"A randomized controlled trial of amitriptyline for chronic oral food refusal"

描述（由申请人提供）：胃造口术（G-）和胃空肠（G-J）喂养管放置在婴儿和儿童中，这些婴儿和儿童拒绝进食或由于各种医学原因（神经系统疾病、心脏缺陷和遗传疾病等）而无法进食足够的食物以维持正常生长。虽然饲管通常是作为医疗并发症的临时短期解决方案，但它可以成为肠内营养的永久管道。虽然管饲通常可以挽救那些表现出慢性口服食物拒绝的儿童的生命，但长期持续的管饲给患者，护理人员和家庭带来了重大的经济，心理和情感负担。过渡到口服喂养对于儿童充分发挥其健康和富有成效的生活潜力至关重要。本申请的目的是研究使用阿米替林治疗幼儿疼痛的24周门诊多学科治疗的有效性，以便从胃造口术喂养过渡到口服喂养。 公共卫生相关性：早产儿存活率的提高增加了较大婴儿和幼儿喂养问题的患病率，超过一半的慢性病儿童出现严重的喂养问题。随着胃造口管饲的流行率增加，与将儿童从管饲过渡到口服喂养相关的挑战也增加了。实现从管饲到口服喂养的过渡对于儿童充分发挥其健康和富有成效的生活潜力至关重要。

DESCRIPTION (provided by applicant): Gastrostomy (G-) and gastro-jejunal (G-J) feeding tubes are placed in infants and children who refuse to eat or are unable to eat enough to sustain normal growth due to a variety of medical reasons: neurological disease, heart defects, and genetic disorders, among others. Although often intended as temporary, short-term solution to medical complications, feeding tubes can become a permanent conduit for enteral nutrition. While tube feeding routinely saves the lives of children who exhibit chronic oral food refusal, long-term continuation of tube feeding creates a significant financial, psychological, and emotional burden to patients, caregivers, and families. Making the transition to oral feeding is crucial for children to achieve their full potential for a healthy and productive life. The purpose of this application is to investigate the effectiveness of a 24-week outpatient multidisciplinary treatment using amitriptyline to treat pain in young children in order to transition from gastrostomy feeding to oral feeding. PUBLIC HEALTH RELEVANCE: Improved preterm infant survival has increased the prevalence of feeding problems in older infants and toddlers and severe feeding problems occur in over half of children with chronic medical conditions. As the prevalence of gastrostomy tube feeding has increased, so have the challenges associated with transitioning a child from tube to oral feeding. Achieving the transition from tube to oral feeding is critical for children to reach their full potential of a healthy and productive life.