title: Gastrostomy tube feeding of children with cerebral palsy: variation across six European countries.
abstract: OBJECTIVE
  To compare the prevalence of gastrostomy tube feeding (GTF) of children with cerebral palsy (CP) in six European countries.
  
  
  METHODS
  Data on 1295 children (754 males, 541 females; mean age 5y 11mo, range 11y 2mo, min 6mo, max 11y 8mo) with CP born from 1999 to 2001 were collected from geographically defined areas in six European countries; four of the areas covered the whole country. Distribution of CP was unilateral 37%, bilateral 51%, dyskinetic 8%, and ataxic 4%. Sixty children were classified in Gross Motor Function Classification System (GMFCS) levels I and II, 6 in level III and 34 in levels IV and Vas Outcome measures were GTF, age at placement, feeding difficulties and the children's height and weight for age standard deviation scores (z-scores).
  
  
  RESULTS
  The use of GTF among all children with CP was highest in western Sweden (22%, 95% confidence interval [CI] 16-29), and lowest in Portugal (6%, 95% CI 3-10), northern England (6%, 95% CI 3-9) and in Iceland (3%, 95% CI 0-13; p<0.001). The difference between areas was greater among children in GMFCS levels IV and V (non-ambulant); in this group, lower height z-scores were more prevalent in the areas with lower prevalence of GTF. The children's age at placement of gastrostomy also varied between areas (p<0.002).
  
  
  CONCLUSIONS
  The observed differences in the use of GTF may reflect differences in access to treatment or clinical practice, or both. Our results suggest that the use of GTF may improve growth in height and weight among children with more severely affected gross motor function - the group most likely to have associated feeding difficulties.
authors: Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. magnusodin86@gmail.com
authors: Magnus O
authors: MO
authors: Dahlseng
authors: Guro L
authors: GL
authors: Andersen
authors: Maria
authors: M
authors: DA Graca Andrada
authors: Catherine
authors: C
authors: Arnaud
authors: Rajesh
authors: R
authors: Balu
authors: Javier
authors: J
authors: De la Cruz
authors: Teresa
authors: T
authors: Folha
authors: Kate
authors: K
authors: Himmelmann
authors: Karen
authors: K
authors: Horridge
authors: Pétur B
authors: PB
authors: Júlíusson
authors: Magnus
authors: M
authors: Påhlman
authors: Gija
authors: G
authors: Rackauskaite
authors: Solveig
authors: S
authors: Sigurdardottir
authors: Peter
authors: P
authors: Uldall
authors: Torstein
authors: T
authors: Vik
mesh_terms: D002547:Cerebral Palsy / Q000453:epidemiology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D005060:Europe; D019959:Feeding and Eating Disorders of Childhood / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D014600:Utilization Review