Tube Dependence

Abstract

This article focuses on the issue of tube dependence (TD) in infancy and early childhood. The condition occurs in patients after temporary tube feeding and must be considered as an unintended side effect of modern treatment practices affecting young patients reactively. Whereas some recent literature has described small samples of enterally fed children being exposed to certain weaning programs, the particular phenomenon of unintentional dependence has not been discussed. A tube-dependent child remains tube fed although his/her medical condition and developmental potential would allow the transition to oral nutrition. Children with TD show characteristic symptoms such as food refusal and opposition to any oral feeding attempts. They often suffer from additional episodes of vomiting, nausea, gagging, and retching and in some cases develop severe failure to thrive. Parents of affected children get involved as codependents engaged in constant preparations of the next tube feeds. In this situation, families can become obsessed about wanting their child to learn to eat by himself/herself, ending up in intrusive feeding patterns. Professionals tend to make parents responsible for the behavioral aspects of the condition, but the diagnostic shift of TD into a behavioral category will not help solve the problem. The development of TD can be prevented if typical symptoms are recognized early and effective tube weaning is implemented. Because therapeutic programs exist, the fate of remaining tube dependence should be prevented. This article presents a first overview of a large sample of tubedependent infants who had been referred specifically for the exclusive sake of tube weaning.

Development, prevention, and treatment of feeding tube dependency

“…Tube dependency is an unintended result of long-term enteral feeding [13] and is defined as the active refusal to eat (or drink), lack of motivation or inability to learn, or showing no precursors of eating development and skills after long-term enteral feeding [12, 15, 28]. The child consequently remains dependent on the feeding tube, although there are no medical grounds for the continuation of tube feeding anymore [12, 13].…”

“…The child consequently remains dependent on the feeding tube, although there are no medical grounds for the continuation of tube feeding anymore [12, 13]. …”

“…Preterm infants, infants who have chronic medical conditions, infants with tube feeding between the ages 3 and 6 months, and children with long-term tube feeding, are more at risk of developing severe feeding disorders [6, 32]. Therefore, tube-dependent children are usually fragile but medically stable survivors of neonatal intensive care or child surgery [2, 13, 35]. Unfortunately, no data regarding the prevalence and/or incidence of tube dependency is available, probably due to the fact that tube dependency is not recognized as a separate disorder in medical classification systems such as the International Statistical Classification of Diseases and Related Health Problems (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the psychiatric field.…”

“…Besides the absence of a medical reason for continuing enteral feeding in tube dependency, long-term tube feeding may also have serious side effects and complications, such as infections, aspiration, airway blocking, severe feeding disorders, and interaction problems between caregivers and child (see Table 2) [12, 13, 33]. Parents of children with feeding disorders often suffer from feeding-related anxiety, and mothers may show greater attachment insecurity [8, 9].…”

Wieviel Gramm braucht eine Seele - Psychosomatische Behandlung von Fütter- und Gedeihstörungen im Säuglings- und Kleinkindalter

“…Diese Störungen sind für die Veranschaulichung der Arbeit der Psychosomatik von besonderem Interesse, da die Verschränkung zwischen Psyche und Soma immer gegeben ist: Selbst wenn man eine rein psychische Ursache postulieren möchte, sind die Auswirkungen einer schweren Essstörung oft auch körperlich, nämlich Unterernährung, Mangelerscheinungen und drohende Entwicklungsdefizite (Benoite u. Coolbear, 1998;. Allerdings gibt es schwere körperlich Erkrankungen, die zu Ernährungsschwierigkeiten bis zur Sondenabhängigkeit führen (Dunitz-Scheer et al, 2010). Dann ist das Essen als Möglichkeit von Kommunikation, als Quelle sensorischer Lernerfahrungen und wichtiger Bereich der Autonomieentwicklung gestört, was unweigerlich Auswirkungen auf die psychische Entwicklung des Kindes wie auch der ganzen Familie hat (Coolbear u. Benoit, 1999;Ward, Lee, Lipper, 2000).…”