Most visits to the emergency room because of feeding tube complaints in children with cerebral palsy involve severe gross motor impairment and are easily managed by a physician, a study finds.
Educating caregivers and other health professionals about feeding tube replacement would mean most feeding tube-related complications could be managed closer to home.
Children with cerebral palsy have difficulties eating by themselves, which leads to poor nutrition and other complications that are usually resolved by using a feeding tube. The most commonly used feeding tubes in children with cerebral palsy are gastrostomy tubes — inserted through the abdomen delivering nutrition directly to the stomach — or gastrojejunal tubes — placed in the stomach like a gastrostomy tube, but with a thin, long tube threaded into the jejunal portion of the small intestine.
Currently, approximately 11% of children with cerebral palsy use a feeding tube. This number rises to 32% in children with severe motor impairment.
Feeding tubes are associated with numerous benefits for children and their families, but also carry risks associated with tube placement and maintenance. Approximately 6% of emergency room visits by children with cerebral palsy are related to feeding tube complications, such as tube misplacement.
In this study, researchers attempted to describe the characteristics of emergency-room visits related to either gastrostomy or gastrojejunal tubes among children with cerebral palsy. The team also wanted to determine the complexity of complications associated with feeding tubes and the management approaches taken.
Researchers reviewed the medical records of children with cerebral palsy who presented with a feeding tube-related complaint to two pediatric emergency departments in the Australian state of Victoria between 2008 and 2012.
Of the total 3,631 emergency department presentations, 234 (6%) were due to feeding tube complications. However, only 183 presentations were considered due to missing data. Eighty-seven cerebral palsy patients accounted for these presentations, of which 51.7% had a single emergency presentation for a feeding tube-related complaint, 18% had two, 9% had three, 13% had four and 8% had five or more presentations.
Most emergencies (90%) occurred in children with severe motor impairment and in children who were 9 or younger (67%). There were 105 (70%) cases of dislodgment — when the tube moves or comes out accidentally — and a significant number of cases occurred with tubes that had been recently placed.
Overall, 83% of emergencies were due to gastrostomy-tube complications and 6% to gastrojejunal-tube complications. The remaining were due to other types of feeding tubes not considered in the study. Gastrojejunal tube-related emergencies had a higher risk of resulting in overnight hospitalizations.
Most (90%) of the times the tube was replaced by a physician without further complications. However, in 11% of the cases the attempt at reinsertion failed and in 9% of the cases resulted in hospitalization.
“This raises the question of whether dislodged [gastrostomy] tubes in children with CP could be effectively managed elsewhere other than a tertiary center,” researchers stated.
This is of special significance because more than half of the patients did not live in large cities and likely had to travel long distances to reach a specialized pediatric hospital.
“Management of [gastrostomy]-tube complications closer to home would mean decreased travel burden on families and more efficient use of tertiary hospital [emergency department] resources,” researchers said.
Because not all caregivers at regional centers might feel confident to replace the feeding tube of a child with cerebral palsy and parents might not trust non-specialized personnel, it could be useful to establish educational campaigns regarding feeding tube replacement.
“The establishment of [gastrostomy] tube education and support teams could strengthen statewide education in emergency [gastrostomy]-tube management for both children and adults,” researchers said.
“Providing parents with information about [emergency departments] or other community-based providers that are confident in managing [gastrostomy] tubes in children with complex needs may be helpful for families and could also provide guidance when they are considering where to present for urgent care,” they concluded.