Long-term efficacy of clinical hunger provocation to wean feeding tube dependent children

Krom, Hilde; Meij, Tim G. J. de; Benninga, Marc A.; Dijk-Lokkart, Elisabeth M. van; Engels, Michelle; Kneepkens, C. M. F.; Kuiper-Cramer, Liesbeth; Otten, Marie Anne G.M.; Veer, Liesbeth van der Sluijs; Stok-Akerboom, Anita M.; Zilverberg, Riëtte; Zundert, Suzanne M.C. van; Kindermann, Angelika

doi:10.1016/j.clnu.2019.12.021

Cited by 10 publications

(10 citation statements)

References 37 publications

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“…This may interfere with a relaxed eating pattern. In other cases, parents may feel or be advised that natural feelings of hunger will eventually resolve the feeding problems, as is the case in hunger provocation [40]. As children with an NSSD may have a higher-than-normal energy expenditure, this strategy may differ from healthy infants, and may contribute to a low BMI.…”

Section: Psychosocial Dysfunctionmentioning

confidence: 99%

Feeding Problems in Patients with Noonan Syndrome: A Narrative Review

Tiemens¹,

Haaften

Leenders

et al. 2022

JCM

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Noonan syndrome (NS) belongs to the group of Noonan syndrome spectrum disorders (NSSD), which is a group of phenotypically related conditions. Feeding problems are often present not only in infancy but also in childhood, and even beyond that period. We describe the different aspects of feeding problems using a (theoretical) concept proposed in 2019. More than 50% of infants with NS develop feeding problems, and up to half of these infants will be tube-dependent for some time. Although, in general, there is a major improvement between the age of 1 and 2 years, with only a minority still having feeding problems after the age of 2 years, as long as the feeding problems continue, the impact on the quality of life of both NS infants and their caregivers may be significant. Feeding problems in general improve faster in children with a pathogenic PTPN11 or SOS1 variant. The mechanism of the feeding problems is complex, and may be due to medical causes (gastroesophageal reflux disease and delayed gastric emptying, cardiac disease and infections), feeding-skill dysfunction, nutritional dysfunction with increased energy demand, or primary or secondary psychosocial dysfunction. Many of the underlying mechanisms are still unknown. The treatment of the feeding problems may be a medical challenge, especially when the feeding problems are accompanied by feeding-skill dysfunction and psychosocial dysfunction. This warrants a multidisciplinary intervention including psychology, nutrition, medicine, speech language pathology and occupational therapy.

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Section: Psychosocial Dysfunctionmentioning

confidence: 99%

Feeding Problems in Patients with Noonan Syndrome: A Narrative Review

Tiemens¹,

Haaften

Leenders

et al. 2022

JCM

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“…In the first survey by Gardiner et al, 10 most (7 of 12) of the feeding teams reported outpatient weaning, and others chose inpatient (4 of 12) or day hospital (4 of 12) weaning. By contrast, other studies have found that each team individualizes the reduction rate of EN, half by adopting a rapid reduction (<40% initial nutrition volume within 3 days) approach 5,9,13–15 . Various factors contributed to the choice of the setting in our study, such as the child's age and/or the need for medical supervision.…”

Section: Discussionmentioning

confidence: 76%

“…Treatment of tube‐feeding dependency and tube weaning are frequent challenges for health professionals who care for this group of children. Several weaning modalities have been developed: gradual or intensive; inpatient, outpatient, or a combination; and online (net coaching) 2,4–9 . However, all weaning programs are based on individual, unstandardized experience, or protocols.…”

Section: Introductionmentioning

confidence: 99%

Weaning children from prolonged enteral nutrition: A survey of practice on behalf of the French Society of Paediatric Gastroenterology, Hepatology, and Nutrition

Dipasquale

Lecoeur

Aumar

et al. 2021

J Parenter Enteral Nutr

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Background No consensus currently exists on tube‐weaning practice worldwide. The aim of this study was to describe tube‐weaning practice (indications and modalities) of a panel of pediatric gastroenterologists involved in the management of prolonged enteral nutrition (EN). Methods A cross‐sectional survey of pediatric gastroenterologists involved in the management of children receiving prolonged (>3 months) EN who were likely to be weaned was conducted. A questionnaire containing 24 questions was disseminated to the French Speaking Group of Paediatric Gastroenterology, Hepatology, and Nutrition members. The association between weaning practice and the experience of respondents was investigated. Results In total, 311 professionals were approached, and 64 questionnaires were completed (response rate 21%). Nearly all respondents (n = 61, 95%) reported using individualized weaning programs. Weaning attempts were performed more frequently at home, and follow‐up was performed in the outpatient clinic (97%) by progressive EN volume reduction (83%). Inpatient weaning was performed by only 28% of participants. The choice of the setting was predominantly (59%) based on parental request. Management and follow‐up involved mainly the referring pediatric gastroenterologist and the dietitian. Fifty‐one (80%) of the respondents experienced ≥1 weaning failure. Conclusions This is one of only a few studies examining real‐life pediatric tube‐weaning practices. Considerable practice variation between centers was observed; some of the common practices included the setting of weaning (outpatient vs inpatient) and the eligibility criteria. Increasing knowledge about weaning modalities is the starting point for the design of consensual standardized programs.

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“…It was reassuring, as in our first series 6 to find no evidence that weight loss led to slowing of growth. Few studies of rapid tube weaning have tracked growth over time, but one found a marked decline in height centile, 17 while another did not. 15 Our slower approach, which avoids more drastic variation in energy intake, seems to successfully protect against growth compromise.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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ObjectiveTo describe the prevalence of weight loss during tube weaning and its impact on wean duration and growth.SettingTertiary feeding clinic, UK.PatientsAll children seen for weaning from long-term enteral feeding between 2008 and 2016.InterventionsOutpatient withdrawal of enteral feeding.DesignCase series of children being weaned from tube feeding, documenting clinical details, periods of weight loss and timing of feed changes, as well as height and weight at baseline and within 1 year after feed cessation.Main outcome measuresAmount and frequency of weight loss, wean duration, change in body mass index (BMI) and height SD z score.ResultsWeaning was attempted in 58 children, median age 2.7 years, and 90% had stopped feeds after median (range) 5.9 (1–40) months. Weight loss was seen in 51 (88%) children and was more common and severe in children with initially higher BMI. Time to feed cessation reduced by median 4.9 months between 2008–2011 and 2012–2016, while having feeds increased prolonged the wean duration, by median 13 months. After feed cessation, mean (95% CI) BMI had dropped by 0.84 (0.5 to 1.2) z scores, but neither change in BMI, nor the amount and frequency of weight loss, related to growth.ConclusionsShort-term weight loss is to be expected during tube weaning and is not associated with compromised growth. It is important to avoid overfeeding enterally fed children and not to increase feeds again in response to weight loss.

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Long-term efficacy of clinical hunger provocation to wean feeding tube dependent children

Cited by 10 publications

References 37 publications

Feeding Problems in Patients with Noonan Syndrome: A Narrative Review

Feeding Problems in Patients with Noonan Syndrome: A Narrative Review

Weaning children from prolonged enteral nutrition: A survey of practice on behalf of the French Society of Paediatric Gastroenterology, Hepatology, and Nutrition

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

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