Abstract
Background
Children with cerebral palsy can be significantly disabled in terms of their ability to suck, chew and swallow. This can lead to significant impairment in feeding and, eventually, to undernutrition. It can also result in aspiration of food into the lungs. Length of feeding time may be considerably increased and, instead of being an enjoyable experience, mealtimes may be distressing for both child and carer. For children unable to maintain a normal nutritional state feeding by mouth, gastrostomy or jejunostomy tubes are increasingly 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 the feeding of children with cerebral palsy, many carers find it very emotionally difficult to accept this intervention. Moreover, the intervention is costly and there is the possibility of complications. The effectiveness and safety of the treatment requires further assessment. This review is an update of one previously published in 2004.
Objectives
To assess the effects of nutritional supplementation given via gastrostomy or jejunostomy to children with feeding difficulties due to cerebral palsy.
Search methods
For this update, we searched the following databases in July 2012: CENTRAL, MEDLINE , Embase, CINAHL, Science Citation Index, Conference Proceedings Citation Index, LILACS and Zetoc. We searched for trials in ICTRP and Clinicaltrials.gov, and for theses in WorldCat and Proquest Index to Theses. We also contacted other researchers and experts in this field.
Selection criteria
We looked for randomised controlled trials that compared delivery of nutrition via a gastrostomy or jejunostomy tube compared with oral feeding alone for children up to the age of 16 years.
Data collection and analysis
Screening of search results was undertaken independently by two review authors. No data extraction was possible as there were no included studies.
Main results
No trials were identified that met the inclusion criteria for this review.
Authors’ conclusions
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.
Plain language summary
Feeding by tube into the stomach or intestine versus feeding by mouth for children with cerebral palsy
Children with cerebral palsy can have problems with sucking, chewing and swallowing. This can make it difficult to eat and lead eventually to undernutrition or problems caused by food going down the wrong way and getting into the lungs. Mealtimes may be long and distressing for the child and for their carer. 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 nutrition. These processes can be costly, as well as being emotionally difficult for families, and complications are possible. We searched 12 databases in July 2012 but did not find any studies that randomly put children into two groups to investigate the effects of tube feeding via gastrostomy (or jejunostomy) compared to feeding by mouth only. Well-designed studies are needed to help medical professionals and families make difficult decisions about how to treat children with cerebral palsy and physical difficulties in eating.
