Factors Impacting on Eating in Pediatric Intestinal‐Transplant Recipients: A Mixed‐Methods Study

Abstract

Background: No empirical data are found examining why eating may be difficult for some children following intestinal transplant and not others. This study aimed to describe the eating behaviours and nutritional intake of intestinal transplant recipient children and examine factors that may impact on their eating. Methods: Caregivers of all (n=34) intestinal transplant recipients <18 years in the United Kingdom were invited to participate in this mixed methods study comprising a quantitative component (questionnaires, food diary) and qualitative interview. Questionnaires included the Children's Eating Behaviour Questionnaire and demographic/nutrition-related items and a three-day food diary. Analysis was by descriptive statistics using SPSS. Semi-structured telephone interviews explored caregiver perceptions of their child's eating. Analysis was thematic. Results: Nine caregivers were recruited and completed the questionnaire and food diary. Eight of these were interviewed. Home tube feeding was required by 77% (n=7) of children post-transplant, 56% (n=5) were 'food avoidant' and median energy intake was 93% (range, 61-137%) of requirements. The findings revealed complex, interrelated positive and negative medical, caregiver and child-related influences on eating. Learning to eat at the recommended age and having positive and significant pre-transplant eating experiences appeared protective, whilst being nil-by-mouth and having aversive experiences were barriers. Conclusion: This study provides the first empirical evidence of factors that may impact on eating after intestinal transplant in children. The findings suggest promoting eating pre-transplant, where the negative physical consequences can be managed, may be protective and there may be eating difficulty predictors that could be used to facilitate targeted interventions.

Megacystis Microcolon Intestinal Hypoperistalsis Syndrome

“…In our study, all of the transplanted patients except 1, who was <1‐month post‐transplant, achieved enteral autonomy. A recent study suggested that promoting safe oral feeds pre‐transplant is one of the main predictors of successful eating after transplant, which can significantly impact the quality of life of these patients (26). In our study, we observed that among the transplanted patients who achieved enteral autonomy, 8 were on full oral feeds and among the 11 nontransplanted patients, 8 were on at least minimal oral feeds.…”

Intestinal transplantation: an update

“…In high volume centres the outcomes for isolated intestinal grafts are similar to the survival on home PN [40,41]. Long-term nutritional autonomy is achievable in the majority of patients, though there can be challenges with regards to eating behaviours and food avoidance, particularly in children [39,42].…”

Nutrition in intestinal transplantation: centre stage or supporting act?

“…Progression to an oral diet can be more difficult due to food aversion as food might be associated with negative symptoms. Especially in paediatric patients, who sometimes have never eaten before or in limited amounts, this can pose a challenge, requiring stepwise introduction by an experienced nutritionist [46]. Some centres also avoid lactose and are careful with typical allergens (e.g.…”