Impact of an educational program on the feeding of neurologically impaired children

Carvalho, Ana Paula Cajaseiras de; Chiari, Brasília Maria; Gonçalves, Maria Inês Rebelo

doi:10.1590/S2317-17822013005000004

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Articles • CoDAS 25 (05) • 06 Dec 2013 • https://doi.org/10.1590/S2317-17822013005000004 copy

Impact of an educational program on the feeding of neurologically impaired children

Authorship SCIMAGO INSTITUTIONS RANKINGS

PURPOSE:

To verify the impact of an educative program focused on aspects related to feeding developed with a group of caregivers of children with chronic non-progressive encephalopathy.

METHODS:

Cross-sectional comparative study conducted with 30 children diagnosed with chronic non-progressive encephalopathy and their caregivers with the use of a questionnaire and video recordings of a meal conducted by the main caregiver. In order to verify the impact of an educational program in the knowledge and conduct of caregivers, patients were divided into two groups: study - consisting of caregivers submitted to a questionnaire and a video recording before and after the educational program; control - group in which caregivers underwent the procedures in two occasions, but without access to the educational program.

RESULTS:

Around 93.33% of caregivers were females, most had low educational level, and only 10% had a professional activity. Previous knowledge of caregivers concerning feeding was restricted, with 66% of caregivers not knowing what aspiration was, 60% being unfamiliar with the complications associated with such occurrence, and 86.66% stating that there is no relation between voice and swallowing. During feeding, only 26.66% of the caregivers used verbal commands related to feeding, and 50% did not realize the difficulties presented by their children. We observed a difference with regard to knowledge and conduct in the study group only.

CONCLUSION:

The educational program had a positive impact on the knowledge and conduct of caregivers concerning the feeding of their children with chronic non-progressive encephalopathy.

Cerebral palsy; Feeding; Caregivers; Knowledge; Training

Sample characteristics		G1 (control)		G2 (study)		Total		p-value
Sample characteristics		n	%	n	%	n	%	p-value
Children
	Gender							0.240
	Females	6	40	3	20	9	30
	Males	9	60	12	80	21	70
CNPE								0.0748
	Hemiparesis	1	6.66	4	26.66	5	16.66
	Diplegia	3	20			3	10
	Tetraparesia	11	73.33	11	73.33	22	73.33
Age (years)								0.646
	Mean	6.2		6.8
	Standard deviation	3.8		3.8
	Minmax	112		112
Caregivers								0.150
	Females	13	86.66	15	100	28	93.33
	Males	2	13.33			2	6.66
Schooling								0.084
	Incomplete elementary	10	66.66	14	93.33	24	80
	Complete elementary	1	6.66			1	3.33
	Incomplete high school	1	6.66			1	3.33
	Complete high school	3	20	1	6.66	4	13.33
Professional activity								0.073
	Yes	3	20			3	10
	No	12	80	15	100	27	90
Age (years)								0.319
	Mean	31.9		29.6
	Standard deviation	4.6		8.0
	Minmax	2245		2237

Knowledge		G1 (control)		G2 (study)		Total		p-value
Knowledge		n	%	n	%	n	%	p-value
Signs of difficulty*
	Choking	11	73.33	12	80	23	76.66
	Cough	6	40	5	33.33	11	36.66
	Fatigue	6	40	7	46.66	13	43.33
	Anterior exhaustment	4	26.66	6	40	10	33.33
	Stasis in the oral cavity	6	40	4	26.66	10	33.33
	Vomiting	4	26.66	6	40	10	33.33
Definition of aspiration*
	Does not know	10	66.66	10	66.66	20	66.66
	Food stuck on mouth	1	6.66	1	6.66	2	6.66
	Food goes to lungs	2	13.33	2	13.33	4	13.33
	Food goes to nose	3	20	2	13.33	5	16.66
Complications of aspiration*
	Pneumonia	3	20	2	13.33	5	16.66
	Shortness of breath	5	33.33	4	26.66	9	30
	Increase in secretion	2	13.33	1	6.66	3	10
	Malnutrition	1	6.66			1	3.33
	Fever	3	20			3	10
	Sore throat	1	6.66	2	13.33	3	10
	Death	3	20	1	6.66	4	13.33
	Does not know	8	53.33	10	66.66	18	60
Facing choking
	Slaps on the back	10	66.66	7	46.66	17	56.66
	Offer something to drink	1	6.66	4	26.66	5	16.66
	Puts the child in standing position	1	6.66			1	3.33
	Puts the child in sitting position	2	13.33	1	6.66	3	10
	Waits	2	13.33	3	20	5	16.66
	Other	4	26.66	5	33.33	9	30
Facing food stasis*
	Waits untill they swallow	10	66.66	8	53.33	18	60
	Offers more food			2	13.33	2	6.66
	Asks to swallow	5	33.33	10	66.66	15	50
	Asks to spit	2	13.33			2	6.66
	Takes it off the mouth	3	20	3	20	6	20
	Gives water	4	26.66	3	20	7	23.33
	Use other strategies	1	6.66	2	13.33	3	10
Reasons to give up feeding*
	The child does not open the mouth	5	33.33	6	40	11	36.66
	The child chokes too much	6	40	5	33.33	11	36.66
	The child spits out the food	4	26.66	3	20	7	23.33
	The child cries	4	26.66	6	40	10	33.33
	The child is tired	3	20	6	40	9	30
	The child is asleep or sleepy			6	40	6	20
Verbal interation during feeding								0.1919
	No	2	13.33	2	13.33	4	13.33
	Rarely	4	26.66	7	46.66	11	36.66
	Frequently	4	26.66	3	20	7	23.33
	Always	5	33.33	3	40	8	26.66
Importance of verbal commands about feeding								0.1753
	Yes	14	93.33	11	73.33	25	83.33
	No	1	6.66	4	26.66	5	16.66
Factors that interfere in feeding*
	To talk with the child	1	6.66	3	20	4	13.33
	Television on	4	26.66	7	46.66	11	36.66
	Parallel talking	8	53.33	5	33.33	13	43.33
	Hurry in feeding	4	26.66	5	33.33	9	30
	The child speaks during feeding	1	6.66	6	40	7	23.33
	The child is fed lying down	4	26.66	5	33.33	9	30
	Other	1	6.66			1	3.33

Functional aspects		G1 (control)		G2 (study)		Total		p-value
Functional aspects		n	%	n	%	n	%	p-value
Perception of change in voice during feeding
	Yes	4	26.66	5	33.33	9	30	0.4098
	No	7	46.66	6	40	13	43.33
	Never paid attention	4	26.66	4	26.66	8	26.66
Change in voice								0.3779
	Slight			1	6.66	1	3.33
	Hoarseness	4	26.66	3	20	7	23.33
	Wet			1	6.66	1	3.33
	NA	11	73.33	10	66.66	21	70
Perception of change in breathing during feeding								0.3093
	Yes	7	46.66	5	33.33	12	40
	No	5	33.33	7	46.66	12	40
	Never paid attention	3	20	3	20	6	20
Change in breathing								0.1314
	Fast	5	33.33	2	13.33	7	23.33
	Weak	2	13.33	3	20	5	16.66
	Noisy	1	6.66			1	3.33
	NA	7	46.66	10	66.66	17	56.66
Relation between voice and swallowing								0.2669
	Yes	3	20	1	6.66	4	13.33
	No	12	80	14	93.33	26	86.66
Relation between breathing and swallowing								0.3779
	Yes	9	60	8	53.33	17	56.66
	No	6	40	7	46.66	13	43.33

Caregivers’ knowledge		G1 (control group)				p-value	G2 (study group)				p-value
		First collection		Second collection			First collection		Second collection
		n	%	n	%		n	%	n	%
Definition of aspiration						0.1587					0.0017*
	Inadequate	2	13.33	11	73.33		1	6.66	4	26.66
	Adequate	3	20	2	13.33		2	13.33	9	60
	Does not know	10	66.66	2	13.33		12	80	2	13.33
Concordance between the definition of aspiration and clinical complications						0.1587					0.0125*
	Yes	3	20	4	26.66		5	33.33	2	13.33
	No	12	80	11	73.33		10	66.66	13	86.66
Relation between voice and swallowing						0.1587					0.0082*
	Yes	3	20	2	13.33		1	6.66	10	66.66
	No	12	80	13	86.66		14	93.33	5	33.33
Relation between breathing and swallowing						0.2965					0.0059*
	Yes	6	40	5	33.33		6	40	15	100
	No	9	60	10	66.66		9	60
Concordance between perception of voice and relation voice/swallowing						0.2965					0.0082*
	Yes	3	20	4	26.66		3	20	12	80
	No	12	80	11	73.33		12	80	3	20
Concordance between perception of breathing and relation breathing/swallowing						0.2965					0.0455*
	Yes	4	26.66	6	40		6	40	14	93.33
	No	11	73.33	9	60		9	60	1	6.66

Behavioral aspects		G1 (control group)				p-value	G2 (study group)				p-value
		First collection		Second collection			First collection		Second collection
		n	%	n	%		n	%	n	%
Verbal interaction with the child						0.0899					0.0544
	Present	9	60	11	73.33		7	46.66	9	60
	Absent	6	40	4	26.66		8	53.33	6	40
Commands related to feeding						0.1587					0.0216*
	Present	5	33.33	6	40		3	20	8	53.33
	Absent	10	66.66	9	60		12	80	7	46.66
Perception of child’s difficulty by the caregiver						0.2223					0.0139*
	Yes	3	20	3	20		4	26.66	9	60
	No	7	46.66	7	46.66		8	53.33	5	33.33
	NA	5	33.33	5	33.33		3	20	1	6.66
Change in conduct by caregiver						0.5000					0.0544
	Yes	3	20	3	20		4	26.66	7	46.66
	No	7	46.66	7	46.66		8	53.33	5	33.33
	NA	5	33.33	5	33.33		3	20	3	20
Strategy by the caregiver to improve difficulty						0.5000					0.0216*
	Yes	3	20	3	20		2	13.33	7	46.66
	No	12	80	12	80		13	86.66	8	53.33

Sociedade Brasileira de Fonoaudiologia Al. Jaú, 684, 7º andar, 01420-002 São Paulo - SP Brasil, Tel./Fax 55 11 - 3873-4211 - São Paulo - SP - Brazil
E-mail: revista@codas.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence address: Ana Paula Cajaseiras de Carvalho R. José Luiz Calazans, s/n, Bloco E3/201, Jatiúca, Maceió (AL), Brasil, CEP: 57035-850. E-mail: anacajaseiras@yahoo.com.br