.01-1.07, p = 0.005) and gestational age < 34 weeks (RR 0.26, 95%CI 0.07-0.089, p = 0.032) were associated with later tube feeding. Early VFSS findings have low predictive value regarding later feeding route. Aspiration events should be considered as complementary information for clinical decision.
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Affiliation(s)
- Priscilla Poliseni Miranda
- Graduate Program in Child and Adolescent, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Deborah Salle Levy
- Speech and Language Pathology Service, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos Street, 2350 - Room 1045, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil
- Department of Health and Human Communication, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Renata Rocha Kieling
- Graduate Program in Child and Adolescent, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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12
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Dadich A, Kaplun S, Kaplun C, Hopwood N, Elliot C. 'it was that … specialist … that finally listened to us … that's probably a weird answer to what you were expecting': Clinician and carer perspectives on brilliant feeding care. Health Expect 2022; 26:488-497. [PMID: 36482799 PMCID: PMC9854327 DOI: 10.1111/hex.13683] [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: 07/26/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION To extend research on positive aspects of health care, this article focusses on health care for children who tube-feed-this is because knowledge about tube-feeding for children is limited and fragmented. This is achieved by consulting with clinicians and carers who supported children who tube-feed to clarify their understandings of and experiences with brilliant feeding care. METHODS Nine clinicians and nine carers who supported children who tube-fed were interviewed. The interview transcripts were analysed thematically. RESULTS Findings highlighted several features of brilliant feeding care-namely: practices that go above and beyond; attentiveness; empowerment; being 'on the same page'; hopefulness and normalcy. CONCLUSIONS These findings show that seemingly trivial or small acts of care can make a significant meaningful difference to carers of children who tube-feed. Such accounts elucidate brilliant care as grounded in feasible, everyday actions, within clinicians' reach. The implications associated with these findings are threefold. First, the findings highlight the need for clinicians to listen, be attuned and committed to the well-being of children who tube-feed and their carers, share decision-making, source resources, and instil hope. Second, the findings suggest that carers should seek out and acknowledge clinicians who listen, involve them in decision-making processes, and continue to source the resources required to optimize child and carer well-being. Third, the findings point to the need for research to clarify the models of care that foster brilliant feeding care, and the conditions required to introduce and sustain these models. PATIENT OR PUBLIC CONTRIBUTION All of the carers and clinicians who contributed to this study were invited to participate in a workshop to discuss, critique, and sense-check the findings. Three carers and one clinician accepted this invitation. Collectively, they indicated that the findings resonated with them, and they agreed with the themes, which they indicated were well-substantiated by the data.
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Affiliation(s)
- Ann Dadich
- School of BusinessWestern Sydney UniversityParramattaNSWAustralia
| | - Simone Kaplun
- School of BusinessWestern Sydney UniversityParramattaNSWAustralia
| | - Cathy Kaplun
- Transforming early Education and Child Health (TeEACH) Strategic Research InitiativeWestern Sydney UniversityWestmeadNew South WalesAustralia
| | - Nick Hopwood
- Faculty of Arts and Social ScienceUniversity of Technology SydneyBroadwayNew South WalesAustralia
| | - Christopher Elliot
- Department of PaediatricsSt George HospitalKogarahNew South WalesAustralia
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13
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Cipolla J, Reeves-Latour J, Ramsay M, Li P. Mothers' experiences and perceptions of their child's weaning process from tube feeding within a multidisciplinary Paediatric Feeding Program. Paediatr Child Health 2022; 27:353-358. [PMID: 36200097 PMCID: PMC9528776 DOI: 10.1093/pch/pxac055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/19/2022] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES Previous studies have described the negative impact that tube feeding of children with complex chronic diseases has on the caregivers' emotions, relationships and daily life. It is unclear whether these negative experiences persist or change during and after the weaning process. We sought to explore mothers' experiences and perceptions of their child being weaned off tube feeding within a Paediatric Feeding Program (PFP). METHODS We conducted a qualitative study using semi-structured interviews with mothers whose children <4 years old had experienced feeding tube weaning within an outpatient, family-centred, telemedicine-supported PFP. The transcripts were analyzed using thematic analysis. RESULTS We conducted 9 interviews with mothers of children (n = 10) in the PFP at which point data saturation was achieved. Three main themes emerged: a) the initial emotional toll on mothers stemming from fear of perceived adverse consequences of decreasing tube feeds and uncertainty surrounding efficacy of weaning; b) achievement of weaning via a family-centered approach through gaining trust, close contact, and collaboration with the team; and c) attainment of mothers' expectations of family life through transformed relationships and social activities. A positive evolution of emotions was observed, attributable to the support of the PFP. CONCLUSIONS These experiences suggest that our outpatient weaning program had a positive impact on the stress, fear, and relational challenges that mothers reported before and during initial tube weaning. These findings highlight potential areas of discussion with families at multiple stages of the child's tube feeding experience, to help normalize emotions for families and support coping strategies.
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Affiliation(s)
- Josie Cipolla
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Jonathan Reeves-Latour
- Centre for Outcomes Research and Evaluation, the Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Maria Ramsay
- Department of Psychology, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Patricia Li
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, the Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
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14
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Dipasquale V, Aumar M, Ley D, Antoine M, Romano C, Gottrand F. Tube Feeding in Neurologically Disabled Children: Hot Topics and New Directions. Nutrients 2022; 14:nu14183831. [PMID: 36145204 PMCID: PMC9506511 DOI: 10.3390/nu14183831] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022] Open
Abstract
Tube feeding is a therapeutic intervention that is aimed at providing nutritional support and is important in the nutritional and gastrointestinal management of children with neurological disability (ND) worldwide. Since the publication of the first European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) consensus paper in 2017, some aspects of tube-feeding modalities have attracted the interest of the scientific community more than others, including the type of enteral formulas, enteral access, and the challenging practice of tube weaning. The purpose of this review was to report on the most recent hot topics and new directions in tube-feeding strategies for children with ND.
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Affiliation(s)
- Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”, 98124 Messina, Italy
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
- Correspondence:
| | - Madeleine Aumar
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
- University Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, F59000 Lille, France
| | - Delphine Ley
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
- University Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, F59000 Lille, France
| | - Matthieu Antoine
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”, 98124 Messina, Italy
| | - Frédéric Gottrand
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
- University Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, F59000 Lille, France
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15
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Kooij M, Koster E, Eveleens R, Joosten K. Nutritional follow-up in children after discharge: Organisation in a tertiary care centre. J Hum Nutr Diet 2022; 36:664-672. [PMID: 36062542 DOI: 10.1111/jhn.13083] [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: 01/13/2022] [Accepted: 08/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND To improve the standard of care for patients with a nutritional intervention we aim to evaluate how nutritional follow-up (FU) is organized at discharge and after 6 months. METHODS From November 16, 2020 until December 20, 2020 we retrospectively included patients admitted >1 day to the general ward of a tertiary hospital. Medical charts were reviewed for demographics, anthropometric measurements and nutritional interventions (e.g. tube, parenteral nutrition). Involved health care provider (HCP), dietician and speech and language therapist (SLT) was scored. Nutritional care FU was categorised as in a primary, secondary or tertiary care setting. RESULTS We included 206 (52.4% male) patients, median length of stay (LOS) of 4 [3 - 8] days. Pre-hospitalisation 58 (28.2%) patients had a nutritional intervention compared to 74 (35.9%) patients at discharge. In total 80 (38.8%) patients received nutritional care FU by a total of 114 HCP, approximately half (53.5%) were dieticians. FU was mostly conducted by a dietician in the tertiary care (78.7%) and by an SLT in the primary care (54.5%). For 15 (20.3%) patients the discharge letter included complete reports of nutritional interventions. At 6 months FU 26.6% of the children still had a nutritional intervention. Mean weight SDS increased significantly between discharge from the hospital and 6 months FU. CONCLUSION A considerable amount of paediatric patients received a nutritional intervention pre- and post-hospitalisation. Nutritional care is organised around a multitude of different HCP, however not in all cases multidisciplinary. Nutritional care was scarcely reported correctly in the discharge letter. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marissa Kooij
- Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, Netherlands
| | - Emma Koster
- Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Koen Joosten
- Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, Netherlands
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Grentz L, Furfari K, Keifer R, Potter NL. Appetite guided approach to pediatric enteral tube weaning in the home setting pilot study. JPEN J Parenter Enteral Nutr 2022; 46:1725-1730. [PMID: 35526140 DOI: 10.1002/jpen.2394] [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: 01/06/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Infants and children, who temporarily use feeding tubes to maintain body composition and growth, often have difficulty resuming oral feeds once medically stable. We report survey results from Growing Independent Eaters (GIE), an interdisciplinary approach providing home-based virtual support during a child-led appetite guided enteral wean. METHOD Surveys addressing participant wean success, weight, and feeding practices were sent to 76 families who participated in a GIE-led wean; 31 surveys were completed and returned. RESULTS All participants who were not eating or drinking orally pre-wean, fully or partially weaned off enteral support. Infants weaned faster (37.7 days) than children (80.1 days). Mean weight loss during the intervention was 6.6% for infants and 5.9% for children. Six-months post-wean 93% of participants surpassed their pre-wean weight. CONCLUSION The GIE method was successful for weaning infants and children off enteral support. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lisa Grentz
- Growing Independent Eaters, Spokane, Washington, USA
| | - Kristin Furfari
- Growing Independent Eaters, Spokane, Washington, USA
- Department of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Rebekah Keifer
- Growing Independent Eaters, Spokane, Washington, USA
- Department of Speech and Hearing Sciences, Washington State University, Spokane, Washington, USA
| | - Nancy L Potter
- Department of Speech and Hearing Sciences, Washington State University, Spokane, Washington, USA
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17
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Weaning children from prolonged enteral nutrition: A position paper. Eur J Clin Nutr 2022; 76:505-515. [PMID: 34462558 DOI: 10.1038/s41430-021-00992-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/17/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023]
Abstract
Enteral nutrition (EN) allows adequate nutritional intake in children for whom oral intake is impossible, insufficient or unsafe. With maturation and health improvements, most children ameliorate oral skills and become able to eat orally, therefore weaning from EN becomes a therapeutic goal. No recommendations currently exist on tube weaning, and practices vary widely between centres. With this report, the French Network of Rare Digestive Diseases (FIMATHO) and the French-Speaking Group of Paediatric Hepatology, Gastroenterology and Nutrition (GFHGNP) aim to develop uniform clinical practice recommendations for weaning children from EN. A multidisciplinary working group (WG) encompassing paediatricians, paediatric gastroenterologists, speech-language therapists, psychologists, dietitians and occupational therapists, was formed in June 2018. A systematic literature search was performed on those published from January 1, 1998, to April 30, 2020, using MEDLINE. After several rounds of e-discussions, relevant items for paediatric tube weaning were identified, and recommendations were developed, discussed and finalized. The WG members voted on each recommendation using a nominal voting technique. Expert opinion was applied to support the recommendations where no high-quality studies were available.
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18
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Feeding outcomes in post-discharge feeding clinic for infants following cardiac surgery. Cardiol Young 2022; 32:628-635. [PMID: 34304751 DOI: 10.1017/s1047951121002833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The aim of this study was to describe the development and assess the usefulness of a feeding clinic to help infants with CHD tolerate the highest level of oral feeding while achieving growth velocity and supporting neurodevelopment. MATERIALS AND METHODS This retrospective, cohort study assessed feeding outcomes for infants who underwent cardiac surgery at <30 days of age with cardiopulmonary bypass between February 2016 and April 2020. Diagnoses, age at surgery, hospitalisation variables, and feeding outcomes were compared between two cohorts, pre- and post-implementation of a specialised feeding clinic using Exact Wilcoxon signed-rank test, chi-squared, or Fisher's exact test. The association between time to full oral feed and risk factors was assessed using univariable and multivariable Cox regression model. RESULTS Post-clinic infants (n = 116) surgery was performed at a median of 6 days of life (interquartile range: 4, 8) with median hospital length of stay of 19 days (interquartile range: 16, 26). Infants' median age at first clinic visit was at 30 days old (interquartile range: 24, 40) and took median 10 days (interquartile range: 7, 12) after hospital discharge to first clinic visit. In the post-clinic cohort, the median time to 100% oral feeding was 47 days (interquartile range: 27, 96) compared to the 60 days (interquartile range: 20, 84) in the pre-clinic cohort (n = 22), but the difference was not statistically significant. DISCUSSION The cardiac feeding clinic was utilised by our neonatal surgery population and feasible in coordination with cardiology follow-up visits. Future assessment of cardiac feeding clinic impact should include additional measures of feeding and neurodevelopmental success.
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Huynh G, Vishram A, Graham-Parker C, Blatz D, Carroll M, Turner J. Mealtime Support: A Pilot Case Series study of an Effective, Cost-saving Outpatient Hunger-Based Feeding Program for Tube Dependency. JPGN REPORTS 2022; 3:e154. [PMID: 37168756 PMCID: PMC10158302 DOI: 10.1097/pg9.0000000000000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/14/2021] [Indexed: 05/13/2023]
Abstract
Tube feeding is essential for children who cannot meet nutritional requirements orally. Over time, this can lead to tube dependency with negative impacts on the quality of life of children and families. Objective We aimed to examine the efficacy of a multidisciplinary child-led, hunger-based approach called "Mealtime Support" at the Stollery Children's Hospital in Edmonton. Nutritional outcomes, parental satisfaction, and cost implications were evaluated over 9 months postprogram completion per child. Methods The ambulatory meal program was delivered 2-3 times a day, for 2 weeks, by an occupational therapist and dietitian, under medical supervision. Hunger was promoted by reducing tube fed calories by 80% before commencement. Caregivers completed 12-question subjective surveys pre- and postintervention. Microcosting methods compared costs between the program and ongoing tube feeding. Results From 2016 to 2017, 6 children were enrolled and 5 completed the program. At 1-month postintervention, 4/5 of the children were 100% orally fed. Parents reported improvement in mealtime struggles (P = 0.005), reduction in worry about their child's eating (P = 0.005), and improvement in their child's appetite/variety foods eaten (P = 0.004). Over 2 years, the potential cost savings were estimated at $43,471.00. By 6 months, all feeding tubes were removed. Conclusions Mealtime support was safe and successful in reducing tube dependency and cost-effective compared to no intervention or hospital based programs, which suggests that there is a need to develop and fund Canadian outpatient feeding programs.
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Affiliation(s)
- Geraldine Huynh
- From the Department of Pediatrics, University of Alberta, Edmonton, AB
| | - Alysha Vishram
- From the Department of Pediatrics, University of Alberta, Edmonton, AB
| | | | - Debbie Blatz
- From the Department of Pediatrics, University of Alberta, Edmonton, AB
| | - Matthew Carroll
- From the Department of Pediatrics, University of Alberta, Edmonton, AB
| | - Justine Turner
- From the Department of Pediatrics, University of Alberta, Edmonton, AB
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20
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How to support parents and healthcare professionals in the decision-making process of tube feeding in children? Disabil Health J 2021; 15:101261. [PMID: 35022149 DOI: 10.1016/j.dhjo.2021.101261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tube 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. OBJECTIVE This study focussed on the parents' experiences and expectations about tube feeding of children and a solution to improve the management and communication of it. METHODS We 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. RESULTS In 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. CONCLUSIONS The 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.
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Abstract
Providing adequate and appropriate nutrition to children with medical complexity (CMC) is often a challenging task. These patients are a diverse group whose varying nutritional needs must be carefully assessed and monitored. Optimal feeding and nutrition strategies in CMC require an individual approach and may include oral, enteral (gastric or jejunal), or parenteral provision of nutrients. Complications of enteral feeding, including those associated with medical devices such as feeding tubes, are common, and provider familiarity with some of the more common complaints is helpful. We provide here a summary of different feeding approaches, with exploration of the rationale for each, as well as discussion of common complications and some practical troubleshooting tips.
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Backman E, Karlsson AK. Children's Perspectives on Mealtimes When Living with a Gastrostomy Tube: A Qualitative Study. J Pediatr Nurs 2021; 58:53-59. [PMID: 33321374 DOI: 10.1016/j.pedn.2020.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore children's experiences of mealtimes when living with a gastrostomy tube. DESIGN AND METHODS The study used a qualitative descriptive design framed within ecocultural theory. Seven children, three girls and four boys, aged 6-12 years with long-term health conditions and a gastrostomy tube participated in individual interviews. The interviews were qualitatively analysed by means of systematic text condensation. RESULTS Four main categories comprised the findings of the children's mealtimes experiences: "Stable in form, open to variation," "An individual, and a shared activity," "An object that needs to be dealt with" and "A part of me." A complex picture emerged, where the children experienced nutrition, whether through the gastrostomy tube or orally, as necessary for a healthy body, although this did not suffice to make the mealtime experience positive. CONCLUSIONS Regardless of the children's amount of oral intake, everyday mealtimes were valued as opportunities for social interaction and experienced as a predictable, routine activity no different from the mealtimes of other families. The accounts illustrated that in many situations the children knew precisely what they needed and did not need, what they liked and disliked and why. PRACTICE IMPLICATIONS Healthcare professionals should take children's knowledge into consideration to a greater extent when planning follow-up and intervention. The study illuminates that children can take an active part in their healthcare when offered flexible and carefully designed communication material, even in the presence of communicative and/or intellectual disability.
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Affiliation(s)
- Ellen Backman
- School of Health and Welfare, Halmstad University, Sweden; Regional habilitation center, Sweden..
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23
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Dipasquale V, Lecoeur K, Aumar M, Guimber D, Coopman S, Nicolas A, Lecoufle A, Van Malleghem A, Turck D, Ley D, Gottrand F. Weaning children from prolonged enteral nutrition: A survey of practice on behalf of the French Society of Paediatric Gastroenterology, Hepatology, and Nutrition. JPEN J Parenter Enteral Nutr 2021; 46:215-221. [PMID: 33667013 DOI: 10.1002/jpen.2100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/11/2021] [Accepted: 02/28/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND No consensus currently exists on tube-weaning practice worldwide. The aim of this study was to describe tube-weaning practice (indications and modalities) of a panel of pediatric gastroenterologists involved in the management of prolonged enteral nutrition (EN). METHODS A cross-sectional survey of pediatric gastroenterologists involved in the management of children receiving prolonged (>3 months) EN who were likely to be weaned was conducted. A questionnaire containing 24 questions was disseminated to the French Speaking Group of Paediatric Gastroenterology, Hepatology, and Nutrition members. The association between weaning practice and the experience of respondents was investigated. RESULTS In total, 311 professionals were approached, and 64 questionnaires were completed (response rate 21%). Nearly all respondents (n = 61, 95%) reported using individualized weaning programs. Weaning attempts were performed more frequently at home, and follow-up was performed in the outpatient clinic (97%) by progressive EN volume reduction (83%). Inpatient weaning was performed by only 28% of participants. The choice of the setting was predominantly (59%) based on parental request. Management and follow-up involved mainly the referring pediatric gastroenterologist and the dietitian. Fifty-one (80%) of the respondents experienced ≥1 weaning failure. CONCLUSIONS This is one of only a few studies examining real-life pediatric tube-weaning practices. Considerable practice variation between centers was observed; some of the common practices included the setting of weaning (outpatient vs inpatient) and the eligibility criteria. Increasing knowledge about weaning modalities is the starting point for the design of consensual standardized programs.
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Affiliation(s)
- Valeria Dipasquale
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille, Lille, France
| | - Katia Lecoeur
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille, Lille, France
| | - Madeleine Aumar
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille, Lille, France.,U1286-INFINITE-Institute for Translational Research in Inflammation, University Lille, Inserm, CHU Lille, Lille, France
| | - Dominique Guimber
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille, Lille, France
| | - Stéphanie Coopman
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille, Lille, France
| | - Audrey Nicolas
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille, Lille, France
| | - Audrey Lecoufle
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille, Lille, France
| | - Audrey Van Malleghem
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille, Lille, France
| | - Dominique Turck
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille, Lille, France.,U1286-INFINITE-Institute for Translational Research in Inflammation, University Lille, Inserm, CHU Lille, Lille, France
| | - Delphine Ley
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille, Lille, France.,U1286-INFINITE-Institute for Translational Research in Inflammation, University Lille, Inserm, CHU Lille, Lille, France
| | - Frédéric Gottrand
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille, Lille, France.,U1286-INFINITE-Institute for Translational Research in Inflammation, University Lille, Inserm, CHU Lille, Lille, France
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24
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Kim C, Brown S, Brown J, Ornelas E. Long-term Outcomes of Children With Pediatric Feeding Disorders Treated in an Inpatient Multidisciplinary Program. J Pediatr Gastroenterol Nutr 2021; 72:388-391. [PMID: 33560757 DOI: 10.1097/mpg.0000000000002977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT The purpose of this longitudinal observational study was to evaluate the effectiveness of a multidisciplinary inpatient treatment model for feeding disorders by analyzing long-term nutritional and health outcomes 12 months following discharge. Fifty patients completed the study. Average caloric intake by mouth as a percentage of goal for gastrostomy tube (GT)-dependent patients (n = 31) increased from pre-admit, week 1, and week 2 of the inpatient program (30%, 70%, and 84%, respectively), and was sustained from week 3 to 12-month follow-up (85% and 86%, respectively). Eighty-one percentage were discharged without GT support and 65% remained off GT support at 12 months. Oral supplement dependence for non-GT patients (n = 19) decreased from pre-admit, discharge, and 12-month follow-up (51%, 31%, and 19% of caloric intake, respectively). BMI z-scores improved during and after treatment. The present study demonstrated an effective approach for treatment of pediatric feeding disorders, including decreased reliance on oral supplementation and GT dependence.
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Affiliation(s)
- Cindy Kim
- Cindy Kim, CHOC Children's Hospital of Orange County, CHOC Children's Feeding Program, Orange, CA
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25
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Hopwood N, Moraby K, Dadich A, Gowans J, Pointon K, Ierardo A, Reilly C, Syrmis M, Frederiksen N, Disher-Quill K, Scheuring N, Heves R, Elliot C. Paediatric tube-feeding: An agenda for care improvement and research. J Paediatr Child Health 2021; 57:182-187. [PMID: 33277951 DOI: 10.1111/jpc.15286] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
This article presents an agenda to improve the care and wellbeing of children with paediatric feeding disorder who require tube feeding (PFD-T). PFD-T requires urgent attention in practice and research. Priorities include: routine collection of PFD-T data in health-care records; addressing the tube-feeding lifecycle; and reducing the severity and duration of disruption caused by PFD-T where possible. This work should be underpinned by principles of involving, respecting and connecting families.
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Affiliation(s)
- Nick Hopwood
- School of International Studies and Education, University of Technology Sydney, Broadway, New South Wales, Australia.,Department of Curriculum Studies, University of Stellenbosch, Stellenbosch, South Africa
| | - Khadeejah Moraby
- Central Early Childhood and Families Service, Allied Health, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Sydney, New South Wales, Australia
| | - Jessica Gowans
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Keren Pointon
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Anna Ierardo
- Department of Paediatrics, St George Hospital, Sydney, New South Wales, Australia
| | - Claire Reilly
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Maryanne Syrmis
- Speech Pathology Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Nadine Frederiksen
- Department of Occupational Therapy and Music Therapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Kate Disher-Quill
- Department of Paediatrics, St George Hospital, Sydney, New South Wales, Australia
| | - Noémi Scheuring
- Department of Pediatrics, Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Rudolf Heves
- Educational Technology, Web-Medu Health and Lifestyle Consulting Private Limited Company (Member of Rufusz Group), Budapest, Hungary
| | - Chris Elliot
- Department of Paediatrics, St George Hospital, Sydney, New South Wales, Australia.,Department of Community Child Health, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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26
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Eustace K, Cole L, Hollaway L. Attitudes and Perceptions of Blenderized Tube Feed Use Among Physicians and Advanced Practice Providers. JPEN J Parenter Enteral Nutr 2021; 45:1755-1761. [PMID: 33433025 DOI: 10.1002/jpen.2069] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Blenderized tube feeds (BTFs) have increased in popularity among enteral patients and their caregivers as an alternative to commercial formula. Motivations include ingredient flexibility, increased tolerance, and inclusion in family meals. Research has explored the attitudes and perceptions of patients, caregivers, and registered dietitian nutritionists but not those of physicians and advanced practice providers (APPs). The purpose of this study was to evaluate their attitudes and perceptions of BTFs. METHODS A survey created via Research Electronic Data Capture tools was distributed to physicians and APPs to evaluate clinical practice characteristics, experience, knowledge, and perceptions of BTFs. RESULTS Survey response rate was 17.3% (n = 206). Half of respondents reported familiarity with BTFs, but 95% of respondents had received no formal training regarding BTFs. Physicians reported higher levels of confidence in BTF knowledge than APPs. However, the overall level of confidence in BTF knowledge was poor, with a majority of respondents (73.3% [n = 151]) reporting either "not very confident" or "not confident at all." The most perceived benefits included tailoring diet to better fit the patients' needs (70.9% [146]) and psychological benefits (59.2% [122]). Barriers that most concerned respondents included tube occlusions (59.7% [123]) and nutrition inadequacy (47.6% [98]). χ2 Analysis revealed no relationship between type of provider and perceived benefits or barriers. CONCLUSION A majority of physicians and APPs are willing to support BTF use but lack education or guidance, resulting in poor confidence. Increased familiarity with BTF use and awareness of available education materials are required to help physicians and APPs support patients utilizing BTFs.
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Affiliation(s)
- Kathleen Eustace
- Department of Clinical Nutrition, School of Health Professions, University of Texas Southwestern, Dallas, Texas, USA
| | - Lillian Cole
- Paragon Home Infusion, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lauren Hollaway
- Children's Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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27
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Hopwood N, Elliot C, Pointon K. Changing the World for Children with Complex Feeding Difficulties: Cultural-Historical Analyses of Transformative Agency. CULTURAL-HISTORICAL PSYCHOLOGY 2021. [DOI: 10.17759/chp.2021170215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
How to bring about positive change is a key concern in cultural-historical theory. There is an urgent imperative to address questions of transformation at the nexus of the individual and the social. One way to approach this is through the concept of agency, the means through which people go beyond coping with problems or adapting to the status quo, instead striving to make the future that ought to be a reality. This paper takes up ideas from Stetsenko’s transformative activist stance (TAS), Sannino’s transformative agency by double stimulation (TADS), and Edwards’ relational agency, tracing the emergence and enactment of agency among parents of children with complex feeding difficulties. These children were unable to eat orally, instead using a tube to feed. Each family strived towards, and realised, futures where their child was able to feed orally, without a tube. Parents acted agentically in ways that were contingent upon relevant cultural tools. Such tools are key to futures that are more inclusive, equitable and nurturing for all children and their families. The paper highlights the value of contemporary cultural-historical approaches to agency in understanding and provoking transformation at the nexus of the individual and social.
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Garcia AM, Beauchamp MT, Patton SR, Edwards S, Dreyer Gillette ML, Davis AM. Family mealtime behaviors in children who are tube fed and preparing to transition to oral eating: A comparison to other pediatric populations. J Health Psychol 2020; 27:1014-1020. [PMID: 33339464 DOI: 10.1177/1359105320982034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study examined differences in observed mealtime behaviors between children preparing to transition to oral feeding and children with various other chronic illnesses using a standardized measure of mealtime beaviors. The parent-child mealtime relationship can become strained due to problematic mealtime behaviors that limit food intake, as well as inadvertent reinforcement of disruptive behavior by caregivers. Frequency/rate of behaviors were compared between children with tube feeding (CwTF) and from previous studies of children with chronic illnesses using the Dyadic Interactive Nomenclature for Eating (DINE). Parents of CwTF used more coaxing, physical prompts, and reinforcement during meals, while parents of children with chronic illnesses used more direct commands and engaged in more parent talk. Findings support differences in parent-child mealtime interactions and eating behaviors across pediatric illness subgroups.
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Affiliation(s)
| | - Marshall T Beauchamp
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,University of Kansas Medical Center, Kansas City, KS, USA
| | - Susana R Patton
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,University of Kansas Medical Center, Kansas City, KS, USA.,Nemours Children's Health System, Jacksonville, FL, USA
| | - Sarah Edwards
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,Children's Mercy Kansas City, Kansas City, MO, USA
| | - Meredith L Dreyer Gillette
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,Children's Mercy Kansas City, Kansas City, MO, USA
| | - Ann M Davis
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,University of Kansas Medical Center, Kansas City, KS, USA
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29
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Hopwood N, Elliot C, Moraby K, Dadich A. Parenting children who are enterally fed: How families go from surviving to thriving. Child Care Health Dev 2020; 46:741-748. [PMID: 32901970 DOI: 10.1111/cch.12808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Complex feeding difficulties requiring enteral (tube) feeding affect everyone around the child. Parents experience additional stress and are at risk of social isolation. This study investigated the strategies families develop and use to adjust and adapt to enteral feeding so they were not just surviving but thriving as a family. METHODS Twenty parents whose children had been or continued to be enterally fed were interviewed, four of them twice as their experience of enteral feeding progressed. Learning theory was used to conceptualize findings in terms of changing use of tools that mediated parents' response to feeding-related challenges. RESULTS Parents encountered dilemmas relating to enteral feeding: maintaining participation in everyday activities, managing responses to the use of tubes for feeding, and doing what feels right for their child. They used four kinds of mediating tools to overcome these: memory aids and readiness tools, metaphors and narratives, repurposed everyday objects and personalized routines and materialities. CONCLUSIONS This novel account of tool used to resolve dilemmas provides an empirically and theoretically grounded basis for supporting parents to thrive despite the challenges of enteral feeding. Specifically, it can guide information given to help parents anticipate and cope with dilemmas arising from enteral feeding.
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Affiliation(s)
- Nick Hopwood
- School of International Studies and Education, University of Technology Sydney, Broadway, New South Wales, Australia.,Department of Curriculum Studies, Stellenbosch University, Matieland, South Africa
| | - Chris Elliot
- Department of Pediatrics, St George Hospital, Kogarah, New South Wales, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Community Child Health, Sydney Children's Hospitals Randwick, Sydney, New South Wales, Australia
| | - Khadeejah Moraby
- Central Early Childhood and Families Service, Allied Health, Women's and Children's Health Network, North Adelaide, South Australia, Australia.,Speech Pathology Department, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Penrith, New South Wales, Australia
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30
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Chou E, Lindeback R, Sampaio H, Farrar MA. Nutritional practices in pediatric patients with neuromuscular disorders. Nutr Rev 2020; 78:857-865. [PMID: 31968103 DOI: 10.1093/nutrit/nuz109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Children with neuromuscular disorders (NMDs) may experience a spectrum of nutritional issues with adverse health consequences. This review summarizes the current understanding of nutritional care in pediatric NMDs, recognizing disease-specific aspects of nutrition alongside the challenges and needs in dietetic care. General or disease-related nutritional issues for children with NMDs include being underweight, overweight, or obese and having swallowing difficulty, gastroesophageal reflux, diarrhea, and/or constipation. Specific challenges in NMD nutritional assessment include alterations in body composition and energy requirements and difficulties in measuring anthropometry. Multidisciplinary dietetic intervention focuses on optimizing nutrient intakes to avert growth failure or obesity and managing feeding difficulties and gastrointestinal problems. Care guidelines are disease specific and vary in approach and detail. To promote best clinical practice across diverse settings, a standardized approach to assessing growth and nutrition across all pediatric NMDs is needed to direct optimal care centered on individual requirements. Future studies should focus on determining the prevalence of specific nutritional issues and the effectiveness of specific interventions among various pediatric NMD populations.
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Affiliation(s)
- Emile Chou
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rachel Lindeback
- Department of Nutrition and Dietetics, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Hugo Sampaio
- Department of Neurology, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Michelle A Farrar
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
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31
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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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32
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Syrmis M, Frederiksen N, Reilly C. Weaning children from temporary tube feeding: Staff survey of knowledge and practices. J Paediatr Child Health 2020; 56:1290-1298. [PMID: 32468718 DOI: 10.1111/jpc.14927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022]
Abstract
AIM To explore the understanding of and practices of health-care workers in weaning children from feeding tubes. METHODS An electronic survey of doctors, nurses, and allied health professionals at Children's Health Queensland obtained demographic information and awareness of various areas of tube feeding management particularly tube weaning. RESULTS The 155 health-care providers formed three well-matched groups in terms of number and years of experience. Only 18 had formal training in tube weaning. Participants had high levels of knowledge regarding reasons for commencing and possible complications associated with tube feeding. However, health-care providers generally were found to have limited to no knowledge of tube weaning practices. Nearly half of participants (46%) did not know the best time to plan for a tube wean and only 16 indicated that they or their work units documented tube exit plans, regardless of type of feeding tube, in children's medical charts. Time frames were rarely included as part of tube exit plans. Participants ranked medical stability and presence of a safe swallow most highly as important indicators for successful tube weaning. Multidisciplinary management was also identified as valuable. Tube weaning was predominately managed by children's primary health unit/service and largely involved a medical officer and dietician. CONCLUSIONS Poor awareness of tube weaning practices such as tube exit strategies may be impacting on the quality of care received by children who are tube fed. Future research should be directed towards developing and evaluating guidelines accompanied by educational resources to further advance tube weaning practices.
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Affiliation(s)
- Maryanne Syrmis
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Nadine Frederiksen
- Occupational Therapy and Music Therapy Department, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Claire Reilly
- Dietetics and Food Services Department, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
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33
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Cheng CF, Werner NE, Doutcheva N, Warner G, Barton HJ, Kelly MM, Ehlenbach ML, Wagner T, Finesilver S, Katz BJ, Nacht C, Coller RJ. Codesign and Usability Testing of a Mobile Application to Support Family-Delivered Enteral Tube Care. Hosp Pediatr 2020; 10:641-650. [PMID: 32616602 DOI: 10.1542/hpeds.2020-0076] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Enteral tubes are prevalent among children with medical complexity (CMC), and complications can lead to costly health care use. Our objective was to design and test the usability of a mobile application (app) to support family-delivered enteral tube care. METHODS Human-centered design methods (affinity diagramming, persona development, and software development) were applied with family caregivers of CMC to develop a prototype. During 3 waves of usability testing with design refinement between waves, screen capture software collected user-app interactions and inductive content analysis of narrative feedback identified areas for design improvement. The National Aeronautics and Space Administration Task Load Index and the System Usability Scale quantified mental workload and ease of use. RESULTS Design participants identified core app functions, including displaying care routines, reminders, tracking inventory and health data, caregiver communication, and troubleshooting. Usability testing participants were 80% non-Hispanic white, 28% lived in rural settings, and 20% had not completed high school. Median years providing enteral care was 2 (range 1-14). Design iterations improved app function, simplification, and user experience. The mean System Usability Scale score was 76, indicating above-average usability. National Aeronautics and Space Administration Task Load Index revealed low mental demand, frustration, and effort. All 14 participants reported that they would recommend the app, and that the app would help with organization, communication, and caregiver transitions. CONCLUSIONS Using a human-centered codesign process, we created a highly usable mobile application to support enteral tube caregiving at home. Future work involves evaluating the feasibility of longitudinal use and effectiveness in improving self-efficacy and reduce device complications.
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Affiliation(s)
| | - Nicole E Werner
- Department of Industrial and Systems Engineering, and.,Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Gemma Warner
- Department of Pediatrics, School of Medicine and Public Health
| | | | - Michelle M Kelly
- Department of Pediatrics, School of Medicine and Public Health.,Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Teresa Wagner
- American Family Children's Hospital, University of Wisconsin Health, Madison, Wisconsin; and
| | - Sara Finesilver
- Department of Pediatrics, School of Medicine and Public Health
| | | | - Carrie Nacht
- Department of Pediatrics, School of Medicine and Public Health
| | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health,
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34
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Jones E, Southwood H, Cook C, Nicholson T. Insights into paediatric tube feeding dependence: A Speech-language pathology perspective. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:327-337. [PMID: 32366127 DOI: 10.1080/17549507.2020.1754910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose: To explore possible factors contributing to paediatric tube feeding dependency from the speech-language pathology perspective. Tube feeding dependency can have serious repercussions for children and their families with failed or slow weaning/transitioning from tube to oral feeding, more likely after the age of five.Method: A mixed methods approach was conducted. During the first quantitative phase, an online national survey of speech-language pathologists (SLPs) from the health and non-health sectors was carried out followed by interviews with a subset of the respondents. Forty-three SLPs completed the survey. In the second qualitative phase, 10 participants from the survey were interviewed in depth as to their opinions about why tube dependency occurs. Survey data from phase one were analysed using descriptive statistics and chi square comparisons. Interview data were categorised using thematic analysis. Findings from both methodologies were combined to report the results.Result: Two interlinking meta-themes were identified from the combined data sets. These were: (1) Medicalisation of tube fed children in infancy as a root cause of tube feeding dependency and (2) Fragmentation of the tube fed child's continuity of care. The specific results indicated several possible reasons for tube feeding dependency including medical emphasis on weight gain, prolonged nasogastric tube feeding and waiting too long for transition from tube to oral feeding. A lack of integrated care and clinician confidence in non-health settings also appeared to be a factor contributing to tube feeding dependency.Conclusion: Early and ongoing biomedical focus on weight gain affected long-term goals for transitioning leading, subsequently, to tube feeding becoming normalised by school age.
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Affiliation(s)
- Emily Jones
- Institute of Education, College of Humanities and Social Sciences, Massey University, Auckland, New Zealand
| | - Helen Southwood
- Institute of Education, College of Humanities and Social Sciences, Massey University, Auckland, New Zealand
| | - Catherine Cook
- School of Nursing, College of Health, Massey University, Auckland, New Zealand
| | - Tom Nicholson
- Institute of Education, College of Humanities and Social Sciences, Massey University, Auckland, New Zealand
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35
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Bennett K, Hjelmgren B, Piazza J. Blenderized Tube Feeding: Health Outcomes and Review of Homemade and Commercially Prepared Products. Nutr Clin Pract 2020; 35:417-431. [PMID: 32362020 DOI: 10.1002/ncp.10493] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The popularity of homemade blenderized tube feeding (HBTF) continues to increase among enteral nutrition (EN) consumers and healthcare providers alike, citing improved feeding tolerance over standard commercial enteral formulas, among other health outcomes. Within the past 5-10 years, there has been a surge in the development of commercial blenderized tube feeding (CBTF) products. CBTF products promote similar benefits from whole foods like those used in HBTF while being a nutritionally-consistent, easy to use, and shelf-stable option for EN consumers. Research is improving but is still limited for HBTF and virtually nonexistent for CBTF products. This review aims to summarize current health outcomes of HBTF, compare HBTF with CBTF, evaluate CBTF products, and provide considerations for future research and practices.
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36
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Ermarth A, Thomas D, Ling CY, Cardullo A, White BR. Effective Tube Weaning and Predictive Clinical Characteristics of NICU Patients With Feeding Dysfunction. JPEN J Parenter Enteral Nutr 2019; 44:920-927. [DOI: 10.1002/jpen.1717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 09/02/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Ermarth
- Department of PediatricsUniversity of Utah School of Medicine Salt Lake City Utah USA
- Division of Pediatric GastroenterologyUniversity of Utah School of Medicine Salt Lake City Utah USA
| | - Debbie Thomas
- Primary Children's HospitalIntermountain Healthcare Salt Lake City Utah USA
| | - Con Yee Ling
- Department of PediatricsUniversity of Utah School of Medicine Salt Lake City Utah USA
- Division of NeonatologyUniversity of Utah School of Medicine Salt Lake City Utah USA
| | - Adam Cardullo
- Department of PediatricsUniversity of Utah School of Medicine Salt Lake City Utah USA
| | - Ben R. White
- Department of PediatricsUniversity of Utah School of Medicine Salt Lake City Utah USA
- Division of NeonatologyUniversity of Utah School of Medicine Salt Lake City Utah USA
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37
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Trollip A, Lindeback R, Banerjee K. Parental Perspectives on Blenderized Tube Feeds for Children Requiring Supplemental Nutrition. Nutr Clin Pract 2019; 35:471-478. [DOI: 10.1002/ncp.10368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Antonia Trollip
- Dietetics Department Sydney Children's Hospital Network Westmead NSW Australia
| | - Rachel Lindeback
- Dietetics Department Sydney Children's Hospital Network Westmead NSW Australia
| | - Katie Banerjee
- Rehab Department Sydney Children's Hospital Network Westmead NSW Australia
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38
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Katzman DK, Norris ML, Zucker N. Avoidant restrictive food intake disorder: First do no harm. Int J Eat Disord 2019; 52:459-461. [PMID: 30676659 DOI: 10.1002/eat.23021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This opinion piece offers some considerations, both medical and psychological, for the use of nasogastric tube (NGT) feedings in the treatment of avoidant restrictive food intake disorder (ARFID) in children and adolescents. METHOD Although there is empirical support for the use of NGT feedings in the treatment of anorexia nervosa, this evidence base does not exist for the treatment of ARFID. As such, there is need to delineate pragmatic considerations in the use of this procedure. RESULTS Issues of medical necessity notwithstanding, we advise that the use of this procedure be considered more cautiously due to the oral sensitivities inherent in many individuals with ARFID and the potential psychological consequences. These sensitivities may make the experience of NGT feedings particularly aversive, with the potential of creating iatrogenic conditioned food aversions. DISCUSSION This article encourages clinicians to give careful thought and attention when considering NGT feedings in children and adolescents with ARFID.
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Affiliation(s)
- Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark L Norris
- Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Eastern Ontario (CHEO) and University of Ottawa, Ottawa, Ontario, Canada.,CHEO Research Institute, Ottawa, Ontario, Canada
| | - Nancy Zucker
- Division of Child and Family Mental Health and Developmental Neuroscience, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
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39
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Backman E, Granlund M, Karlsson AK. Documentation of everyday life and health care following gastrostomy tube placement in children: a content analysis of medical records. Disabil Rehabil 2019; 42:2747-2757. [DOI: 10.1080/09638288.2019.1573383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ellen Backman
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Regional Habilitation Centre, Region Halland, Kungsbacka, Sweden
| | - Mats Granlund
- CHILD Research group, SIDR, School of Health Sciences, Jönköping University, Jönköping, Sweden
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40
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Jacquier D, Newman CJ. Parent-reported sleep disorders in children with motor disabilities: a comparison with the Sleep Disturbance Scale for Children's new norms. Sleep Med 2018; 55:26-32. [PMID: 30743207 DOI: 10.1016/j.sleep.2018.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/10/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Children with motor disabilities such as cerebral palsy or neuromuscular diseases present more sleep disorders than their typically developing (TD) peers. However, research on these populations has always been performed using historical normative datasets or controls such as siblings. Therefore, we assessed the sleep quality of children with motor disabilities in comparison with a large, contemporary, general population sample. METHODS Demographic, medical, and the Sleep Disturbance Scale for Children (SDSC) questionnaires were sent to parents of children aged 4-18 years and followed by our tertiary pediatric neurorehabilitation clinic, and to those of school-aged children in regional primary and secondary schools. TD participant data allowed us to set pathological sleep score thresholds (T score ≥70). RESULTS We collected 245 responses for children with motor disabilities and 2891 for those from the general population (37% and 26% response rates, respectively). Cerebral palsy was the most frequent diagnosis (N = 109, 44.5%). Children with motor disabilities had significantly more frequent pathological sleep reported in their total SDSC score (7% vs 1.9%, odds ratio (OR) 3.98, 95% confidence interval (CI) 2.17-7.27, p < 0.001) and in five subscores. Single-parent households and drug-resistant epilepsy showed significant positive associations with pathological sleep among children with motor disabilities. For TD peers, parental unemployment and parental nationality were positively associated with pathological sleep. CONCLUSION This population-based study robustly estimated the prevalence of sleep disorders in children with motor disabilities. Sleep disorders were significantly more frequent in children with motor disabilities, but at a lower frequency than previously reported.
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Affiliation(s)
- David Jacquier
- Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, University Hospital of Lausanne, Lausanne, Switzerland.
| | - Christopher John Newman
- Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, University Hospital of Lausanne, Lausanne, Switzerland
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41
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ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Organisational aspects. Clin Nutr 2018; 37:2392-2400. [DOI: 10.1016/j.clnu.2018.06.953] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/18/2022]
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42
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Breaks A, Smith C, Bloch S, Morgan S. Blended diets for gastrostomy fed children and young people: a scoping review. J Hum Nutr Diet 2018; 31:634-646. [DOI: 10.1111/jhn.12563] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Anne Breaks
- Department of Language and Cognition; University College London; London UK
| | - Christina Smith
- Department of Language and Cognition; University College London; London UK
| | - Steven Bloch
- Department of Language and Cognition; University College London; London UK
| | - Sally Morgan
- Division of Language and Communication Science; City University London; London UK
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43
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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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Orel A, Homan M, Blagus R, Benedik E, Orel R, Fidler Mis N. Nutrition of Patients with Severe Neurologic Impairment. Radiol Oncol 2018. [PMID: 29520209 PMCID: PMC5839085 DOI: 10.1515/raon-2017-0060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Commercial enteral formulas are generally recommended for gastrostomy feeding in patients with severe neurologic impairment. However, pureed food diets are still widely used and even gaining popularity among certain groups. We tried to compare the effectiveness of gastrostomy feeding for treatment of severe malnutrition with either enteral formulas or pureed feeds. Patients and methods A 6-month nutritional intervention was made with 37 malnourished children, adolescents and young adults (2–26 years old) with severe neurologic impairment (Gross Motor Function Classification system [GMFCS] grade V). The individual needs were calculated. Participants were fed by gastrostomy with either enteral formulas (n = 17) or pureed food (n = 20). Measurements to assess nutritional status were made at the beginning and at the end of intervention. Results The Z scores for weight-for-age and for the body-mass index increased more in enteral formula than in pureed food group (2.07 vs. 0.70, p = 0.0012; and 3.75 vs. 0.63, p = 0.0014, respectively). Fat mass index increased more in enteral formula than in pureed food group (1.12 kg/m2vs. 0.38 kg/m2; p = 0.0012). Patients in the enteral formula group showed increase in lean body mass expressed as fat-free mass index (0.70 kg/m2), while those in pureed food group did not (-0.06 kg/m2) (p = 0.0487). Conclusions The results suggest that even professionally planned pureed food diet is less effective than commercial enteral formula for nutritional rehabilitation of malnourished patients with severe neurologic impairment. However, larger and if possible randomised clinical studies should be made to confirm our findings.
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Affiliation(s)
- Anija Orel
- University Medical Centre Ljubljana, Children's Hospital, Ljubljana, Slovenia.,University of Ljubljana, Biotechnical Faculty, Department of Food Science and Nutrition, Ljubljana, Slovenia
| | - Matjaz Homan
- University Medical Centre Ljubljana, Children's Hospital, Ljubljana, Slovenia.,University of Ljubljana, Faculty of Medicine, Chair of Paediatrics, Ljubljana, Slovenia.,University of Ljubljana, Biotechnical Faculty, Department of Food Science and Nutrition, Ljubljana, Slovenia
| | - Rok Blagus
- University of Ljubljana, Faculty of Medicine, Institute for Biostatistics and Medical Informatics, Ljubljana, Slovenia
| | - Evgen Benedik
- University Medical Centre Ljubljana, Children's Hospital, Ljubljana, Slovenia.,University of Ljubljana, Biotechnical Faculty, Department of Food Science and Nutrition, Ljubljana, Slovenia
| | - Rok Orel
- University Medical Centre Ljubljana, Children's Hospital, Ljubljana, Slovenia.,University of Ljubljana, Faculty of Medicine, Chair of Paediatrics, Ljubljana, Slovenia.,University of Ljubljana, Biotechnical Faculty, Department of Food Science and Nutrition, Ljubljana, Slovenia
| | - Natasa Fidler Mis
- University Medical Centre Ljubljana, Children's Hospital, Ljubljana, Slovenia.,University of Ljubljana, Biotechnical Faculty, Department of Food Science and Nutrition, Ljubljana, Slovenia
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Alsaeed D, Furniss D, Blandford A, Smith F, Orlu M. Carers' experiences of home enteral feeding: A survey exploring medicines administration challenges and strategies. J Clin Pharm Ther 2018; 43:359-365. [PMID: 29351363 PMCID: PMC6849733 DOI: 10.1111/jcpt.12664] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/02/2018] [Indexed: 12/18/2022]
Abstract
What is known and objectives The use of enteral tube feeding at home is becoming more widespread, with patients ranging in age and diseases. Dysphagia and swallowing difficulties can compromise nutritional intake and the administration of oral medications, affecting therapeutic outcomes negatively. Carers’ experiences of medicines administration and medicines optimization have not been explored fully. The objectives of this study were to identify issues carers experience in medicines administration; the strategies they have developed to cope; and suggestions to improve the medicines administration process. Methods An online survey was promoted nationally; 42 carers completed it. Descriptive statistical analysis was applied, as well as thematic analysis of open‐ended responses. Results were compared against the 4 principles of medicines optimization. Results and discussion 93% of respondents administered medications with enteral feeding tubes, but only 62% had received advice from healthcare professionals and only 8% had received written information on how to do so. Responses identified 5 medicines administration issues experienced by carers; 4 strategies they developed to cope; and 3 main areas of suggestions to improve medicines administration via enteral feeding at home. What is new and conclusion The 4 principles of medicines optimization have not previously been applied to enteral feeding. We present a novel account of carers’ experiences, for example coping with ill‐suited formulations and a lack of training and support, which should inform better practice (Principle 1). Carers sometimes experience suboptimal choice of medicines (Principle 2). Carers’ practices are not always well‐informed and may affect therapeutic outcomes and safety (Principle 3). There is scope for improvement in carer training, education and support to better support medicines optimization (Principle 4).
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Affiliation(s)
- D Alsaeed
- School of Pharmacy, Department of Pharmacy Practice and Policy, University College London, London, UK.,UCL Institute of Digital Health, University College London, London, UK
| | - D Furniss
- UCL Institute of Digital Health, University College London, London, UK.,UCL Interaction Centre, University College London, London, UK
| | - A Blandford
- UCL Institute of Digital Health, University College London, London, UK.,UCL Interaction Centre, University College London, London, UK
| | - F Smith
- School of Pharmacy, Department of Pharmacy Practice and Policy, University College London, London, UK.,UCL Institute of Digital Health, University College London, London, UK
| | - M Orlu
- UCL Institute of Digital Health, University College London, London, UK.,School of Pharmacy, Department of Pharmaceutics, University College London, London, UK
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Intervention for Feeding Difficulties in Children With a Complex Medical History: A Randomized Clinical Trial. J Pediatr Gastroenterol Nutr 2018; 66:152-158. [PMID: 28753179 DOI: 10.1097/mpg.0000000000001683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE This study aimed to compare outcomes of different multidisciplinary feeding therapy approaches in children with feeding difficulties. METHODS Children aged 2 to 6 years with feeding difficulties and a medically complex history (MC) were recruited. Children with feeding difficulties and a nonmedically complex history (NMC) were included as a comparison group. Participants attended a clinical assessment, and eligible participants were randomized to receive targeted feeding intervention incorporating either operant conditioning or systematic desensitization. Parents could elect to receive intervention in an intensive (10 sessions in a week) or weekly (10 sessions during 10 weeks) format. Both groups received immersive parent training. A review was completed 3 months post-intervention. RESULTS In total, 98 participants were eligible to participate (MC, n = 43; NMC, n = 55). Data from 20 children from the MC group (47%) and 41 children from the NMC group (75%) were included in the final analysis. Clinically significant improvements were observed following both arms of therapy, consistent with previous research. Parents of children in the MC arm were significantly more likely to elect for intensive intervention than weekly (MC = 12/20, 60%; 12/41, 29%; P = 0.02). CONCLUSIONS Both therapy protocols were considered clinically effective. The difference in attrition rates between the etiological groups suggests primary differences in how service delivery should be managed. Progress for the medically complex child may be slower while medical issues are stabilized, or while the focus for parents shifts to other developmental areas. In planning services for a medically complex group, therefore, it is essential that consideration be given to medical and family needs.
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Mirete J, Thouvenin B, Malecot G, Le-Gouëz M, Chalouhi C, du Fraysseix C, Royer A, Leon A, Vachey C, Abadie V. A Program for Weaning Children from Enteral Feeding in a General Pediatric Unit: How, for Whom, and with What Results? Front Pediatr 2018; 6:10. [PMID: 29423394 PMCID: PMC5788903 DOI: 10.3389/fped.2018.00010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/10/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe a series of children who were hospitalized for a tube-weaning program in the general pediatric ward of a pediatric tertiary university hospital: describe our method, to determine the success rate of our inpatient pediatric tube weaning program, and search for relevant factors linked to its success or failure. METHOD We analyzed the medical files of consecutive children who were hospitalized for gastric-tube weaning over an 8-year period. We analyzed outcomes in terms of feeding and growth with at least 2 years of data. Success (weaning within 3 months) and failure were compared by characteristics of children. RESULTS We included 37 children (29 females) with mean (SD) age 31.4 (21) months. Most had a severe medical history (30% prematurity; 50% intrauterine growth restriction, 50% neurological and genetic anomalies). The weaning program was successful for half of the children. Factors linked to success of the program were female sex (p = 0.0188), normal neurodevelopment (p = 0.0016), nasogastric tube (p = 0.0098), and with <24 months on EF before the stay (p = 0.0309). DISCUSSION Comparing the efficiency of various methods and results among teams was difficult, which indicates the need to establish consensus about the outcome criteria. We confirm the need for these types of stays and programs.
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Affiliation(s)
- Justine Mirete
- General Pediatrics Department, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Béatrice Thouvenin
- General Pediatrics Department, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gaelle Malecot
- General Pediatrics Department, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Morgane Le-Gouëz
- General Pediatrics Department, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | - Christel Chalouhi
- General Pediatrics Department, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Catherine du Fraysseix
- General Pediatrics Department, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélie Royer
- General Pediatrics Department, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anais Leon
- General Pediatrics Department, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Clément Vachey
- Clinical Investigation Center, INSERM CIC 1431, University Hospital of Besançon, Besançon, France
| | - Véronique Abadie
- General Pediatrics Department, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
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Abstract
Management of pediatric intestinal failure has evolved in recent decades, with improved survival since the advent of specialized multidisciplinary intestinal failure centers. Though sepsis and intestinal failure associated liver disease still contribute to mortality, we now have growing data on the long-term outcomes for this population. While intestinal adaptation and parenteral nutrition weaning is most rapid during the first year on parenteral support, achievement of enteral autonomy is possible even after many years as energy and protein requirements decline dramatically with age. Intestinal transplant is an option for patients experiencing complications of long-term parenteral nutrition who are expected to have permanent intestinal failure, but outcomes are hindered by immunosuppression-related complications. Much of the available data comes from single center retrospective reports, with variable inclusion criteria, intestinal failure definitions, and follow-up durations; this limits the ability to analyze outcomes and identify best practices. As most children now survive long-term, the focus of management has shifted to the avoidance and management of comorbidities, support of normal growth and development, and optimization of quality of life for these medically and surgically complex patients.
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Affiliation(s)
- Brenna S Fullerton
- Department of Surgery, Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Fegan 3, Boston, MA 02115
| | - Charles R Hong
- Department of Surgery, Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Fegan 3, Boston, MA 02115
| | - Tom Jaksic
- Department of Surgery, Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Fegan 3, Boston, MA 02115.
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Dovey TM, Wilken M, Martin CI, Meyer C. Definitions and Clinical Guidance on the Enteral Dependence Component of the Avoidant/Restrictive Food Intake Disorder Diagnostic Criteria in Children. JPEN J Parenter Enteral Nutr 2017; 42:499-507. [DOI: 10.1177/0148607117718479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/09/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Terence Michael Dovey
- Institute of the Environment, Health and Societies, Social Sciences and Health, Brunel University London, London, Middlesex, United Kingdom
| | - Markus Wilken
- Institute for Pediatric Feeding Tube Management and Weaning, Siegburg, Germany
- University of Applied Science Fresenius, Idstein, Hessen, Germany
| | | | - Caroline Meyer
- WMG and Warwick Medical School, University of Warwick, Coventry, Warwickshire, United Kingdom
- Coventry and Warwickshire Partnership NHS Trust, Coventry, United Kingdom
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50
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Abstract
Feeding disorders often present in children with complex medical histories as well as those with neurodevelopmental disabilities. If untreated, feeding problems will likely persist and may lead to additional developmental and medical complications. Treatment of pediatric feeding disorders should involve an interdisciplinary team, but the core intervention should include behavioral feeding techniques as they are the only empirically supported therapy for feeding disorders.
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