Original ArticleDiscontinuation of enterostomy tube feeding by behavioral treatment in early childhood: A randomized controlled trial☆,☆☆
Section snippets
Subjects
Infants aged 4 to 36 months who were fed by gastrostomy or gastrojejunostomy tubes for ≥1 month and had resistance to feeding were eligible. Resistance to feeding was defined (by parental report) as (1) food refusal ≥25% of the time during each meal for ≥1 month’s duration and ≥1 problem behavior at mealtimes or (2) no attempts at oral feeding for ≥1 month because infants resisted such attempts. Resistance to feeding was then categorized into mild, moderate, or severe based on a trained
Results
At the third follow-up visit, 15 (47%) of 32 patients in behavioral therapy and 0 (0%) of 32 in nutritional therapy were no longer dependent on tube feeding (χ2 = 19.6, P =.0001; Table II).Follow-up visit No.* No. of successes (%)† Behavioral intervention Nutritional intervention P value 1 4 (13) 0 (0) .04 2 8 (25) 0 (0) .002 3 15 (47) 0 (0) .000 4 15 (47) 2 (6) .000 †Defined as enterostomy tube feedings not needed for ≥1 month before the visit and weight maintenance or
Discussion
This study demonstrates that a behavioral intervention is more efficacious than a nutritional intervention alone in eliminating the need for enteral tube feeding in infants with resistance to feeding. An increasing number of infants who survive because of advances in medical technology require enteral tube feeding to meet their nutritional needs but develop resistance to the reintroduction of oral feeds. Thus the availability of this treatment option could have a positive impact on the quality
Acknowledgements
We thank the study participants and Derek Stephens, MSc, statistician in the Division of Clinical Epidemiology, The Hospital for Sick Children, for his assistance with data analysis.
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Weaning from a feeding tube in children with congenital heart disease: A review of the literature
2021, Progress in Pediatric CardiologyCitation Excerpt :Nowak-Cooperman & Quinn-Shea state the child must be medically able to sustain a 5–10% weight loss as well as tolerate a period of sub-optimal caloric intake and reduction of optimal fluid intake [33]. Tube weaning programs include inpatient hospital programs, which comprised the majority of articles reviewed [19–21,23–25,27,29,31–36], as well as day treatment or intensive outpatient programs [26,28], less intensive outpatient programs [3,21,22,36–39], home-based or ‘netcoaching’ programs [10,30,40], and outpatient programs with video support [18]. The duration of programs was variable, but our review of studies indicated that many programs lasted 2–4 weeks [10,14,19,21,27,29,31–34,36].
Botulinum Toxin as a Treatment for Feeding Difficulties in Young Children
2020, Journal of PediatricsLong term nutritional and growth outcomes of children completing an intensive multidisciplinary tube-feeding weaning program
2020, Clinical NutritionCitation Excerpt :The consequences of tube dependency are externally regulated feeding in the absence of an objective medical indication, and the need for a tube withdrawal process [4,5]. Reports on tube-weaning programs in the literature are limited, and programs vary in duration and therapeutic approach including: hunger provocation [6–8], behavioral interventions [9–11], sensory stimulation [12] and medications [13]. Tube-weaning programs have been performed as inpatient [14,15], outpatient [16,17] or home-based weaning [18] with reported success rates of 40–50% [10,14] to 80–100% [6,7,15].
Long-term efficacy of clinical hunger provocation to wean feeding tube dependent children
2020, Clinical NutritionCitation Excerpt :A systematic review (SR) by Sharp et al. (2017) [11] reporting on 593 children included 6 studies regarding appetite manipulation with success rates of 44–90% at discharge [5,11,12,24,30,36,37]. Other studies not included in the SR using appetite manipulation showed short-term success rates varying from 47 to 100% [2,3,7,13,14,23,38–42]. Especially considering the high rate of previously unsuccessful other interventions to wean these challenging patients, these short-term efficacy rates may be considered to be high [24].
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Supported by grants from the Medical Research Council of Canada, The Ontario Mental Health Foundation, and the National Health and Research Development Program.
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Reprint requests: Diane Benoit, MD, Department of Psychiatry, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada.