Feeding Disorders in Children With Tracheostomy Tubes

Abstract

Background We aimed to describe feeding dysfunction in a group of children with tracheostomy. Methods Single‐center, retrospective chart review of all children with a tracheostomy who were evaluated by our interdisciplinary feeding program. Demographic and diagnostic data, nutrition variables, acceptance of food consistencies, as well as 2 validated psychometric instruments for assessment of feeding dysfunction were analyzed. Results Thirteen tracheostomy‐dependent children (5/13; 38% ventilator dependent) were evaluated at a median age of 51 months (interquartile range [IQR], 26–69). The majority of children (8/13; 62%) underwent evaluation after decannulation. Four children (30%) had a history of a cuffed tracheostomy tube. Eleven children (85%) used a speaking valve prior to decannulation, only 2 of whom started before initial discharge with a tracheostomy. Children with a tracheostomy had low‐median weight‐ and height‐for‐age z‐scores (−1.27 and −1.73, respectively), with normal‐median body mass index (BMI)–for‐age z‐score (0.175). Children received 75% of feedings via tube feeding (IQR, 13%–97%). Compared with other children with feeding disorders, children with tracheostomy had delays in initial acceptance of most food textures and general diet, and the Mealtime Behavior Questionnaire showed significantly worse overall scores (P = .01), and the About Your Child's Eating survey showed significantly higher parental perception of resistance to eating (P = .0001). Conclusion Requirement of enteral nutrition, poor oral‐feeding skills, chronic malnutrition, and worse mealtime behaviors are associated with tracheostomy. A history of ventilator dependence, cuffed tracheostomy, and inpatient speaking valve–use were infrequently associated with interdisciplinary feeding‐program evaluation.

Early childhood developmental skills of children with tracheostomies and ventilators recently discharged home

“…Another study looked at 5‐year outcomes of children with IMV and identified a high association between neurocognitive function and ventilator dependence, although cognitive assessment was determined by chart review and team consensus, without objective measures 17 . Mechanistically, it is thought that prolonged oral intubation and the presence of a tracheostomy may limit essential early speech and feeding opportunities, and increase likelihood of feeding problems and impaired oral motor skills underlying language expression 18–20 …”

“…17 Mechanistically, it is thought that prolonged oral intubation and the presence of a tracheostomy may limit essential early speech and feeding opportunities, and increase likelihood of feeding problems and impaired oral motor skills underlying language expression. [18][19][20] As a whole, the developmental outcomes of children with IMV have been studied within larger premature cohorts, and have shown greater risk for developmental delays than other prematurely born infants. However, the extent of these delays, their distribution, trajectories, and protective or confounding influence across diverse populations are yet unknown.…”

A Cross-Sectional Study of Pediatric Feeding Disorder in Children with Cystic Fibrosis

“…The rates of PFD are higher in children with other chronic diseases like short bowel syndrome and children with tracheostomy (20,21). Overall, PFD criteria were met by nearly 2 out of 3 children with CF in our study.…”

“…Our own group has studied PFD in 3 chronic conditions: in children with tracheostomy (20), short bowel syndrome (21), and in the current study, CF. In each of these, the hypothesis was different.…”

Family mealtime behaviors in children who are tube fed and preparing to transition to oral eating: A comparison to other pediatric populations

“…Little is known about the specific mealtime behaviors of children who are tube fed with the goal of transitioning to oral feeding. The most commonly used method to assess mealtimes is parent report obtained via questionnaires or interview (Ax et al, 2020; Henningfeld, 2020). While several questionnaires and interviews demonstrate adequate sensitivity and validity, others lack generalizability among multiple childhood illnesses or developmental sub-groups (for a listing of specific strengths and weaknesses, see Poppert et al, 2015).…”