Inpatient tube weaning in children with long-term feeding tube dependency: A retrospective analysis

• Published in: Infant mental health journal 2010-11, Vol.31 (6), p.664-681
• Main Authors: Trabi, Thomas, Dunitz-Scheer, Marguerite, Kratky, Elisabeth, Beckenbach, Hannes, Scheer, Peter J.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Medical sciences; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Reeducation. Readaptation. Sociotherapy; Treatments
• ISSN: 0163-9641; 1097-0355
• DOI: 10.1002/imhj.20277

This study investigates the outcome of an intervention program to establish oral feeding after prolonged tube feeding in children. The intervention is based on supervised reduction of enteral formula within a few days supported by a 3‐week program of speech therapy, occupational therapy, psychoanalytically based eating therapy, physical therapy, psychodynamic coaching, and nutritional counseling of the infant and his or her parents. Two hundred twenty‐one cases were included in this study. All patients had been severely ill or were handicapped and had been exclusively fed by tube for most of their lives. The major outcome variable was complete discontinuation of tube feeding with sufficient oral feeding after treatment, defined as the child's ability to sustain stable body weight by self‐motivated oral feeding. Two hundred three patients (92%) were completely fed orally after treatment. Tube feeding was discontinued completely within 8 days in mean, and mean in‐patient treatment time was 21.6 days. The current method can be used by a trained and experienced team to wean tube‐dependent children from prolonged tube feeding. Tube weaning should be addressed from the beginning of tube feeding in all children who are expected to restore oral feeding after the phase of nutritional stabilization. Since successful programs are rare, we were motivated to present our results of this elaborate program in this article. Este estudio investiga el resultado de un programa de intervención para establecer en los niños la alimentación bucal después de una prolongada alimentación por tubos. La intervención está basada en una supervisada reducción de fórmula entérica dentro de pocos días, apoyada en un programa de 3 días de terapia del habla, terapia ocupacional, terapia de alimentación basada en el sicoanálisis, terapia física, entrenamiento sicodinámico y consejos nutricionales para el infante y sus padres. En este estudio se incluyen 221 casos. Todos los pacientes habían estado severamente enfermos o se habían incapacitado y habían sido alimentados exclusivamente por medio de tubos durante la mayor parte de sus vidas. La variable de resultado más fuerte fue la completa descontinuación de la alimentación por tubos con suficiente alimentación bucal después del tratamiento, definida como la habilidad del niño para sostener el peso estable del cuerpo por medio de alimentación bucal automotivada. Después del tratamiento, 203 pacientes (92%) fueron completamente alimentados buca