Characteristics of feeding tube dependency with respect to food aversive behaviour and growth

Abstract

The use of feeding tubes in pediatric medical procedures and management has dramatically increased over the last three decades. With this increase, the prevalence of Feeding Tube Dependency (FTD) - a reliance on enteral feeding following medical recovery due to lack of oral intake of nutrition, despite being able to eat- has increased too. It has been suggested, that cases with FTD show avoidant feeding behaviours such as food refusal, gagging or swallowing resistance, but evidence for this hypothesis is scarce. In a German population of 146 cases requesting feeding tube dependency treatment between 2005 and 2008 the frequency of occurrence of avoidant behaviour in FTD cases has been evaluated and was correlated to growth. The study includes children under 50 months of age being tube fed for at least three months. Parents received the Anamnestic Questionnaire for Feeding Disorder and Tube Weaning (AFT), which evaluates nutritional supply, tube feeding, feeding disorder symptoms, medical diagnosis, growth and psychosocial variables. The study group was comprised of 101 children (50 male, 51 female), with a median age of 15 months (IQR: 10-26.5) and a median tube feeding duration of 13 months (IQR: 8-27). The most prevalent medical diagnoses were congenital malformations (n = 51) and prematurity (n = 27). Parents reported daily symptoms of food aversion through all age groups, like food refusal 2 (IQR: 1-3), gagging 1 (IQR: 0-3), vomiting 1 (0.1-2) and total symptoms 6 (5-11). Vomiting was negatively correlated with weight and length percentile and head circumference. Cases with FTD show frequent and persistent food avoidant behaviors, which may be explain the need for specific psychological treatment during transitioning from tube dependency to oral eating.

Health related quality of life of infants and children with avoidant restrictive food intake disorder

“…Dunitz‐Scheer et al () also reported an impaired quality of life, but did not mention if and how the quality of life had been measured. Since tube feeding can impact health and psychosocial functioning in children, we suspected that ARFID patients receiving tube feeding, would also have lower HRQOL subscales (Benoit et al, ; Hartdorff et al, ; Krom et al, ; Krom et al, ; Wilken et al, ). However, no significant differences were found in our study.…”

“…Furthermore, the fact that our tertiary care center has a large NICU ward, and is an expert center for certain genetic diseases and syndromes contributed to our popula- (Eddy et al, 2015;Fisher et al, 2014;Norris et al, 2016). Additionally, the diversity within the ARFID population may be attributed to the chronic medical conditions and/or development delays associated with feeding issues (Bryant-Waugh, Markham, Kreipe, & Walsh, 2010;Rommel, de Meyer, Feenstra, & Veereman-Wauters, 2003;Wilken et al, 2018). As such, the DSM-5 criteria do not exclude patients with the aforementioned comorbidities from the ARFID diagnosis.…”

“…To the best of our knowledge, however, the HRQOL of children with ARFID, and in particular, in those who are tube-dependent, has not yet been studied. It is known, however, that tube feeding can result in loss of appetite, food aversion, delayed transition to oral feeding, and impact the psychosocial functioning of the child and it's family (Benoit, Wang, & Zlotkin, 2000;Hartdorff et al, 2015;Krom et al, 2018;Krom, de Winter, & Kindermann, 2017;Wilken, Bartmann, Dovey, & Bagci, 2018). Therefore, the primary aim of our study is to compare the HRQOL of infants and children with ARFID to both healthy and chronically ill controls.…”

A clinical description of children with solid organ transplants who present with feeding disorder

“…Early screening for nutrition deficiencies and targeted nutrition therapy may improve outcomes and quality of life for transplant recipients . The nutrition therapy utilized pre‐, peri‐, and post‐transplantation may have the adverse effect of impeding normally developing feeding skills, particularly in very young children . Yet, little is known about the feeding and nutrition habits of pediatric transplant recipients.…”

“…16 The nutrition therapy utilized pre-, peri-, and posttransplantation may have the adverse effect of impeding normally developing feeding skills, particularly in very young children. 17,18 Yet, little is known about the feeding and nutrition habits of pediatric transplant recipients. The current study investigates severity of feeding disorder and parental stress among patients seen at the Children's Hospital of Wisconsin's FSNC that had received a transplant with feeding-disordered patients who did not and the general community.…”