177: Rehabilitation of Feeding-Tube Dependent and Feeding-Disordered Children – A Community Paediatric Experience

Abstract

Background: Feeding rehabilitation of feeding-tube dependent and feeding-disordered infants and children can be a protracted challenge. Standard out-patient approaches rely on behavioural and sensory interventions based on largely anecdotal data. Effective stimulus-based intervention has until now required prolonged admission to the few specialized centers that offer this approach. Objectives: To assess effectiveness of a community hospital or clinic stimulus-based intervention for feeding-tube dependent and feedingdisordered children. Design/Methods: Uncontrolled non-randomized prospective clinical study. Children were either managed as inpatients (17) or outpatients (3) with immediate discontinuation of all tube feeds and implementation of a standard “picky eater” behavioural management program. Supplemental fluids were provided by tube during sleep if the child was noted to have significant ketosis, weight loss and lethargy. Results: A total of 20 children (17 in-patient and three out-patient) were enrolled. Successful progression to full or partial oral feeding was seen within one week of admission in 17 of 19 (89%) of inpatient managed children and three of three (100%) of children managed as outpatients. Three children subsequently required re-initiation of tube feeding due to parental or medical concern with adequacy of intake (74% long-term successful feeding outcome). Two children with severe behavioral or developmental challenges were resistant to this intervention. Conclusions: Selected tube-dependent and feeding disordered children can be successfully managed in a community-based setting without multidisciplinary support using a naturalized non-coercive hunger and thirst-stimulated approach. Parent satisfaction was extremely high. (Table presented) .