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Variables Impacting the Time Taken to Wean Children From Enteral Tube Feeding to Oral Intake

Lively, Emily J.*,†; McAllister, Sue; Doeltgen, Sebastian H.*,†

Journal of Pediatric Gastroenterology and Nutrition: June 2019 - Volume 68 - Issue 6 - p 880–886
doi: 10.1097/MPG.0000000000002330
Original Articles: Nutrition
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Objectives: This study investigated biological factors, which may influence the time taken for children to wean from enteral to oral intake.

Methods: Retrospective case-note audit of 62 tube-fed children (nasogastric or percutaneous endoscopic gastrostomy) aged 6 months to 8 years, participating in an intensive tube weaning program. Program design included family-focused mealtimes, child autonomy, and appetite stimulation. A regression model was developed, which shows the combination of variables with the most predictive power for time taken to wean.

Results: Data from 62 children who were highly dependent (minimum 93% of calories provided enterally) on tube feeding for an extended period of time (mean = 2.1 years) were analysed. Children's mean body mass index z score at time of weaning was −0.47 (standard deviation 1.03) (mean weight = 10.54 kg) and 54 (87%) presented with a range of medical conditions. Forty-four children (71%) remained completely tube free at 3 months postintervention and an additional 5 children (10%) were fully tube weaned within 10 months of program commencement. Type of feeding tube, medical complexity, age, and length of time tube fed all significantly correlated with time taken to wean. Logistic regression modelling indicated that the type of feeding tube in combination with the degree of medical complexity and time tube fed were the strongest predictors of time taken to wean.

Conclusions: Biological factors usually considered to impact on successful weaning from tube feeding (volume of oral intake, oral skill, or mealtime behaviours) were not relevant; however, the type of feeding tube in combination with the degree of medical complexity and time tube fed were the strongest predictors. The impact of psychosocial factors should be investigated to identify if these mitigated the effects of the biological variables.

*Department of Speech Pathology, College of Nursing and Health Sciences, Flinders University

Swallowing Neurorehabilitation Research Laboratory, Centre for Neuroscience, Flinders University, Adelaide, South Australia

Faculty of Health Sciences, The University of Sydney, Sydney, Australia.

Address correspondence and reprint requests to Emily J. Lively, Speech Pathologist, PhD Candidate, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia 5001 (e-mail: will0472@flinders.edu.au).

Received 19 September, 2018

Accepted 13 February, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

E.J.L. is the Director of the intensive interdisciplinary program audited. The remaining authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,