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Balarabe HS, Jeannot BM, Kibansha HM, Isaac E, Kiswezi A. Urethral calculus with a recurrent acute urinary retention in a male child aged 11 years: A case report. Radiol Case Rep 2023; 18:4191-4194. [PMID: 37753501 PMCID: PMC10518677 DOI: 10.1016/j.radcr.2023.08.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023] Open
Abstract
Urolithiasis is the presence of a stone anywhere in the urinary tract, it is commonly seen in adult patients and rare in children, especially when it is associated with acute urinary retention. In children, history is not suggestive and not specific; diagnosis is made by exclusion, and imaging studies often get the findings as incidental. In this case, the clinical presentation made early diagnosis quite difficult. The management of urethral calculi varies according to the site, size, associated urethral pathology, and available resources. It becomes an emergency when it causes acute urinary obstruction, urethral bleeding, or pain. We present a case report of an 11-year-old male with a history of 3 episodes of acute urinary retention secondary to urethral obstruction by calculi. The period between 1 episode and the next was observed to be approximately 1 year, with no logical explanation. Urethral calculus in children is less frequent than in adults worldwide. Urethral calculi are either formed in the native urethra or migrate from the upper urinary tract. Urgent urinary diversion and removal of the calculus with minimal urethral trauma is the recommended treatment.
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Affiliation(s)
- Hauwa Shitu Balarabe
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka Bushenyi, Uganda
| | - Baanitse Munihire Jeannot
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka Bushenyi, Uganda
- Faculty of Medicine, Université Catholique la Sapientia de Goma, Goma, Democratic Republic of the Congo
| | - Hope Matumaini Kibansha
- Faculty of Medicine, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - Edyedu Isaac
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka Bushenyi, Uganda
| | - Ahmed Kiswezi
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka Bushenyi, Uganda
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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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Wright CM, McNair S, Milligan B, Livingstone J, Fraser E. Weight loss during ambulatory tube weaning: don't put the feeds back up. Arch Dis Child 2022; 107:767-771. [PMID: 35351738 DOI: 10.1136/archdischild-2021-323592] [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: 11/26/2021] [Accepted: 03/13/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the prevalence of weight loss during tube weaning and its impact on wean duration and growth. SETTING Tertiary feeding clinic, UK. PATIENTS All children seen for weaning from long-term enteral feeding between 2008 and 2016. INTERVENTIONS Outpatient withdrawal of enteral feeding. DESIGN Case series of children being weaned from tube feeding, documenting clinical details, periods of weight loss and timing of feed changes, as well as height and weight at baseline and within 1 year after feed cessation. MAIN OUTCOME MEASURES Amount and frequency of weight loss, wean duration, change in body mass index (BMI) and height SD z score. RESULTS Weaning was attempted in 58 children, median age 2.7 years, and 90% had stopped feeds after median (range) 5.9 (1-40) months. Weight loss was seen in 51 (88%) children and was more common and severe in children with initially higher BMI. Time to feed cessation reduced by median 4.9 months between 2008-2011 and 2012-2016, while having feeds increased prolonged the wean duration, by median 13 months. After feed cessation, mean (95% CI) BMI had dropped by 0.84 (0.5 to 1.2) z scores, but neither change in BMI, nor the amount and frequency of weight loss, related to growth. CONCLUSIONS Short-term weight loss is to be expected during tube weaning and is not associated with compromised growth. It is important to avoid overfeeding enterally fed children and not to increase feeds again in response to weight loss.
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Affiliation(s)
- Charlotte Margaret Wright
- Department of Child Health, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Stephanie McNair
- Department of Child Health, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Beatrice Milligan
- Department of Child Health, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Jennifer Livingstone
- Dietetics Department, Royal Hospital for Children, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Emily Fraser
- Dietetics Department, Royal Hospital for Children, NHS Greater Glasgow and Clyde, Glasgow, UK
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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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Slater N, Spader M, Fridgen J, Horsley M, Davis M, Griffin KH. Weaning from a feeding tube in children with congenital heart disease: A review of the literature. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Dipasquale V, Lecoeur K, Aumar M, Guimber D, Coopman S, Nicolas A, Turck D, Gottrand F, Ley D. Factors Associated With Success and Failure of Weaning Children From Prolonged Enteral Nutrition: A Retrospective Cohort Study. J Pediatr Gastroenterol Nutr 2021; 72:135-140. [PMID: 32810034 DOI: 10.1097/mpg.0000000000002909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aims of the present study were to assess the efficacy of a tube weaning program, and to identify factors associated with success and failure. METHODS This was a retrospective cohort study including all pediatric patients on enteral nutrition (EN) for ≥6 months for whom at least 1 attempt of weaning was performed in a single tertiary referral center from 2012 to 2017, with a minimum follow-up of 6 months after EN discontinuation. Weaning program was individualized to each child. Weaning success was defined a priori. Factors associated with success were investigated using multivariate analysis. RESULTS Ninety-four patients were enrolled, in whom a total of 114 attempts of weaning were performed at a median age of 51 ± 40 months. Success was achieved in 80 attempts (success rate of 70%). One hundred three (92%) weaning attempts were performed at home with a follow-up in the outpatient clinic, mostly (74%) by a progressive (>1 month) reduction of tube feeding. Patients who required psychological support during weaning had more failures than patients who did not (odds ratio = 5.7, 95% confidence interval [1.2-27.0], P = 0.03). The presence of impaired oral feeding skills at the time of EN discontinuation was also predictive of failure (odds ratio = 6.2, 95% confidence interval [0.05-0.5], P = 0.005). CONCLUSIONS Our progressive, mostly outpatient-based, patient-tailored program of weaning from EN is effective for tube-dependent children. Children who need psychological support during weaning and those who present impaired oral feeding skills represent a subgroup of at-risk patients for whom alternative weaning strategies may need to be considered.
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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
| | - Katia Lecoeur
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille
| | - Madeleine Aumar
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille.,Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, University 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
| | - Stéphanie Coopman
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille
| | - Audrey Nicolas
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille
| | - Dominique Turck
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille.,Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, University 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.,Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, University 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.,Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, University Lille, Lille, France
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Wilken M, Ehrmann S, Rottinghaus B, Bagci S. Behandlung von Sondendependenz bei Kindern. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-01057-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Long-term efficacy of clinical hunger provocation to wean feeding tube dependent children. Clin Nutr 2020; 39:2863-2871. [DOI: 10.1016/j.clnu.2019.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
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Lively EJ, McAllister S, Doeltgen SH. Characterizing International Approaches to Weaning Children From Tube Feeding: A Scoping Review. JPEN J Parenter Enteral Nutr 2020; 45:239-250. [PMID: 32374934 DOI: 10.1002/jpen.1842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 11/09/2022]
Abstract
Approaches to tube weaning enterally fed children and evaluating outcomes vary widely. This limits the utility of research for identifying both "what works" and successful implementation of research outcomes. We used a qualitative scoping review methodology to examine internationally published research. Our primary aim was to identify the main philosophies underpinning intervention design and the main outcome variables used to demonstrate success of existing programs. This information can be used to inform future research design and clinical practice. Literature up until June 2019 was sourced via Medline, Scopus, Ovid, and CINHAL databases; hand searching; and gray literature using Google Advanced Search. Three predominant approaches to tube-weaning interventions were identified: behavioral, child- and family-centered, and biomedical. A wide range of intervention variables were identified, with the level of parental involvement and the use of hunger provocation varying between approaches. Our Review also confirms that there is no consistency in outcome measures used, limiting comparability between programs. We suggest that the role of parents in the weaning process and its impact on both the child and the parent/carer while transitioning from enteral to oral eating are insufficiently understood. We discuss these findings in the context of a suggested framework for future research.
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Affiliation(s)
- Emily J Lively
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Sue McAllister
- Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Sebastian H Doeltgen
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Malécot-Le Meur G, Jacquemet B, Bégo C, Godot C, Abadie V. [Creation of a tool to help assess eating disorders in young children]. SOINS. PEDIATRIE, PUERICULTURE 2020; 41:38-43. [PMID: 32446556 DOI: 10.1016/j.spp.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In order to optimize the care of young hospitalized children with eating disorders, the Orality group at the Necker-Enfants malades University Hospital in Paris has created a therapeutic education tool: the Fleur des sens. This flower which is to be colored at the end of the meal with the child has nine petals representing nine foods that make up the meal, which were initially difficult or even impossible for the young patient to eat. This tool participates in the educational diagnosis and then in the formative evaluation of the child. It is also useful for the parents' understanding of the disease, making the link between sensoriality and food orality.
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Affiliation(s)
- Gaëlle Malécot-Le Meur
- Service de rééducation, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75743 Paris cedex 15, France; Service de pédiatrie générale, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75743 Paris cedex 15, France; Centre de référence du syndrome de Pierre Robin et troubles de la succion-déglutition congénitaux, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75743 Paris cedex 15, France.
| | - Bénédicte Jacquemet
- Service de néonatalogie, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75743 Paris cedex 15, France
| | - Clémence Bégo
- Service de rééducation, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75743 Paris cedex 15, France; Service de néonatalogie, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75743 Paris cedex 15, France; Service de gastroentérologie et nutrition, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75743 Paris cedex 15, France
| | - Cécile Godot
- Unité transversale d'éducation thérapeutique, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75743 Paris cedex 15, France
| | - Véronique Abadie
- Service de pédiatrie générale, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75743 Paris cedex 15, France; Centre de référence du syndrome de Pierre Robin et troubles de la succion-déglutition congénitaux, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75743 Paris cedex 15, France
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Abstract
BACKGROUND AND OBJECTIVES Children who become tube-dependent need specialized treatment in order to make the transition to oral feeding. Little is known about long-term effects of tube weaning programs. This study analyzes long-term effects (outcome, growth, and nutrition data) in a large sample of formerly tube-dependent children 1 to 6 years after participation in tube weaning programs, based on the "Graz model of tube weaning." METHODS Parents of children who completed a tube weaning program between 2009 and 2014 (N = 564) were asked to complete a questionnaire on their child's growth and nutrition. Data was analyzed using SPSS V22.0 for Windows (SPSS, Chicago, IL). RESULTS Response rate was 47.16% (N = 266). Seven children had died between completion of the program and the long-term follow-up. Two hundred and thirty-nine children (92.3%) were still exclusively orally fed 1 to 6 years after completion of the weaning program, 17 children (6.6%) were partially tube-fed. Three children were completely tube-fed (1.1%). Growth data showed no significant changes in zBMI (World Health Organization standards z values for body mass index) between completion of weaning and long-term follow-up. Provided data on nutrition of fully orally fed patients showed that most children (N = 162, 68%) were eating an age-appropriate diet, whereas a small percentage (N = 10, 4%) were fed with a high-caloric formula, a selective diet (N = 12, 5%), or a liquid/pureed diet (N = 55, 23%). CONCLUSIONS Many children who undergo a tube weaning program based on the "Graz model of tube weaning" are able to stay on full oral feeds in the years after completion of the wean without deterioration of growth.
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Shine AM, Finn DG, Allen N, McMahon CJ. Transition from tube feeding to oral feeding: experience in a tertiary care paediatric cardiology unit. Ir J Med Sci 2018; 188:201-208. [DOI: 10.1007/s11845-018-1812-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 04/07/2018] [Indexed: 10/17/2022]
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