1 / 13

To (tube) feed or not to (tube) feed: how to decide?

To (tube) feed or not to (tube) feed: how to decide?. Charlotte M Wright Honorary Consultant Paediatrician, RHSC Yorkhill Professor of Community Child Health Glasgow University. Yorkhill Feeding Clinic. Psychologist, Dietetician, Paediatrician Set up in 2002 to:

marged
Télécharger la présentation

To (tube) feed or not to (tube) feed: how to decide?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. To (tube) feed or not to (tube) feed: how to decide? Charlotte M Wright Honorary Consultant Paediatrician, RHSC Yorkhill Professor of Community Child Health Glasgow University

  2. Yorkhill Feeding Clinic • Psychologist, Dietetician, Paediatrician • Set up in 2002 to: • Wean children ‘stuck’ on tube feeding • Work with weight faltering children at risk of tube feeding • Assess need for tube feeding where there is doubt • Assessment • Review full medical, dietary and behavioural history • Detailed growth and body composition assessment • Video’d meals • Dietary assessment

  3. Three children referred for assessment for possible tube feeding • Quadriplegic cerebral palsy • Community staff recommending tube feeding because of • Feeding disco-ordination • Poor weight gain • Parents unwilling or unhappy to start tube feeding

  4. Assessing growth in cerebral palsy • Children with cerebral palsy tend to • Be very short • Have low BMI (low muscle mass) • Using SD scores to assess growth • 0 = 50th centile • -2 = 2nd = 2% of all children • -4 = very tiny = <1in a thousand children • A child who is proportionate will have roughly same weight and height SD score

  5. Case study one: SM Boy aged 7.4 years • Functional level • At level of 6 week old baby • Eating • Enjoys being fed • Very slow, small amounts • Health • No major illnesses • Growth and fat stores • Emaciated +++ • 1.1 kg lighter than in 18m ago • Weight 11.3 kg (-8 SD) • Height -4 SD, BMI -6SD

  6. SM Progress • Tube feeding started slowly with close monitoring and mineral supplements to prevent refeeding syndrome • Good initial weight gain, but then some re-loss, feeds increased further • Less interested in foods, otherwise fine • 20% heavier after 8m

  7. Case study 2: AM Boy aged 16 years • Major difficulties feeding at school • Videofluoroscopy showed silent reflux • Family told to stop all oral feeding • Tube feeding started • Referred to feeding clinic for 2nd opinion

  8. AM assessment • Functional level • Limited cognition, no voluntary movement • Eating • Enjoys food++; Little choking when fed at home • Health • No chest infections or other ill health • Growth • Has grown steadily till now, height 0.4th centile • Fat stores • Weight 30 kg (-5 SD) BMI -5SD • Weight loss (3kg) since stopped oral feeding • Body fat 9th centile (~25th before weight loss) • Lean mass 0.4th centile

  9. AM progress • Continued full tube feeding • Depressed ++ • No change in health • Family eating in secret so as not to upset him • Regained lost weight • Gradual improvement in mood • Family give tastes of favourite foods as a treat

  10. Case study 3: CF Girl aged 15 years • Functional level • Lively and cheerful • In wheelchair • Voluntary movement of arms, poor coordination • Eating • Loves her food but makes mess when eating • Health • Excellent health • Growth and fat stores • Stable growth pattern for 4 years • Weight -3-4SD, Height -3, BMI 2nd centile • Fat 9-25th, lean 9-25th centile

  11. Progress • No need for artificial feeding • Support family and advise school on how to minimise mess • Continued well at follow up

  12. Pros and cons of tube versus oral feeding

  13. Monitoring subsequent progress • Is child happier and in better health? • Are feeds well tolerated? • Weight gain • Sufficient? • Excessive? • Has their growth improved?

More Related