Table 3

Summary of included studies; case reports

First author and date	Participants	Intervention	Length of follow up	Outcome	Author’s comment
Key: ARP, antireflux procedure; CP, cerebral palsy; GOR, gastro-oesophageal reflux; PEG, percutaneous endoscopic gastrostomy
Kirberg⁶⁹ 1988	2 children with CP, feeding difficulty and aspiration.	PEG.	7 and 4 months respectively.	GOR: none.	Safe quick procedure took only 7–8 minutes.
	Ages: 3 and 16 months.			Growth: not reported.
				Death: none.
				Complications: immediate none, no site infection.
Langley⁷⁰ 1995	1 child with CP and feeding difficulty.	Gastrostomy, then a user friendly behavioural programme with aim of reinstating oral feeding.	10 months.	GOR: not reported.	There were psychosocial, as well as physical components, to the eating difficulty.
	Age 18 months.			Growth: not reported.
				Death: no.
				Other: All nutrition taken by mouth 10 months after start of behavioural programme.
Patel⁷¹ 1997	1 child with CP and symptomatic GOR.	Gastrostomy and ARP.	12 months.	GOR: not reported.	Child made good recovery following the 2nd operation, no further episodes of volvulus occurred during 12 months follow up.
	Age 2 years.			Growth: not reported.
				Death: no.
				Other: major complication, 3 weeks after gastrostomy underwent emergency investigation and surgery for volvulus of the stomach between the oesophagus and the gastrostomy.
Rashid¹⁸ 1997	1 child with CP, feeding difficulty and aspiration.	Gastrostomy and ARP	15 months.	GOR: not reported after gastrostomy and ARP.	Hypothesis: regurgitation of pancreatic juices causes pancreatitis and may occur due to intermittent obstruction of the duodenum or ampulla of Vater by the tube.
	Age: 2.5 years.			Growth: slightly overweight.
				Death: yes.
				Other: major complication, acute pancreatitis, confirmed at autopsy as the cause of death. Lungs showed evidence of old aspiration pneumonia.
Worley⁷² 1998	1 child with CP and feeding difficulty.	Gastrostomy and refeeding.	Not stated.	GOR: not reported.	Parents were poor and had not realised that the gastrostomy feeds could be obtained from a government assistance programme.
	Age: 9 years.			Growth: weight, average for 15.5 month old.
				Length, average for 31 month old.
				Death: no.
				Other: complication, poor nourishment due to failure to feed adequately. On re-feeding in hospital developed asymptomatic hypophosphataemia.
Clancy⁷³ 2000	1 child with CP and feeding difficulty.	PEG.	Not stated.	GOR: not reported.	Feeding tube removed by gastroscope, new tube inserted, feeding commenced within 4 hours.
	Age: 7 years.			Growth: not reported.
	1 child with CP and feeding difficulty.			Death: not reported.
	Age: 7 years.			Other: complication, acute intestinal obstruction, feeding tube wedged in 1st part of duodenum.
Tedeschi⁷⁴ 2000	1 child with CP, feeding difficulty and respiratory crises during meals.	Gastrostomy	18 months	GOR: respiratory crises did not improve with gastrostomy.	Infants with feeding problems and CP may show maturation in feeding patterns. The author considered the gastrostomy to be unhelpful and the infection to have caused “indescribable suffering”.
	Age: 16 months.			Improvement occurred with maturity and antacid and
				prokinetic medication.
				Growth: not reported.
				Death: no.
				Other: Severe fungal infection at ostomy site.
				By 3 years able to self feed orally with aids.
Jones⁷⁵ 2001	1 child with CP and GOR with persistent vomiting treated unsuccessfully with dietary manipulation.	Gastrostomy and ARP.	9 months.	GOR: not reported after ARP.	Within 1 month of supplements clinical symptoms and signs of scurvy had gone and bony callous formed.
	Age: 3 years.			Growth: weight, on 50th centile when admitted to hospital.
				Death: no
				Other: complication, clinical signs of scurvy, multiple fractures with demineralisation of bones, and peripheral oedema. Tests confirmed vitamin C (severe), vitamin A and zinc deficiency.