Tube‐weaning infants and children: A survey of <scp>A</scp>ustralian and international practice

Gardiner, Alison Y.; Fuller, David; Vuillermin, Peter

doi:10.1111/jpc.12608

Cited by 20 publications

(23 citation statements)

References 13 publications

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“…Various hunger-inducing weaning programs exist internationally, which may be home based [26, 38] or clinical [4, 7, 20]. However, there is limited literature regarding the efficacy and safety of these programs [17]. …”

Section: Tube Weaning Methodsmentioning

confidence: 99%

Development, prevention, and treatment of feeding tube dependency

2017

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Enteral nutrition is effective in ensuring nutritional requirements and growth. However, when tube feeding lasts for a longer period, it can lead to tube dependency in the absence of medical reasons for continuation of tube feeding. Tube-dependent children are unable or refuse to start oral activities and they lack oral skills. Tube dependency has health-, psychosocial-, and economy-related consequences. Therefore, the transition to oral feeding is of great importance. However, this transition can be very difficult and needs a multidisciplinary approach. Most studies for treatment of tube dependency are based on behavioral interventions, such as family therapy, individual behavior therapy, neuro-linguistic programming, and parental anxiety reduction. Furthermore, oral motor therapy and nutritional adjustments can be helpful in tube weaning. The use of medication has been described in the literature. Although mostly chosen as the last resort, hunger-inducing methods, such as the Graz-model and the Dutch clinical hunger provocation program, are also successful in weaning children off tube feeding. Conclusion: The transition from tube to oral feeding is important in tube-dependent children but can be difficult. We present an overview for the prevention and treatment of tube dependency. What is known: • Longer periods of tube feeding can lead to tube dependency. • Tube weaning can be very difficult. What is new: • Weaning as soon as possible and therefore referral to a multidisciplinary team are recommended. • An overview of treatment options for tube dependency is presented in this article.

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Section: Tube Weaning Methodsmentioning

confidence: 99%

Development, prevention, and treatment of feeding tube dependency

2017

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“…Despite the desire of families to have their children on oral feeding, there is a significant lack of resources to facilitate this transition. In a study by Gardiner et al, this lack of resources results in significant practice variation in transitioning patients to oral feeding, and this is a critical step for all infants including those with EA (75). …”

Section: Management Of Oropharyngeal Dysphagia-associated Feeding Difmentioning

confidence: 99%

Feeding Problems and Their Underlying Mechanisms in the Esophageal Atresia–Tracheoesophageal Fistula Patient

Mahoney

Rosen

2017

Front. Pediatr.

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Feeding difficulties such as dysphagia, coughing, choking, or vomiting during meals, slow eating, oral aversion, food refusal, and stressful mealtimes are common in children with repaired esophageal atresia (EA) and the reasons for this are often multifactorial. The aim of this review is to describe the possible underlying mechanisms contributing to feeding difficulties in patients with EA and approaches to management. Underlying mechanisms for these feeding difficulties include esophageal dysphagia, oropharyngeal dysphagia and aspiration, and aversions related to prolonged gastrostomy tube feeding. The initial diagnostic evaluation for feeding difficulties in a patient with EA may involve an esophagram, videofluoroscopic imaging or fiberoptic endoscopic evaluation during swallowing, upper endoscopy with biopsies, pH-impedance testing, and/or esophageal motility studies. The main goal of management is to reduce the factors contributing to feeding difficulties and may include reducing esophageal stasis, maximizing reflux therapies, treating underlying lung disease, dilating strictures, and altering feeding methods, routes, or schedules.

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“…The basic principles of tube weaning have been identified to be straightforward and should be achievable in any centre that undertakes long‐term tube feeding 1,2 . Many Australian health facilities have an appropriate range of resources that would and have enabled successful transitioning from tube to oral feeding 1,3,4 . The length of tube feeding dependency (TFD) and the quality of intervention children receive, however, differ on a case by case basis 1,3,4 .…”

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confidence: 99%

Weaning children from temporary tube feeding: Staff survey of knowledge and practices

Syrmis

Frederiksen

Reilly

2020

J Paediatrics Child Health

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Aim To explore the understanding of and practices of health‐care workers in weaning children from feeding tubes. Methods An electronic survey of doctors, nurses, and allied health professionals at Children's Health Queensland obtained demographic information and awareness of various areas of tube feeding management particularly tube weaning. Results The 155 health‐care providers formed three well‐matched groups in terms of number and years of experience. Only 18 had formal training in tube weaning. Participants had high levels of knowledge regarding reasons for commencing and possible complications associated with tube feeding. However, health‐care providers generally were found to have limited to no knowledge of tube weaning practices. Nearly half of participants (46%) did not know the best time to plan for a tube wean and only 16 indicated that they or their work units documented tube exit plans, regardless of type of feeding tube, in children's medical charts. Time frames were rarely included as part of tube exit plans. Participants ranked medical stability and presence of a safe swallow most highly as important indicators for successful tube weaning. Multidisciplinary management was also identified as valuable. Tube weaning was predominately managed by children's primary health unit/service and largely involved a medical officer and dietician. Conclusions Poor awareness of tube weaning practices such as tube exit strategies may be impacting on the quality of care received by children who are tube fed. Future research should be directed towards developing and evaluating guidelines accompanied by educational resources to further advance tube weaning practices.

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Tube‐weaning infants and children: A survey of Australian and international practice

Cited by 20 publications

References 13 publications

Development, prevention, and treatment of feeding tube dependency

Development, prevention, and treatment of feeding tube dependency

Feeding Problems and Their Underlying Mechanisms in the Esophageal Atresia–Tracheoesophageal Fistula Patient

Weaning children from temporary tube feeding: Staff survey of knowledge and practices

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