Is it common for patients with severe cerebral palsy (CP) to require feeding tubes?

Feeding Tubes in Severe Cerebral Palsy

Yes, it is common for patients with severe cerebral palsy to require feeding tubes due to significant difficulties with swallowing, chewing, and feeding that can lead to malnutrition and aspiration pneumonia.

Prevalence and Indications

• Feeding tubes are frequently required in patients with severe cerebral palsy (CP) due to significant disabilities in sucking, chewing, and swallowing abilities 1
• Neurological disorders, including cerebral palsy, represent approximately 50% of cases requiring percutaneous endoscopic gastrostomy (PEG) tube placement 2
• Patients with severe CP often experience:
  • Dysphagia (difficulty swallowing)
  • Risk of aspiration pneumonia
  • Prolonged feeding times
  • Inadequate nutritional intake
  • Weight loss and growth failure 1

Benefits of Tube Feeding in Cerebral Palsy

• In a population-based follow-up study, 90% of families reported improved quality of life for both the child with CP and the family after tube feeding initiation 1
• Tube feeding in severe CP can:
  • Prevent weight loss and maintain growth trajectories
  • Reduce the risk of aspiration pneumonia
  • Decrease feeding-related stress for caregivers
  • Improve pulmonary function in some cases 3
• Survival rates after gastrostomy/jejunostomy placement in children with severe CP were 83% after 2 years and 75% after 7 years 1

Types of Feeding Tubes Used

• Percutaneous endoscopic gastrostomy (PEG) is the most common type of feeding tube used for long-term nutritional support in CP 2
• Nasogastric tubes may be used for short-term feeding but are generally not preferred for long-term use due to:
  • Ease of dislodgement
  • Patient discomfort
  • Potential complications 4
• Jejunostomy tubes may be considered in cases with severe gastroesophageal reflux 5

Decision-Making Algorithm for Tube Feeding in CP

1. Assess severity of feeding difficulties:

   • Presence of dysphagia with risk of aspiration
   • Inability to maintain adequate nutritional status orally
   • Prolonged feeding times (>3 hours daily) 1, 3

2. Consider tube feeding when:

   • Oral intake is below 50% of energy requirements for more than 10 days despite adequate support and oral supplements 2
   • Evidence of aspiration on swallowing studies
   • Failure to thrive or weight loss despite nutritional interventions 3

3. Choose appropriate tube type:

   • For expected duration <4 weeks: nasogastric tube
   • For expected duration >4 weeks: PEG tube 2

Evidence Limitations

• There is a lack of randomized controlled trials comparing tube feeding versus oral feeding alone in children with CP 5
• A Cochrane review found no trials meeting inclusion criteria, highlighting the need for well-designed studies 5
• Most evidence comes from observational studies rather than randomized controlled trials 1, 3

Complications and Considerations

• Despite the benefits, tube feeding in CP can have complications:
  • Insertion site infections
  • Tube dislodgement
  • Gastrointestinal symptoms (vomiting, diarrhea)
  • Potential for overfeeding 1
• Negative reports from families were primarily associated with increased stress related to the feeding process itself, not the decision to place a feeding tube 1

Monitoring Recommendations

• Regular reassessment of nutritional status and growth parameters
• Monitoring for complications such as tube site infections
• Positioning patients at 30° or more during feeding and for 30 minutes after to minimize aspiration risk 6
• Checking gastric residual volumes when initiating tube feeding or when signs of feeding intolerance occur 6

While the decision to place a feeding tube can be emotionally difficult for caregivers, the evidence suggests that tube feeding is common and often beneficial for patients with severe cerebral palsy who cannot maintain adequate nutrition orally.