Weaning children from tube to oral feeding

Abstract

Most of the children seen by specialists in neonatalogy, neuropaediatrics or neurosurgery do not have any problems in starting with oral feeding after a period of tube feeding lasting between 15 and 20 days. Children who have been tube fed for a longer period, however, can find it very difficult or even impossible to re-establish oral feeding when they have sufficiently recovered from their underlying problem. To cope with this situation we propose a procedure based on the afferentation or re-afferentation of the oropharyngeal cavity by sensory stimulations and by re-establishment of the biological clock (circadian rhythm) by applying these stimulations during tube feeding at regular hours. In 19 children who showed difficulties oral feeding became possible a short time after such a procedure had been applied. If the principles of swallowing neurophysiology and the biological rhythm are respected, this procedure, which also involves a contribution from the family, leads to quicker oral feeding and shorter stay in hospital.

Feeding Issues Associated with the Autism Spectrum Disorders

“…Periods of longer than 1 week of tube feeding put the child at risk for 'oral deprivation,' i.e. they deprive the child of the daily practice of oral behaviors which in turn seem to have a detrimental effect on the associated brain development [46,47]. If it occurs in infancy children will experience great difficulty in making the transition to oral feeding.…”

Gastrostomy tube feeding: when to start, what to feed and how to stop

“…The absence or involution of the afferent sensory input (tactile, olfactory and taste) from the oro-pharynx, which normally occurs during oral feeding, means that, when attempts are made to start oral feeding, the presence of food in the mouth is likely to be misinterpreted as a noxious stimulus and to stimulate the gag reflex and lead to oro-aversion. Thus, early oral stimulation is a crucial component of feeding management in the exclusively tube-fed neonate and intraoral massage, for instance, has been shown to be useful in inhibiting the gag reflex and helping it to mature into an adult pattern (Senez et al, 1996).…”

Rehabilitación de la alimentación por vía oral en niños con enfermedades respiratorias crónicas y nutrición enteral prolongada

“…Aunque la causa que determina la indicación de la NE puede mejorar, se requieren a veces periodos prolongados de meses o años para el destete (7,11,12). Los pacientes presentan menor motivación para comer en respuesta al hambre, aversión y/o deficiente respuesta a la estimulación oral.…”

“…Si un niño no acepta alimentos por vía oral, es incapaz de asociar la comida a la satisfacción del hambre (13). Se han descrito múltiples esquemas terapéuticos para rehabilitar la vía oral, muchos de los cuales son programas intensivos multidisciplinarios ambulatorios (7,(13)(14)(15)(16). Algunos proponen intervenciones conductuales (17)(18)(19) y además de intervenciones multidisciplinarias, nuevos estudios sugieren incorporar antidepresivos, anticonvulsivantes u orexígenos, con respuesta parcial y evidencia escasa (20).…”