Dysphagia and Feeding Post ABI

Children post-ABI have been found to have the same swallowing problems as those in the adult population (Morgan et al. 2002). The incidence of dysphagia in children after a severe TBI is 68-76% (Morgan 2010). Such a high rate is problematic as children already have difficulty meeting their metabolic demands following a brain injury, and problems with swallowing and feeding further attenuate the ability to obtain their metabolic goals (Morgan 2010). Assessing the ability of an individual with TBI to feed is an important task for the rehabilitation team. Bedside evaluations are completed once the child is alert enough to eat. Results of the bedside evaluation may lead to a videoflouroscopy, which can reveal pharyngeal and oral deficits (Morgan et al. 2002).

Individual Studies

Table: Feeding Treatments for Children with ABI 

Discussion

Early enteral administration of an immune enhanced formula (glutamine, arginine, antioxidants, and omega-3 fatty acids; Stresson) did not improve mean caloric and protein intake in children compared to modified regular feeding (Tentrini) (Briassoulis et al. 2006). Although not significant long-term, within 24 hours nitrogen balance important for metabolism was greater for children receiving the immune enhanced formula. Authors attribute this increase to presence of additional nitrogen in arginine and the presence of arginine and glutamine that trigger nitrogen growth (Briassoulis et al. 2006). Overall, immunonutrition was only beneficial to reduce cytokines, specifically interleukin-8, and early gastric colonization (Briassoulis et al. 2006).

In addition to the content of food, the texture of food is important as well. Texture affected the amount of food intake for children following a severe ABI (DeMatteo et al. 2002), which as mentioned earlier is important to regulate in order to reach the enhanced metabolic demands. Soft textures were the most difficult to intake and minced and pureed texture varied in efficacy between children (N=3) (DeMatteo et al. 2002). The person administering the food had a significant effect on the child’s food intake, therefore authors discuss the importance of individualized treatment plans for feeding in children following a severe ABI (DeMatteo et al. 2002).

Conclusions

There is Level 1b evidence that the administration of enhanced immune formulas are not superior to regular formulas in regards to increasing caloric and protein intake; however enhanced immune formulas do reduce interleukin-8 and early gastric colonization.

There is Level 5 evidence that food texture and the caregiver are important factors when feeding a person post ABI.

 

 

Enhanced immune formulas are not superior to regular formulas in regards to caloric and protein intake; however, they do have potential beneficial anti-inflammatory properties in children post-TBI.

Food texture and the person feeding are important factors when feeding a child post acquired brain injury.