Feeding difficulties in children with cerebral palsy: low-cost caregiver training in Dhaka, Bangladesh

• Published in: Child : care, health & development health & development, 2012-11, Vol.38 (6), p.878-888
• Main Authors: Adams, M. S., Khan, N. Z., Begum, S. A., Wirz, S. L., Hesketh, T., Pring, T. R.
• Format: Article
• Language: English
• Subjects: Bangladesh; caregiver education; Caregiver Training; Caregivers; Caregivers - economics; Caregivers - education; Cerebral palsy; Cerebral Palsy - economics; Cerebral Palsy - psychology; Cerebral Palsy - rehabilitation; Child; Child Welfare; Child, Preschool; Children & youth; Diet; Disability Evaluation; Disabled Children - psychology; Disabled Children - rehabilitation; Educational Status; Feeding and Eating Disorders - economics; Feeding and Eating Disorders - psychology; Feeding and Eating Disorders - rehabilitation; Feeding Behavior; feeding disorders; Female; Home Visits; Humans; Infant; Intervention; interventions; low-income setting; Male; maternal stress; Medical technology; Nutrition; Nutrition Surveys; Nutritional Status; Occupational training; Ostomy; Parenteral nutrition; Quality of Life - psychology; Statistics as Topic; Surveys and Questionnaires
• ISSN: 0305-1862; 1365-2214
• DOI: 10.1111/j.1365-2214.2011.01327.x

Background  The majority of children with cerebral palsy have feeding difficulties, which, if not managed, result in stressful mealtimes, chronic malnutrition, respiratory disease, reduced quality of life for caregiver and child, and early death. In well‐resourced countries, high‐ and low‐cost medical interventions, ranging from gastrostomy tube feeding to caregiver training, are available. In resource‐poor countries such as Bangladesh, the former is not viable and the latter is both scarce and its effectiveness not properly evaluated. The aim of this study was to evaluate the effectiveness of a low‐cost, low‐technology intervention to improve the feeding practices of carers of children with moderate–severe cerebral palsy and feeding difficulties in Bangladesh. Methods  An opportunistic sample of 37 caregivers and their children aged 1–11 years were invited to a six‐session training programme following an initial feeding assessment with brief advice. During home visits, pre‐ and post‐measures of nutritional status, chest health and feeding‐related stress were taken and feeding practices were observed. A control phase was evaluated for 20 of the participant pairs following initial assessment with advice, while awaiting full training. Results  A minimum of four training sessions showed significant improvements in the children's respiratory health (P= 0.005), cooperation during mealtimes (P= 0.003) and overall mood (P < 0.001). Improvements in growth were inconsistent. Dramatic reductions were observed in caregiver stress (P < 0.001). A significant difference in the outcomes following advice only compared with advice plus training was also observed. Conclusions  In situations of poverty, compliance is restricted by lack of education, finances and time. Nonetheless, carers with minimal formal education, living in conditions of extreme poverty were able to change feeding practices after a short, low‐cost training intervention, with highly positive consequences. The availability of affordable food supplementation for this population, however, requires urgent attention.