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Psychological preparation for nasogastric feeding in children
C E Holden1, A MacDonald, M Ward
1Birmingham Children's NHS Trust.
Insights
Detailed psychological preparation significantly reduces distress for older children and adolescents undergoing nasogastric tube placement for enteral nutrition. Younger children showed no difference, highlighting the need for sensitive, individualized support for all pediatric patients.
Area of Science:
- Pediatric Psychology
- Clinical Nutrition
- Child Health
Background:
- Enteral nutrition via nasogastric tube is common in pediatric care.
- Nasogastric tube insertion can be a distressing procedure for children and their families.
- The impact of psychological preparation on children's experience with nasogastric tubes requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of detailed psychological preparation for children undergoing nasogastric tube placement.
- To compare the outcomes between younger children (2-6 years) and older children/adolescents (7-16 years).
- To identify key elements of preparation that reduce distress.
Main Methods:
- Prospective study of 48 children receiving home enteral nutrition.
- Random allocation to standard or detailed psychological preparation.
- Age-based grouping (Group A: 2-6 years, Group B: 7-16 years) with blinded questionnaire assessment.
Main Results:
- Detailed preparation was time-consuming but beneficial for older children (Group B), reducing distress from nasogastric tube passage (P < 0.05).
- No statistical difference was found in younger children (Group A), with parental assessment being crucial.
- Parental perception of value was high for nurse and play therapist involvement (P < 0.05).
Conclusions:
- Detailed psychological preparation is effective for older children and adolescents undergoing nasogastric tube procedures.
- Younger children require sensitive, individualized preparation, with parental input being key.
- Preparation for painful procedures and sensitive follow-up are essential for pediatric patients.
Abstract:
Psychological preparation of children undergoing enteral nutrition by nasogastric tube was evaluated in a prospective study of 48 children nursed at home. They were randomly allocated to receive either standard informal preparation or detailed psychological preparation and support. The children were divided into two groups according to age: group A comprised toddlers and younger children aged 2-6 years and group B comprised older children and adolescents aged 7-16 years. Detailed questionnaires were administered to all parents and older children by dietetic colleagues who were blinded to the type of preparation received by the children. The results emphasize that detailed psychological preparation of families takes time. Passage of a nasogastric tube was seen as very distressing to both parents and children. Having a nasogastric tube was perceived as a major problem by group A. There was no statistical difference in the effects of enteral nutrition between younger children who received routine preparation and those who received detailed preparation; however, parental assessment of their child's behaviour was the sole means of determining how the younger child felt and reacted. In group B, there were marked differences: scores suggested that those who received detailed preparation had been better prepared for enteral feeding in hospital and at home and that the passage of the nasogastric tube, although unpleasant, was less distressing to them (P < 0.05). Talking to a nurse and play therapist was seen by parents as essential (P < 0.05). The authors conclude that children should be prepared for painful procedures and followed up sensitively, according to their needs.