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Biomedical subjects

G Sleigh

Publications and source records attributed to G Sleigh.

10 recordsLinked to original sources
PubMed2005

Mothers' voice: a qualitative study on feeding children with cerebral palsy.

BACKGROUND: Around one third of children with cerebral palsy have severe difficulty eating and drinking and are at risk of undernourishment. A gastrostomy feeding tube may be offered as a way of providing nourishment as it bypasses the main physical difficulties. For the families feeding and concerns about the method of feeding affect many areas of their daily life but we know little about what the experience is actually like. This study aimed to explore mothers' experience of feeding children with cerebral palsy. METHODS: Ten principal carers for children with cerebral palsy and severe eating difficulty were interviewed. Four of the children, one girl and three boys aged 2.5 to 4.5 years were being fed solely by mouth and six children, three girls and three boys, aged 4.5 years to 15 years and 10 months, were fed via a gastrostomy feeding tube. Long, loosely structured tape recorded interviews were transcribed and manually analysed using a phenomenological approach. This involved extracting and coding each relevant phrase that contained meaning; then through sequential stages of ordering and reduction into themes the invariant meanings were uncovered. The transcripts were analysed in two groups, oral and gastrostomy feeding, in an identical manner. RESULTS: Phenomenological analysis resulted in two prose accounts that described in depth the essence of the experience. The accounts were mutually informative. Both groups treasured feeding by mouth suggesting that support for oral feeding should be given a higher priority. The accounts explained why some professional encounters added to families' stress and why consistency of care is so important. The study gives insight about the kinds of support families find helpful. CONCLUSIONS: This study should help those involved to understand the families' predicament better and so make a contribution towards providing more appropriate support.

Attitude to Health↗
PubMed2004

Gastrostomy feeding versus oral feeding alone for children with cerebral palsy.

BACKGROUND: Children with cerebral palsy (CP) can be significantly disabled in terms of their ability to suck, chew and swallow. This can lead to significant impairment in feeding ability and, eventually, to under-nutrition. It can also result in aspiration of food into the lungs. Feeding time may be considerably increased and, instead of being an enjoyable experience, mealtimes may be distressing for both the child and carer. Increasingly for children unable to maintain a normal nutritional state feeding by mouth, gastrostomy or jejunostomy tubes are being used to provide the digestive system with nutrients. A gastrostomy tube is a feeding tube inserted surgically through the abdominal wall directly into the stomach. A jejunostomy feeding tube is inserted into the jejunum, part of the small intestine, either directly or via a previous gastrostomy. Although gastrostomy or jejunostomy placement may greatly facilitate feeding of children with CP, many carers find it very difficult to accept this intervention emotionally. The treatment is also relatively costly. For all of these reasons, its effectiveness requires assessment. OBJECTIVES: To assess the effects of nutritional supplementation given via gastrostomy or jejunostomy in children with feeding difficulties due to cerebral palsy. SEARCH STRATEGY: We searched the Cochrane Library's register of controlled trials (CENTRAL) up to Issue 4, 2003, MEDLINE 1977 - December 2003, EMBASE 1980 - December 2003, CINAHL 1982 - December 2003, LILACS 1980 - end 2003, ASLIB 1983 - 2003 and Dissertation Abstracts 1980 - 2003. SELECTION CRITERIA: Only randomised controlled trials which compared delivery of nutrition via a gastrostomy or jejunostomy tube compared with oral feeding alone for children up to the age of 16 were considered for this review. DATA COLLECTION AND ANALYSIS: Selection of trials, data extraction and assessment of trial quality were undertaken independently by two reviewers. MAIN RESULTS: No trials were identified that met the inclusion criteria for this review. REVIEWERS' CONCLUSIONS: On the basis of this systematic review, considerable uncertainty about the effects of gastrostomy for children with cerebral palsy remains. A well designed and conducted randomised controlled trial should be undertaken to resolve the current uncertainties about medical management for children with cerebral palsy and physical difficulties in eating.

Adolescent↗
PubMed2004

Gastrostomy feeding in cerebral palsy: a systematic review.

AIMS: To determine benefits and risks for gastrostomy or jejunostomy feeding compared with oral feeding for children with cerebral palsy. METHODS: Systematic review. SEARCH STRATEGY: electronic databases--Cochrane Library, Medline, Embase, Cinahl, Lilacs, databases of theses, grey literature. INCLUDED: relevant systematic reviews, randomised controlled trials, observational studies, case reports. EXCLUDED: non-systematic reviews and qualitative research. PARTICIPANTS: children with cerebral palsy. INTERVENTION: use of gastrostomy or jejunostomy tube to provide nutrition. OUTCOME: evaluated outcome measures included death, growth, gastro-oesophageal reflux, other complications, psychosocial aspects, and caregiver wellbeing. RESULTS: No relevant systematic reviews or randomised controlled trials were found. Two cohort studies, 15 case series, and eight case reports met the inclusion criteria. Eight studies specifically described percutaneous endoscopic gastrostomy as the intervention. Weight gain resulted from gastrostomy feeding in most cases. There was an approximately fourfold increased risk of death reported in one cohort study for the gastrostomy fed children. Many complications were reported, including potential for increased gastro-oesophageal reflux and fluid aspiration into the lungs. CONCLUSIONS: Benefits associated with gastrostomy or jejunostomy feeding are difficult to assess from the available evidence. Risks of gastrostomy, particularly in relation to surgical complications, have been described but the size of the risk could not be quantified. The finding of a higher death rate for children fed by gastrostomy may merely reflect the greater disability of these compared with orally fed children. Lack of available evidence and the substantial risk of bias in observational studies suggests that a well conducted randomised controlled trial of sufficient size will be needed to answer these problems.

Cerebral Palsy↗
PubMed1993

Cor pulmonale as a complication of ventriculo-atrial shunts reviewed.

The authors present the case of a nine-year-old patient with spina bifida and hydrocephalus treated with a ventriculo-atrial shunt who developed fatal pulmonary hypertension 5 1/2 years after his last valve revision; he had been well and active up to one month before his death. Details of the dramatic cardiovascular findings are given. The problems of treatment, once symptoms occur, and the difficulty of pre-symptomatic detection are discussed.

Child↗
PubMed1981

Benign (non-paroxysmal) familial chorea. Paediatric perspectives.

We describe a non-progressive choreo-athetoid disorder of early onset, present in three families. There were no appreciable abnormalities in pregnancy, during the perinatal period, or in infancy. In each case the family history suggested transmission as an autosomal dominant trait, the gene showing diminished penetrance. Other families have been reported with the disorder and such titles as benign familial chorea, familial essential (benign chorea, or hereditary non-progressive chorea of early onset have been given to it. Our experience suggests that this is not a rare disorder, and that it is one likely to present in the paediatric age group; correct diagnosis is important so that unnecessary investigations are not undertaken, genetic counselling can be given, and proper management advice offered to families and schools.

Child↗
PubMed1979

A method of developmental assessment at four years and some associated findings.

A method of assessing the developmental status of 4-year-old children, which can be included in a comprehensive medical examination, is described. It was designed for research purposes, so that a global score, and separate scores for each sector of development, are obtained. Girls, children in the upper social classes, and those who attended nursery school had higher scores, in general, at this age. The importance of assessing and investigating the factors associated with lack of cooperation is stressed.

Birth Order↗
PubMed1975

The infant's self-regulation of food intake and weight gain. Difference in metabolic balance after growth constraint or acceleration in utero.

Methods of infant feeding, volume of milk intake, the introduction of solid supplements, and weight gain since birth have been studied in 191 babies at the age of 2 months. There were four groups: a hospital sample infants born to women who had been hypertensive during pregnancy, and infants who had been small-for-dates (S.F.D.) or large-for-dates (L.F.D.) at birth. Among bottle-feeders, S.F.D. infants took significantly more milk per kilogramme body-weight than infants in the hospital sample and hypertensive series; L.F.D. infants took significantly less. Within each group there was a negative correlation between actual weight at 2 months and milk intake per kilogramme body-weight. These findings are at variance with previous studies made on normal babies. Mean weight gain per kilogramme birth-weight per day was significantly increased in the S.F.D. series and reduced in the L.F.D. series compared with the hospital sample. Although mean milk intake per day at the age of 2 months was less for S.F.D. babies than for L.F.D. babies, mean weight gain per day was greater for S.F.D babies. In both extreme groups there was a tendency for breast-fed babies to revert towards the median faster than bottle-fed babies. These feeding and growth patterns of S.F.D. and L.F.D. babies suggest that there are powerful self-regulatory controls within the infant, and that the metabolic balance of S.F.D. infants is different from that of L.F.D. infants in the early postnatal months.

Animals↗