Caring for Tube-Fed Children: A Review of Management, Tube Weaning, and Emotional Considerations
Caring for Tube-Fed Children: A Review of Management, Tube Weaning, and Emotional Considerations
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DOI：
10.1177/0148607115577449
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发表时间：
2016-07-01
影响因子：
3.4
通讯作者：
Hyman, Paul
中科院分区：
文献类型：
--
作者：
Edwards, Sarah;Davis, Ann M.;Hyman, Paul
肠内营养是一种通过口服或通过管子或其他设备将营养输送到肠道的做法。许多儿童依赖肠内喂养来补充他们的营养或作为他们的营养的完全来源。管理使用试管喂养的儿童需要一个提供者团队来解决这样的两难问题，如喂养时间表、断奶、试管喂养的感官影响、与进食相关的疼痛或恶心的治疗、口腔运动问题以及儿童和家庭的行为问题。本综述的目的是总结肠内喂养的多学科方面。这个多学科团队由职业治疗师、言语语言病理学家、胃肠病学家、心理学家、护士、药剂师和营养师组成。只有很少的口腔喂养经验，并通过鼻胃或胃造瘘管喂养的儿童往往会出现口腔厌恶。有限的数据支持，患有喂养障碍的儿童更有可能有感觉障碍，早期的生活疼痛经历导致拒绝喂养。有住院和门诊计划，让患者从管饲到进食都能断奶。亲子互动是管饲儿童评估和治疗的重要组成部分。这篇综述还指出了许多信息差距，包括关于喂养时间表、混合管状喂养的数据、使儿童脱离肠内喂养的最佳方法、管状喂养儿童使用慢性止痛药的疗效，以及最后，在所有管状喂养儿童的父母中评估父母压力的必要性。
Enteral nutrition is the practice of delivering nutrition to the gut either orally or through a tube or other device. Many children are reliant on enteral feedings to either supplement their nutrition or as a complete source of their nutrition. Managing children on tube feedings requires a team of providers to work through such dilemmas as feeding schedules, weaning from tube feeding, sensory implications of tube feeding, treatment of pain or nausea associated with eating, oral-motor issues, and behavioral issues in the child and family. The purpose of the current review is to summarize the multidisciplinary aspects of enteral feeding. The multidisciplinary team consists of a variable combination of an occupational therapist, speech-language pathologist, gastroenterologist, psychologist, nurse, pharmacist, and dietitian. Children who have minimal oral feeding experience and are fed via a nasogastric or gastrostomy tube often develop oral aversions. Limited data support that children with feeding disorders are more likely to have sensory impairment and that early life pain experiences contribute to feeding refusal. There are inpatient and outpatient programs for weaning patients from tube feeding to eating. The parent-child interaction is an important part of the assessment and treatment of the tube-fed child. This review also points out many information gaps, including data on feeding schedules, blenderized tube feedings, the best methods for weaning children off enteral feedings, the efficacy of chronic pain medications with tube-fed children, and, finally, the necessity of the assessment of parental stress among all parents of children who are tube fed.