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[Feeding problems in severely handicapped children]
K Matsui1, H Suzuki, Y Hirayama
1Division of Child Neurology, National Center Hospital for Mental, Nervous and Muscular Disorders, Kodaira, Tokyo.
Insights
Severely handicapped children
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Context:
- Severely handicapped children often present complex feeding challenges.
- Nutritional support and airway management are critical in this population.
Purpose:
- To investigate the relationship between neurological impairment and feeding methods in severely handicapped children.
- To identify clinical and neurophysiological markers that predict feeding outcomes.
Summary:
- Nineteen severely handicapped children were grouped by feeding method (tube-fed, oral-fed with dysphagia, oral-fed). Clinical assessments, cranial CT, EEG, and blink reflex tests were performed.
- Group 1 (tube-fed) showed severe cerebral and brainstem lesions, poor head control, and need for airway intervention. Group 2 (oral-fed with dysphagia) and Group 3 (oral-fed) had milder lesions and better motor control.
- Cranial CT, EEG, and blink reflex (R2 component) findings correlated with the severity of handicap and feeding method, suggesting their utility in management decisions.
Impact:
- Findings aid in determining appropriate feeding strategies for severely handicapped children based on neurological status.
- Highlights the importance of comprehensive neurodiagnostic evaluation for optimizing care and preventing complications.
Abstract:
Nineteen patients with severely handicapped children were divided into 3 groups; tube-fed patients (group 1, n = 8), oral-fed patients with dysphagia (group 2, n = 3) and oral-fed patients (group 3, n = 8). Clinical symptoms, past history, cranial CT, EEG, blink reflex and auditory brainstem response were evaluated in these patients. All patients of group 1 and 2 could not control head or sit by themselves. They needed naso-oral suction. However, nasal airway, intubation and tracheostomy were necessary only in group 1 patients. Five out of 8 patients of group 3 could control head and sit by themselves. No one needed naso-oral suction. CT revealed ventricular dilatation or prominent destructive lesions in group 1. However, patients of group 2 and 3 showed the lesions of mild to moderate degree. EEGs showed poorly developed background activities or electrical status epilepticus in group 1, while they showed relatively well-developed background activities with less prominent paroxysmal discharges in group 2 and 3. R2 component of blink reflex was absent bilaterally in 90% patients of group 1 and 2, while unilateral R2 at least was present in group 3. Feeding problems in severely handicapped children were affected by combination of cerebrum and brainstem involvements. Examination of cranial CT, EEG and blink reflex was useful to determine the method of feeding.