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

Abstract

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.

Characteristics and health service utilization of children most at risk for prolonged temporary tube feeding

“…Eligible medical records were audited from the time of tube insertion until tube removal or 4 months after tube insertion (whichever was sooner). This timeframe was selected based on findings that short‐term temporary tube feeding durations are typically <3 months 1–3,7 . Data were entered in a Research Electronic Data Capture (REDCap) 26 database.…”

“…For example, children with digestive system diseases 7 often take longer to transition to full oral feeding. Previous studies have also reported associations between prolonged temporary tube feeding and age, 3,6,8 extent of tube feeding, 6 and oral feeding competency 7 . Younger children have been identified to cease tube feeding more quickly than older children, 6,8 depending upon the length of time they are tube‐fed 6 and the degree of oral feeding proficiency 3 …”

“…Temporary or short‐term tube feeding optimizes nutrition for children with a wide range of clinical conditions, typically for <3 months 1–3 . Unfortunately, some children's temporary tube feeding journeys can become prolonged 4 .…”

“…Temporary or short-term tube feeding optimizes nutrition for children with a wide range of clinical conditions, typically for <3 months. [1][2][3] Unfortunately, some children's temporary tube feeding journeys can become prolonged. 4 Although prolonged temporary tube feeding can be related to unavoidable medical events (eg, surgery), 36% of children receiving home enteral nutrition support have protracted tube feeding durations despite the resolution of their medical condition.…”

“…7 Younger children have been identified to cease tube feeding more quickly than older children, 6,8 depending upon the length of time they are tube-fed 6 and the degree of oral feeding proficiency. 3 The prevention of prolonged temporary tube feeding has also been linked to health service factors, such as interdisciplinary team intervention and sufficient support provision and care coordination. 3,[9][10][11] Unfortunately, the quality of healthcare received by children needing temporary tube feeding can differ on a case-by-case basis depending upon the knowledge and skills of the treating team, 12 the existence of clinical practice guidelines, 3,9,10,13 and the adequacy of discharge planning, including the provision of parent training.…”