Gastrostomy feeding versus oral feeding alone for children with cerebral palsy
Abstract
Background
Children with cerebral palsy (CP) can be significantly disabled in terms of their ability to suck, chew and swallow. This can lead to significant impairment in feeding ability and, eventually, to under‐nutrition. It can also result in aspiration of food into the lungs. Feeding time may be considerably increased and, instead of being an enjoyable experience, mealtimes may be distressing for both the child and carer. Increasingly for children unable to maintain a normal nutritional state feeding by mouth, gastrostomy or jejunostomy tubes are being used to provide the digestive system with nutrients. A gastrostomy tube is a feeding tube inserted surgically through the abdominal wall directly into the stomach. A jejunostomy feeding tube is inserted into the jejunum, part of the small intestine, either directly or via a previous gastrostomy. Although gastrostomy or jejunostomy placement may greatly facilitate feeding of children with CP, many carers find it very difficult to accept this intervention emotionally. The treatment is also relatively costly. For all of these reasons, its effectiveness requires assessment.
Objectives
To assess the effects of nutritional supplementation given via gastrostomy or jejunostomy in children with feeding difficulties due to cerebral palsy.
Search methods
We searched the Cochrane Library's register of controlled trials (CENTRAL) up to Issue 4, 2003, MEDLINE 1977 ‐ December 2003, EMBASE 1980 ‐ December 2003, CINAHL 1982 ‐ December 2003, LILACS 1980 ‐ end 2003, ASLIB 1983 ‐ 2003 and Dissertation Abstracts 1980 ‐ 2003.
Selection criteria
Only randomised controlled trials which compared delivery of nutrition via a gastrostomy or jejunostomy tube compared with oral feeding alone for children up to the age of 16 were considered for this review.
Data collection and analysis
Selection of trials, data extraction and assessment of trial quality were undertaken independently by two reviewers.
Main results
No trials were identified that met the inclusion criteria for this review.
Authors' conclusions
On the basis of this systematic review, considerable uncertainty about the effects of gastrostomy for children with cerebral palsy remains. A well designed and conducted randomised controlled trial should be undertaken to resolve the current uncertainties about medical management for children with cerebral palsy and physical difficulties in eating.
PICOs
Plain language summary
Gastrostomy feeding versus oral feeding alone for children with cerebral palsy
Children with cerebral palsy can be disabled in their ability to suck, chew and swallow. This can lead to impairment in feeding ability and, eventually, to under‐nutrition and/or problems caused by food entering the lungs. Mealtimes may be long and distressing. Increasingly, feeding by a surgically‐inserted tube into the stomach (gastrostomy) or via a tube inserted into the middle of the small intestine (jejunostomy) is used to provide such children with nutrients. These processes can be costly and emotionally difficult for families. No trials were identified which met the inclusion criteria for this review. Well‐designed trials are called for.
