Weaning from long-term tube dependency

Young children with a complex medical history frequently develop feeding problems. Although tube feeding is effective in providing the necessary energy and nutrients, it decreases the child's motivation to eat and may lead to aversion to oral feeding. The aim of this study was to confirm the results of a previous study showing that a multidisciplinary clinical hunger provocation program for children may lead to quick resumption of oral feeding after long-term tube feeding. In a cross-over study 22 young children who were fully dependent on tube feeding were randomly assigned to 1 of 2 groups: group A (intervention group) which followed a 2-week multidisciplinary clinical hunger provocation program and group B (control group) which followed a 4-week outpatient treatment by the same multidisciplinary team. When one treatment was unsuccessful patients were reassigned to the other treatment group. Primary outcome measures were at least 75 % orally fed at conclusion of the intervention and fully orally fed and gaining weight 6 months after the intervention. In the hunger provocation group 9 out of 11 patients were successfully weaned from tube feeding (2 failures: 1 developed ulcerative colitis and 1 dropped out at the request of the parents). In the control group only 1 patient was successfully weaned and 10 out of the 11 children were reassigned to the hunger provocation program, all being successfully weaned. At 6 months after the intervention 1 patient had to resume tube feeding. In total 1 patient out of 11 (9 %) in the control group was successfully weaned as compared to 18 out of 21 (86 %) in the hunger provocation group (p <0.001). Multidisciplinary clinical hunger provocation is an effective short-term intervention for weaning young children from tube feeding