Parental stress levels in relation to dysphagia and communicative difficulties in pediatric intensive care patients

Aims: This study aimed to investigate the impact of the presence or absence of verbal communication skills in pediatric intensive care unit (PICU) patients who are unable to eat orally and are fed via enteral or parenteral methods, on the stress levels perceived by their parents. Methods: The study included 49 children hospitalized in the PICU with dysphagia and feeding difficulties. The participants’ information regarding tracheostomy, intubation, ability/inability to engage in verbal communication, and type of enteral feeding was recorded. Patients were retrospectively assessed using PRISM (pediatric risk of mortality) scores, and the Turkish version of the Parental Stress Scale was administered to one parent per patient. The participants were grouped based on their child’s verbal communication ability and feeding method (enteral vs. parenteral), and statistical comparisons were made using the Mann-Whitney U test. ROC (receiver operating characteristic) analysis was conducted to identify which of the recorded clinical variables had the most significant effect on parental stress. Results: The mean age of the children was 7.69 years, with 59.2% being male. Of the 49 children included, 31 (63.3%) were classified as non-verbal and 18 (36.7%) as verbal, according to their ability to communicate. While 81.6% were non-intubated, 42.9% had tracheostomies. Feeding methods included nasogastric tube (46.9%), total parenteral nutrition (38.8%), and percutaneous endoscopic gastrostomy (10.2%). The mean PRISM score was 4.0, and the average parental stress score was 69.1. Parents of non-verbal children reported significantly higher stress levels than those of verbal children (p=0.002). Although parental stress appeared higher in the parenteral nutrition group, the difference was not statistically significant (p=0.077). PRISM scores showed no significant differences between groups based on communication or feeding method. According to the ROC analysis [area under the curve (AUC)=0.728], the most significant indicator of parenteral stress was found to be the inability to engage in verbal communication. Conclusion: The findings demonstrate that the inability of children in PICU to verbally communicate significantly increases parental stress levels, independent of illness severity. Although feeding method did not significantly impact parental stress, a trend toward higher stress in parents of parenterally fed children was observed. These results emphasize the importance of preserving or supporting communication abilities in PICU patients. Implementing augmentative and alternative communication strategies (e.g., speaking valves, communication boards) and integrating psychosocial support for caregivers may contribute to improved family-centered care in pediatric critical care settings.