Edwards Sarah, Davis Ann M, Bruce Amanda, Mousa Hayat, Lyman Beth, Cocjin Jose, Dean Kelsey, Ernst Linda, Almadhoun Osama, Hyman Paul
Children's Mercy Hospital and Clinics, Kansas City, MO
Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas Center for Children's Healthy Lifestyles & Nutrition, Kansas City, Missouri.
JPEN J Parenter Enteral Nutr. 2016 Jul;40(5):616-22. doi: 10.1177/0148607115577449. Epub 2015 Mar 19.
Enteral nutrition is the practice of delivering nutrition to the gut either orally or through a tube or other device. Many children are reliant on enteral feedings to either supplement their nutrition or as a complete source of their nutrition. Managing children on tube feedings requires a team of providers to work through such dilemmas as feeding schedules, weaning from tube feeding, sensory implications of tube feeding, treatment of pain or nausea associated with eating, oral-motor issues, and behavioral issues in the child and family. The purpose of the current review is to summarize the multidisciplinary aspects of enteral feeding. The multidisciplinary team consists of a variable combination of an occupational therapist, speech-language pathologist, gastroenterologist, psychologist, nurse, pharmacist, and dietitian. Children who have minimal oral feeding experience and are fed via a nasogastric or gastrostomy tube often develop oral aversions. Limited data support that children with feeding disorders are more likely to have sensory impairment and that early life pain experiences contribute to feeding refusal. There are inpatient and outpatient programs for weaning patients from tube feeding to eating. The parent-child interaction is an important part of the assessment and treatment of the tube-fed child. This review also points out many information gaps, including data on feeding schedules, blenderized tube feedings, the best methods for weaning children off enteral feedings, the efficacy of chronic pain medications with tube-fed children, and, finally, the necessity of the assessment of parental stress among all parents of children who are tube fed.
肠内营养是指通过口服或经管道或其他装置将营养物质输送至肠道的做法。许多儿童依靠肠内喂养来补充营养或作为其全部营养来源。对接受管饲的儿童进行管理需要一组医护人员共同应对诸如喂养时间表、从管饲断奶、管饲的感官影响、与进食相关的疼痛或恶心的治疗、口腔运动问题以及儿童及其家庭的行为问题等困境。本综述的目的是总结肠内喂养的多学科方面。多学科团队由职业治疗师、言语语言病理学家、胃肠病学家、心理学家、护士、药剂师和营养师等不同组合的人员组成。口腔喂养经验极少且通过鼻胃管或胃造口管喂养的儿童常常会出现口腔厌恶。有限的数据表明，患有喂养障碍的儿童更有可能存在感觉障碍，且早期的疼痛经历会导致拒食。有针对患者从管饲过渡到经口进食的住院和门诊项目。亲子互动是管饲儿童评估和治疗的重要组成部分。本综述还指出了许多信息空白，包括关于喂养时间表、匀浆管饲、让儿童停止肠内喂养的最佳方法、管饲儿童使用慢性疼痛药物的疗效，以及最后，对所有管饲儿童的家长进行压力评估的必要性。
