Pros and cons of gastrostomy feeding in children with cerebral palsy

At least a third of children with moderate to severe cerebral palsy (CP) will have feeding difficulties. Malnutrition should not be considered normal in children with CP. Early, persistent, and severe feeding difficulties are a marker for subsequent poor growth and developmental outcomes. Growth patterns in children with cerebral palsy are associated with their overall health and social participation. Growth restriction increases progressively with age and thus mandates early nutritional intervention. In children with severe CP such nutritional intervention is increasingly being administered by gastrostomy feeding tube but controversy surrounds the evidence-base for this approach. Moreover, mothers' decisions about gastrostomy feeding are complex and difficult and must be taken into account in making therapeutic recommendations. This paper discusses the available research evidence and psychosocial issues around gastrostomy feeding in children with severe CP. It seeks to provide a basis for rational clinical decision-making based upon the integration of the best available research evidence with clinical experience and patient values.