Tube dependency is recognized as an unintended result of longterm tube feeding in infants and young children. The condition involves disturbing side effects such as vomiting, gagging, and active food refusal. It prevents infants from making the transition from tube to oral feeding and from starting to learn to eat in the absence of any medical indication for continuation of enteral feeding. Tube dependency can have a destructive impact on the child's development, even in cases when the nutritional influence might be beneficial. The authors set up recommendations for the prevention of tube dependency and suggest guidelines for weaning tube-dependent children based on the results of the Graz program and satellite programs using a similar model. A sample of 221 tubedependent patients aged 4 months to 15 years of age provided the clinical study group on which this article is based. Begun in 1987, a comprehensive tubeweaning program was developed on the basis of clinical experience and encounters with more than 430 tube-dependent children in 20 years, resulting in a success rate of 78/81 (96% for 2007) and 79/84 (94% for 2008). Placement must be preceded by clear criteria and a decision as to the indicated nutritional goal and time of use. The placement of a temporary tube must generate a plan covering maintenance issues, including time, method, and team for weaning. Aspects of tube feeding that go beyond purely medical and nutritional issues need to be considered to minimize the frequency and severity of unintended tube dependency in early childhood.

This rapid weaning programme for children with feeding tube dependency (FTD) improved the feeding behaviour and was associated with constant growth velocity.

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The use of feeding tubes in pediatric medical procedures and management has dramatically increased over the last three decades. With this increase, the prevalence of Feeding Tube Dependency (FTD) - a reliance on enteral feeding following medical recovery due to lack of oral intake of nutrition, despite being able to eat- has increased too. It has been suggested, that cases with FTD show avoidant feeding behaviours such as food refusal, gagging or swallowing resistance, but evidence for this hypothesis is scarce. In a German population of 146 cases requesting feeding tube dependency treatment between 2005 and 2008 the frequency of occurrence of avoidant behaviour in FTD cases has been evaluated and was correlated to growth. The study includes children under 50 months of age being tube fed for at least three months. Parents received the Anamnestic Questionnaire for Feeding Disorder and Tube Weaning (AFT), which evaluates nutritional supply, tube feeding, feeding disorder symptoms, medical diagnosis, growth and psychosocial variables. The study group was comprised of 101 children (50 male, 51 female), with a median age of 15 months (IQR: 10-26.5) and a median tube feeding duration of 13 months (IQR: 8-27). The most prevalent medical diagnoses were congenital malformations (n = 51) and prematurity (n = 27). Parents reported daily symptoms of food aversion through all age groups, like food refusal 2 (IQR: 1-3), gagging 1 (IQR: 0-3), vomiting 1 (0.1-2) and total symptoms 6 (5-11). Vomiting was negatively correlated with weight and length percentile and head circumference. Cases with FTD show frequent and persistent food avoidant behaviors, which may be explain the need for specific psychological treatment during transitioning from tube dependency to oral eating.

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