Withdrawing feeds from children on long term enteral feeding: factors associated with success and failure

Abstract

A majority of children eventually ceased feeds successfully, but slow and failed weaning is more likely after age 5 years.

Energy compensation in enterally fed children

“…However, when the acute medical issues preventing feeding have resolved, some infants seem unable to make the transition to oral feeding and in extreme circumstances may remain dependent on enteral feeding for years, despite being apparently capable of eating (Mason, Harris, & Blissett, 2005). Children in these circumstances often appear to have no interest in food and may lose weight rapidly when their feeds are reduced (Wright, Smith, & Morrison, 2010). This leads to the suggestion that such children may have disordered appetite and energy regulation, either as a result of their underlying condition or because of the disruptive effect of long-term tube feeding.…”

“…Children were recruited from the feeding clinic at the Royal Hospital for Sick Children, Glasgow, set up specifically to assist the withdrawal of children from artificial feeding (Wright et al, 2010). The hospital provides tertiary care for the West of Scotland and manages a range of severe medical and surgical conditions.…”

“…The child may also have missed a critical period of associative learning (Birch, 1998;Hetherington, 2002;Rolls, Engell, & Birch, 2000) and have disordered daily eating patterns (Poustie et al, 2006). Other studies have suggested that both the age at which tube feeding started (Mason et al, 2005) and when reduction in feeds began (Wright et al, 2010) may critically affect the ease of transition.…”

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

“…Nuestro estudio muestra que 50% de los pacientes con indicación de rehabilitación de la alimentación por vía oral lo logra en forma completa y 14% en forma parcial, resultados inferiores a otros reportes, con éxito entre 78 y 92% (6,27,28,32). Ello puede deberse a diferentes factores: pacientes con mayor número y severidad de patologías, terapia poco intensiva, comorbilidades infecciosas frecuentes, presencia parcial de los padres y a los múltiples cuidadores a cargo en un establecimiento hospitalario.…”

“…Aunque es razonable pensar que los niños con NE de menor duración y/o con inicio más temprano de la terapia de rehabilitación lo harán a mayor velocidad (27,32), ello no ocurrió en nuestra muestra; la complejidad y las frecuentes intercurrencias pudieran explicarlo.…”