Characterizing International Approaches to Weaning Children From Tube Feeding: A Scoping Review

Abstract

Approaches to tube weaning enterally fed children and evaluating outcomes vary widely. This limits the utility of research for identifying both “what works” and successful implementation of research outcomes. We used a qualitative scoping review methodology to examine internationally published research. Our primary aim was to identify the main philosophies underpinning intervention design and the main outcome variables used to demonstrate success of existing programs. This information can be used to inform future research design and clinical practice. Literature up until June 2019 was sourced via Medline, Scopus, Ovid, and CINHAL databases; hand searching; and gray literature using Google Advanced Search. Three predominant approaches to tube‐weaning interventions were identified: behavioral, child‐ and family‐centered, and biomedical. A wide range of intervention variables were identified, with the level of parental involvement and the use of hunger provocation varying between approaches. Our Review also confirms that there is no consistency in outcome measures used, limiting comparability between programs. We suggest that the role of parents in the weaning process and its impact on both the child and the parent/carer while transitioning from enteral to oral eating are insufficiently understood. We discuss these findings in the context of a suggested framework for future research.

Complementary food introduction practices in infants with intestinal failure

“…There are multiple approaches that can be used to promote tube feeding weaning. A recent review investigating approaches to tube feeding weaning of pediatric patients identified three primary themes: child and family centered, biomedical treatment focused, or behavioral 37 . The child and family centered approach, as it sounds, heavily involves the caregiver in the weaning process and focuses on the child's self‐regulation with acceptance of oral food/beverages.…”

“…The biomedical treatment focused approach utilizes medications, sensory stimulation and/or tube feeding adjustments to promote oral food/beverage intake. Alternatively, the behavioral strategy uses operant conditioning, such as altering the mealtime environment and the addition or removal of consequences in response to behavior, to address how the child responds to oral food/beverages 37 . There is no indication currently that one approach is preferable to another for promoting success of tube‐feeding weaning.…”

Weight loss during ambulatory tube weaning: don’t put the feeds back up

“…Meanwhile, their parents commonly experience great anxiety around feeding and weight gain 1. A number of programmes have been set up to address tube dependence worldwide 2. Most descriptions in the literature are of inpatient programmes, with feeds being withdrawn over a matter of days 2.…”

“…1 A number of programmes have been set up to address tube dependence worldwide. 2 Most descriptions in the literature are of inpatient programmes, with feeds being withdrawn over a matter of days. 2 There have been fewer descriptions of slower, outpatient tube weaning programmes, [3][4][5] although these will be more feasible in most settings.…”

“…2 Most descriptions in the literature are of inpatient programmes, with feeds being withdrawn over a matter of days. 2 There have been fewer descriptions of slower, outpatient tube weaning programmes, [3][4][5] although these will be more feasible in most settings. The clinic described in this paper was set up within a large National Health Service children's hospital in the UK (www.nhsggc.org.uk/ rhcfeedingclinic) to provide an outpatient multidisciplinary tube weaning service.…”