Rapid home-based weaning of small children with feeding tube dependency: positive effects on feeding behaviour without deceleration of growth

Wilken, Markus; Cremer, Vanessa; Berry, Jennifer N.; Bartmann, Peter

doi:10.1136/archdischild-2012-303558

Cited by 50 publications

(60 citation statements)

References 14 publications

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“…The transition from tube to oral feeding (weaning) may take only several days or weeks, but in others, it can be very challenging, lasting months to years [2, 18, 28, 39]. Since weaning can be very difficult, it is best accomplished with a multidisciplinary approach, including health care workers in the field of pediatrics, dietetics, psychology, speech-language pathology, and/or occupational therapy [15, 31, 38].…”

Section: Tube Weaning Methodsmentioning

confidence: 99%

“…Several studies use reducing or discontinuing tube feeding for appetite stimulation as a weaning method [4, 7, 20, 21, 39]. Various hunger-inducing weaning programs exist internationally, which may be home based [26, 38] or clinical [4, 7, 20].…”

Section: Tube Weaning Methodsmentioning

confidence: 99%

“…Therefore, enteral nutrition might be needed when the child is unable to eat, malnourished, or when dietary measures are insufficient to fulfill nutritional requirements [18]. Although effective in these situations, when tube feeding lasts for a longer period, it can lead to difficulties in the transition to normal oral feeding and tube dependency when these children are medically stable [2, 28, 39]. …”

Section: Introductionmentioning

confidence: 99%

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Development, prevention, and treatment of feeding tube dependency

2017

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Enteral nutrition is effective in ensuring nutritional requirements and growth. However, when tube feeding lasts for a longer period, it can lead to tube dependency in the absence of medical reasons for continuation of tube feeding. Tube-dependent children are unable or refuse to start oral activities and they lack oral skills. Tube dependency has health-, psychosocial-, and economy-related consequences. Therefore, the transition to oral feeding is of great importance. However, this transition can be very difficult and needs a multidisciplinary approach. Most studies for treatment of tube dependency are based on behavioral interventions, such as family therapy, individual behavior therapy, neuro-linguistic programming, and parental anxiety reduction. Furthermore, oral motor therapy and nutritional adjustments can be helpful in tube weaning. The use of medication has been described in the literature. Although mostly chosen as the last resort, hunger-inducing methods, such as the Graz-model and the Dutch clinical hunger provocation program, are also successful in weaning children off tube feeding. Conclusion: The transition from tube to oral feeding is important in tube-dependent children but can be difficult. We present an overview for the prevention and treatment of tube dependency. What is known: • Longer periods of tube feeding can lead to tube dependency. • Tube weaning can be very difficult. What is new: • Weaning as soon as possible and therefore referral to a multidisciplinary team are recommended. • An overview of treatment options for tube dependency is presented in this article.

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Section: Tube Weaning Methodsmentioning

confidence: 99%

Section: Tube Weaning Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development, prevention, and treatment of feeding tube dependency

2017

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“…[15][16][17] There were no long-term differences in BMI before entering the program compared to the follow-up. 10 The initial weight loss did not have a negative impact on the growth of children who transitioned from tube to oral feeding.…”

Section: Impact On Weight Gain and Growthmentioning

confidence: 87%

“…27 In 2 studies, the frequency of the FTD symptoms were addressed. 9,10 Both the studies showed a significant decrease in the FTD symptoms from entering the program to the follow-up. They also reported a significantly improved eating behavior, significant decrease of the FTD symptoms, and significant reduction of supplemental feeding via tube.…”

Section: Impact On Eating Behaviormentioning

confidence: 96%

Home-Based Feeding Tube Weaning

Wilken¹,

Cremer²,

Echtermeyer³

2015

ICAN: Infant, Child, & Adolescent Nutrition

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Messy Play Therapy in the Treatment of Food Aversion in a Patient With Intestinal Failure: Our Experience

Chiatto

Coletta

Aversano

et al. 2018

J Parenter Enteral Nutr

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Background Food aversion (FA) is an eating behavior where children refuse solid or fluid intake. FA can compromise the weaning off parenteral nutrition (PN) in children with intestinal failure (IF), reducing their quality of life (QoL). Around 25% of children with IF experience FA, but few data are available on interventions to get over FA. Messy play therapy (MPT) uses sensory activities to provide another meaningful avenue for learning in children by creating a fun way to experience new textures. This study aims to assess the efficacy of MPT in FA. Methods Demographic data and MPT intervention were retrospectively recorded between 2004 and 2017. Food was categorized by tastes and textures. Data are expressed as median and interquartile range (25%–75%). Results Twelve children were identified. MPT was started at 9 (6–16) months with an enrolling time within the program of 10.11 (7.75–12.5) months. MPT was ended after 19.5 (16.75–28.5) months, and all patients achieved tolerance to oral diet. Significant improvement in savory (P = .001), sweet (P = .002), and mixed texture (P = .001) of food intake was reported. Better QoL and mealtimes with family were reported at median follow‐up of 39 (24–56) months. Conclusions MPT seems to be a positive intervention to overcome FA. In our experience, the children have gone from not tolerating any intake to tolerating an oral diet, which means enjoying their mealtimes. Further studies are needed to evaluate the effectiveness of MPT in a larger scale of patients.

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Rapid home-based weaning of small children with feeding tube dependency: positive effects on feeding behaviour without deceleration of growth

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

Cited by 50 publications

References 14 publications

Development, prevention, and treatment of feeding tube dependency

Development, prevention, and treatment of feeding tube dependency

Home-Based Feeding Tube Weaning

Messy Play Therapy in the Treatment of Food Aversion in a Patient With Intestinal Failure: Our Experience

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