New therapy technique increases oral feeding in infants with feeding tubes

Children with neurological impairment often have issues with swallowing. Some of these children require a long-term feeding tube as they cannot obtain enough nutrition by mouth. While feeding tubes provide benefits to patients, they also present potential risks of harm. Currently, there is no effective treatment for swallowing problems.

A team of clinicians and researchers at The Hospital for Sick Children (SickKids) knew they needed to get innovative to seek possible solutions. They found that an emerging treatment called neuromuscular electrical stimulation (NMES) had been used to improve strength and motor function for children with cerebral palsy. They decided to conduct a pilot study to determine if this could be a promising treatment for this serious health problem. The pilot study brought together staff from various disciplines at SickKids including Sherna Marcus, Occupational Therapist, Dr. Jeremy Friedman, Staff Physician, Division of Paediatric Medicine, and Dr. Sanjay Mahant, Staff Physician, Division of Paediatric Medicine.

“We look after many children with neurologic disability and we see how much these children and their parents struggle with feeding problems,” says Dr. Mahant, who is also Associate Scientist, Child Health Evaluative Sciences, SickKids Research Institute. “This health problem can lead to permanent tube feeding and many hospital visits. This need led us to look for a better solution.”

The pilot study at SickKids included seven patients who were 24 months of age or less and had some neurological impairment and severe difficulty swallowing. The neuromuscular stimulation sessions occurred twice weekly with each session lasting between 20 and 45 minutes. The patients received the treatment for a period between two to four months. NMES consists of placing electrodes on the patient’s skin over their neck muscles. Then, small amounts of electrical current are delivered in order to stimulate the muscles responsible for swallowing. The treatment feels like a light vibration and was completed by an occupational therapist with specialized training in this area.

“When families hear electrical stimulation, it can seem unsettling. However, the treatment does not cause any pain. The infants handled the treatment well and parents shared that their babies seemed comfortable both during and after the treatments,” says Sherna Marcus, who provided the treatment to the infants in the pilot study.

Of the five patients who were not safe to orally feed on any consistency of liquid or puree prior to receiving treatment, three established full oral feeding and two established partial oral feeding. This technique was able to show significant improvements for these patients.

The pilot study was small with only seven patients participating. However, the team found that NMES was safe and has potential for being an effective treatment to treat severe difficulty in swallowing in many more patients. No adverse events occurred other than mild skin irritation on the neck where the electrodes were placed. Equally important, the treatment was acceptable to parents.

Currently, NMES for swallowing is not offered in Canada. More research using a larger randomized controlled trial is needed to determine if this type of therapy should be introduced into practice. The team hopes their findings from this pilot study will encourage practitioners at other centres to obtain training in NMES and pursue further research.

To read more about the pilot study, see the full paper published in the February 2019 online edition of BMJ Paedatrics Open.

This study was funded by a peer-reviewed grant from the Department of Paediatrics at SickKids, the Norman Saunders Complex Care Initiative and the SickKids Foundation. This is an example of how SickKids is making Ontario healthier, wealthier and smarter (www.healthierwealthiersmarter.com).