Prevention of orality disorders in the paediatric intensive care: a review and the recent experience of Robert-Debré hospital

Abstract

In infants hospitalized in the paediatric intensive care unit (PICU), a disorder of the oral behaviour may occur soon in relation to a lack in feeding reflexes solicitation and performance of invasive oral procedures, often in association with artificial nutrition. Such disorders not only include oral aversion, but also sensory, expressive, relational, and psychomotor issues. Looking beyond the intensive care, measures to lower the incidence of such disorders should be seek to limit durations of artificial nutrition and hospitalization, avoid psychomotor retardation, enable a secure parentinfant attachment, and improve the quality of life for children and family. In 2011, Robert Debré Hospital’s PICU team investigated how to prevent oral disorders in hospitalized child. A multidisciplinary group focusing on “oral behaviour” was set up and took several decisions, including the raise of the medical and paramedical staff awareness and training, the development of a preventive care protocol and a leaflet dedicated to the paramedics and children’s families. This project allowed homogenizing day-to-day practice and better involving PICU children’s families. However, the real impact of these protocol and actions on the future of PICU children remains difficult to estimate due to the limited number of included children and a final evaluation is still required. After a preliminary literature review, this article presents our recent activity in preventing and handling the secondary oral disorders in the PICU.