Despite limitations of study design, we have demonstrated similar efficacy of Graz-based less expensive netcoaching versus more expensive onsite intervention in a large referral population with chronic tube dependency with the majority transitioning to complete oral feeds.
This article focuses on the issue of tube dependence (TD) in infancy and early childhood. The condition occurs in patients after temporary tube feeding and must be considered as an unintended side effect of modern treatment practices affecting young patients reactively. Whereas some recent literature has described small samples of enterally fed children being exposed to certain weaning programs, the particular phenomenon of unintentional dependence has not been discussed. A tube-dependent child remains tube fed although his/her medical condition and developmental potential would allow the transition to oral nutrition. Children with TD show characteristic symptoms such as food refusal and opposition to any oral feeding attempts. They often suffer from additional episodes of vomiting, nausea, gagging, and retching and in some cases develop severe failure to thrive. Parents of affected children get involved as codependents engaged in constant preparations of the next tube feeds. In this situation, families can become obsessed about wanting their child to learn to eat by himself/herself, ending up in intrusive feeding patterns. Professionals tend to make parents responsible for the behavioral aspects of the condition, but the diagnostic shift of TD into a behavioral category will not help solve the problem. The development of TD can be prevented if typical symptoms are recognized early and effective tube weaning is implemented. Because therapeutic programs exist, the fate of remaining tube dependence should be prevented. This article presents a first overview of a large sample of tubedependent infants who had been referred specifically for the exclusive sake of tube weaning.
Enteral nutrition affects the child and the whole family system on more than just nutritional level. It is suggested that children and their families should be followed-up by health professionals periodically for nutritional optimization, growth documentation, and other aspects of tube management.
Background and Objectives: Children who become tube-dependent need specialized treatment in order to make the transition to oral feeding. Little is known about long-term effects of tube weaning programs. This study analyzes long-term effects (outcome, growth, and nutrition data) in a large sample of formerly tube-dependent children 1 to 6 years after participation in tube weaning programs, based on the “Graz model of tube weaning.” Methods: Parents of children who completed a tube weaning program between 2009 and 2014 (N = 564) were asked to complete a questionnaire on their child's growth and nutrition. Data was analyzed using SPSS V22.0 for Windows (SPSS, Chicago, IL). Results: Response rate was 47.16% (N = 266). Seven children had died between completion of the program and the long-term follow-up. Two hundred and thirty-nine children (92.3%) were still exclusively orally fed 1 to 6 years after completion of the weaning program, 17 children (6.6%) were partially tube-fed. Three children were completely tube-fed (1.1%). Growth data showed no significant changes in zBMI (World Health Organization standards z values for body mass index) between completion of weaning and long-term follow-up. Provided data on nutrition of fully orally fed patients showed that most children (N = 162, 68%) were eating an age-appropriate diet, whereas a small percentage (N = 10, 4%) were fed with a high-caloric formula, a selective diet (N = 12, 5%), or a liquid/pureed diet (N = 55, 23%). Conclusions: Many children who undergo a tube weaning program based on the “Graz model of tube weaning” are able to stay on full oral feeds in the years after completion of the wean without deterioration of growth.
Prematurity, especially extreme prematurity, is associated with an increased risk for development of tube dependency. Preventive measures for this specific group of children should be considered.
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