ABSTRACT
OBJECTIVES: Limited published data describe the long-term effects of behavioral strategies to wean children from gastrostomy tube (GT) feeding dependence. This study presents data relating to nutritional and psychosocial outcomes observed during a 1-year period in medically complex GT feeding-dependent patients who completed an inpatient behavioral-based tube weaning protocol. METHODS: This was a retrospective study of prospectively and retrospectively collected data associated with a clinical cohort of 77 children diagnosed as having a feeding disorder, GT feeding dependence (>1 year), and an inability to maintain acceptable growth via oral feeding completing an inpatient tube weaning protocol. Nutritional data (percentage of ideal body weight, and oral energy intake as percent ofenergy goal) and psychosocial data (mealtime behavior problems, quality of caregiver and child interactions, and parenting stress) were assessed pre- and post-hospitalization. Nutritional data were also monitored longitudinally at 1, 3, 6, and 12 months postreatment. Data were grouped for retrospective analysis. RESULTS: Mealtime environment and feeding behaviors significantly improved, and all of the patients demonstrated reductions in tube dependence aside from 1 treatment failure. Fifty-one percent of patients were fully weaned from tube feeding after 2 weeks and an additional 12% completed weaning in the outpatient follow-up clinic within 1 year. Patients maintained nutritional stability at the 1-year posttreatment follow-up appointment. CONCLUSIONS: Inpatient behavioral interventions are highly effective and safe for transitioning long-term tube feeding children to oral feeding.
Subject(s)
Behavior Therapy , Child Nutritional Physiological Phenomena , Feeding Behavior , Feeding and Eating Disorders of Childhood/therapy , Gastrostomy/rehabilitation , Nutritional Status , Parent-Child Relations , Child , Child Behavior , Child Development , Child, Preschool , Cohort Studies , Female , Gastrostomy/adverse effects , Hospitals, Pediatric , Humans , Longitudinal Studies , Male , Retrospective Studies , Surveys and Questionnaires , WisconsinABSTRACT
Pediatric nutritional deficiencies are associated not only with poverty and developing countries, but also in children in the developed world who adhere to restricted diets. At times, these diets are medically necessary, such as the gluten-free diet for management of celiac disease or exclusion diets in children with food allergies. At other times, the diets are self-selected by children with behavioral disorders, or parent-selected because of nutrition misinformation, cultural preferences, alternative nutrition therapies, or misconceptions regarding food tolerance. Health care providers must be vigilant in monitoring both growth and feeding patterns to identify inappropriate dietary changes that may result in nutritional deficiencies.
Subject(s)
Diet/adverse effects , Dietary Supplements , Malnutrition/diet therapy , Malnutrition/etiology , Micronutrients/administration & dosage , Adolescent , Celiac Disease/diet therapy , Child , Child, Preschool , Developmental Disabilities/etiology , Diet, Gluten-Free/adverse effects , Diet, Ketogenic/adverse effects , Diet, Macrobiotic/adverse effects , Diet, Reducing/adverse effects , Diet, Vegetarian/adverse effects , Enteral Nutrition/adverse effects , Food Hypersensitivity/diet therapy , Humans , Malnutrition/complications , Malnutrition/diagnosis , Malnutrition/metabolism , Milk Hypersensitivity/diet therapy , Minerals/administration & dosage , Nutrition Assessment , Nutritional Requirements , Nutritional Status , Trace Elements/administration & dosage , Vitamins/administration & dosageABSTRACT
Limited ability to take in nutrients places young patients with dysphagia at risk for malnutrition and failure to gain weight. These children require careful evaluation and ongoing monitoring of growth and nutritional status. Gastroesophageal reflux and recurrent vomiting may contribute to dysphagia when the refluxate causes laryngopharyngeal irritation and can increase the morbidity in patients prone to aspiration. A paucity of evidence-based literature on relevant topics demands both clinical judgment and an interdisciplinary approach for management decisions for these issues. Advances in nutrition and management of aerodigestive conditions related to dysphagia will be reviewed.
Subject(s)
Deglutition Disorders , Esophagitis , Gastrointestinal Tract/physiopathology , Nutritional Status , Child , Child, Preschool , Deglutition Disorders/diagnosis , Deglutition Disorders/physiopathology , Deglutition Disorders/therapy , Energy Intake , Esophagitis/diagnosis , Esophagitis/physiopathology , Esophagitis/therapy , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/physiopathology , HumansABSTRACT
There is no clear consensus on the correct definition of ideal body weight (IBW) in children or on the best method used to calculate IBW. There are at least 3 ways of obtaining IBW in children. They are (1) the McLaren method, (2) the Moore method, and (3) the body mass index method. In children under the age of 8 years, all of these methods provide relatively similar results across all percentiles. In older children, especially at the lowest and highest percentiles, the different methods provide widely disparate results for IBW. It is important to be consistent in the method used as the different methods will provide different results for IBW.
Subject(s)
Body Weight/physiology , Child Nutrition Disorders/diagnosis , Child Nutritional Physiological Phenomena , Adolescent , Adult , Body Mass Index , Child , Child, Preschool , Female , Humans , Male , MathematicsABSTRACT
Maintaining blood glucose (BG) levels within the target range can be an elusive goal in children with type 1 diabetes mellitus (DM). To identify factor(s) that may contribute to glycemic instability, we analyzed the Continuous Glucose Monitoring System (CGMS) (Medtronic MiniMed, Northridge, CA) profiles of a group of children with type 1 DM and a history of frequent BG fluctuations and hypoglycemia. A total of 30 (17 girls, 13 boys) pediatric patients with a history of frequent BG fluctuations and hypoglycemia (mean age, 10.5 +/- 0.7 years; duration, 5.0 +/- 0.6 years), on three to four injections of insulin daily or insulin pump therapy, were evaluated by the CGMS. The mean BG (MBG), absolute means of daily differences (MODD), mean amplitude of glycemic excursion (MAGE), and number of hypoglycemic events (BG <60 mg/dL) for 48 h were calculated in each patient. There was a significant correlation between MBG and glycosylated hemoglobin (HbA1c) (r(2) = 0.22, p < 0.009). There was also a significant correlation between severity of lipohypertrophy and glycemic control (HbA1c) (r(2) = 0.20, p < 0.01). The MODD values had a positive correlation with the severity of injection site lipohypertrophy (r(2) = 0.37, p < 0.0003). The MAGE values had a positive correlation with bolus:basal insulin ratio (r(2) = 0.22, p < 0.009) and number of hypoglycemic events (r(2) = 0.21, p < 0.008), independent of age, MBG, and glycemic control. The 48-h CGMS profile can help characterize day-to-day and within-day BG variability and identify factors influencing glycemic instability in pediatric type 1 DM.
