Appetite‐guided approach to pediatric enteral tube weaning in the home setting: A pilot study

Abstract

Background Infants and children, who temporarily use feeding tubes to maintain body composition and growth, often have difficulty resuming oral feeds once medically stable. We report survey results from Growing Independent Eaters (GIE), an interdisciplinary approach providing home‐based virtual support during a child‐led appetite‐guided enteral wean. Method Surveys addressing participant wean success, weight, and feeding practices were sent to 76 families who participated in a GIE‐led wean; 31 surveys were completed and returned. Results All participants who were not eating or drinking orally prewean were fully or partially weaned off enteral support. Infants weaned faster (37.7 days) than children (80.1 days). Mean weight loss during the intervention was 6.6% for infants and 5.9% for children. Six months postwean, 93% of participants surpassed their prewean weight. Conclusion The GIE method was successful for weaning infants and children off enteral support.

Home-Based Appetite-Guided Weaning of Enteral Nutrition of Infants with Congenital Heart Disease: A Preliminary Clinical Observation

“…As previously reported in the literature [16], the GIE method of enteral weaning starts with an intake process to screen for parent and child wean readiness. An electronically submitted intake form details the child's medical, developmental, growth, feeding, and nutrition history, as well as parental concerns related to feeding, growth, and development.…”

“…All children follow the same series of steps, regardless of their daily quantity of oral intake prior to wean initiation. The timing for each tube feed reduction is child-led based on qualitative and quantitative progress plateaus, rather than a specific time frame [16]. This child-led approach reduces tube feeds in a step-wise manner, guided by the infant's readiness cues (e.g., engagement with food and mealtime comfort/trust) and hunger cues instead of a predetermined wean timeline [16].…”

“…The timing for each tube feed reduction is child-led based on qualitative and quantitative progress plateaus, rather than a specific time frame [16]. This child-led approach reduces tube feeds in a step-wise manner, guided by the infant's readiness cues (e.g., engagement with food and mealtime comfort/trust) and hunger cues instead of a predetermined wean timeline [16]. While other child-led wean approaches are available, the GIE approach differs by making smaller reductions over a longer period of time compared to other childled wean models that reduce large volumes with a shorter timeline [9,10,[12][13][14][15]19].…”

“…Variability exists within weaning programs worldwide with regard to therapeutic intervention, as well as in treatment setting (inpatient, outpatient, home-based, or telehealth) [9,10]. Enteral wean programs also vary by rate of tube feeding reduction (predetermined timeline vs. child-led) [11][12][13][14][15][16][17][18][19]. This preliminary study conducted through Growing Independent Eaters (GIE), a privately operated program conducted in the home setting, utilizes a child-led appetite-based approach to enteral weaning and has demonstrated success overcoming FTD [16].…”

“…Enteral wean programs also vary by rate of tube feeding reduction (predetermined timeline vs. child-led) [11][12][13][14][15][16][17][18][19]. This preliminary study conducted through Growing Independent Eaters (GIE), a privately operated program conducted in the home setting, utilizes a child-led appetite-based approach to enteral weaning and has demonstrated success overcoming FTD [16]. The GIE program offers families guidance and support from a virtual interdisciplinary team, comprised of a feeding therapist, parent coach, registered dietitian, and mental health social worker.…”