SELEN SEREL ARSLAN, FATMA ILGAZ, NUMAN DEMİR, A. Ayşe KARADUMAN

Yutma Bozukluğu Olan Serebral Palsili Çocuklarda Büyüme Yetersizliği ve Beslenme Şeklinin Ebeveynlerin Kaygı Durumu Üzerindeki Etkisi

Amaç: Bu çalışma yutma bozukluğu olan serebral palsili (SP) çocuklarda büyüme, beslenme şekli ve ebeveynlerinin kaygı durumları arasındaki ilişkinin incelenmesi amacıyla planlanmıştır. Bireyler ve Yöntem: Çalışmaya en az 3 aydır yutma bozukluğu şikayeti olan, 1-8 yaş arası SP'li çocuklar ve ebeveynleri dahil edilmiştir. Hastaların demografik bilgileri ve beslenme şekline ilişkin bilgiler anket formuyla alınmıştır. Yaşa göre vücut ağırlığı (YAZ) ve yaşa göre boy uzunluğu (YBZ) z-skorları Dünya Sağlık Örgütü (DSÖ)-Anthro programı kullanılarak değerlendirilmiştir. Yutma fonksiyonunun değerlendirilmesi için Modifiye Baryum Yutma Çalışması (MBYÇ) yapılmıştır. Penetrasyon ve aspirasyon şiddetini belirlemede Penetrasyon ve Aspirasyon Skalası (PAS) kullanılmıştır. Ebeveynlerin kaygı düzeyleri Spielberger Sürekli Kaygı Ölçeği (SSKÖ) kullanılarak değerlendirilmiştir. Bulgular: Çalışmaya yaş ortalaması 3.73±2.0 yıl olan 35 erkek (%50.7) ve 34 (%49.3) kız çocuk olmak üzere toplam 69 çocuk hasta dahil edilmiştir. Ortalama YAZ ve YBZ değerleri sırasıyla -1.27±1.89 ve -1.62±2.39 olarak hesaplanmıştır. Başvuru anında çocukların %59.4'ü normal oral diyet ve %7.2'si sıvı-modifiye diyetle beslenirken, %33.3'ü tüple beslenme desteği almaktaydı. Modifiye Baryum Yutma Çalışması'na göre çocukların %55.1'inde oral faz, %52.2'sinde faringeal faz ve %24.6'sında ise özofageal faz (motilite) sorunları olduğu saptanmıştır. Kaygı ölçeğine göre ebeveynlerin sürekli kaygı görülme sıklığı ve sürekli kaygı düzeyi ortalaması sırasıyla %78.3 ve 44.7±8.54 olarak belirlenmiştir. Hastaların başvuru anındaki beslenme şekli ile ebeveynin sürekli kaygı durumu arasında anlamlı bir ilişki olduğu (p=0.02) saptanmıştır. Sonuç: Erken çocukluk döneminde olan ve yutma bozukluğu şikayeti bulunan bir grup SP'li çocuk üzerinde yapılan bu çalışma, çocukların yarıdan fazlasında yutmanın oral ve faringeal fazında sorun olduğunu göstermiştir. Yutma sorunları ve beslenme güçlüğünün çocuğun beslenme şeklini etkilediği ve bu durumun çocuğun bakımından sorumlu ebeveynlerde daha yüksek kaygı durumu ile ilişkili olduğu belirlenmiştir

Effects of Growth Deficiency and Feeding Method on Parental Anxiety in Cerebral Palsy Children with Swallowing Disorders

Aim: This study was planned to investigate the relationship between growth, feeding method and anxiety status of parents of cerebral palsy children (CP) with swallowing disorders. Subjects and Methods: The study included CP children aged between 1-8 years who had a complaint of swallowing difficulty for at least 3 months, and their parents. Demographic and nutritional information were obtained by a questionnaire. Weight and height-for-age z-scores were calculated by Anthro Software of World Health Organization. The severity of penetration and aspiration was determined by Penetration and Aspiration Scale (PAS). The Spielberger State-Trait Anxiety Inventory (STAI) was used to determine anxiety level of caregivers. Results: A total of sixty-nine CP children (mean age=3.73±2.0 years, 50.7% male) were included. The mean weight-for-age and height-for-age z-scores were -1.27±1.89 and -1.62±2.39, respectively. At the time of admission, 59.4% of the children were fed orally and 7.2% were fed a liquid-modified diet, while 33.3% received tube feeding. According to Modified Barium Swallowing Study 55.1% of children had oral phase, 52.2% had pharyngeal phase and 24.6% had esophageal phase (motility) problems. The frequency and mean level of trait anxiety of parents were calculated as 78.3% and 44.7±8.54, respectively. There was a significant relation between baseline feeding method and trait anxiety of parents (p=0.02). Conclusion: This study in a group of CP children in early childhood and had a complaint of swallowing disorder showed that more than half of these children had problems in oral and pharyngeal phases of swallowing. Swallowing problems and feeding difficulties may affect child’s feeding method and are associated with higher anxiety status of caregivers

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