title: Discontinuation of tube feeding in young children by hunger provocation.
abstract: OBJECTIVE
  Pathological food refusal (PFR) is not rare in young children with chronic conditions requiring prolonged tube feeding. We investigated whether these children could be weaned from tube feeding with a multidisciplinary hunger provocation program.
  
  
  METHODS
  The study included children younger than 2 years with PFR who had been dependent on tube feeding for at least 3 months. They followed a multidisciplinary in-hospital program. During step 1, only 50% of the normal allowance was given by tube. During step 2, oral feeding was offered and completed up to 50% with tube feeding afterwards. During step 3, supplementary tube feeding was given at night. During step 4, only insensible loss (400 mL/m2), was replaced. When the child had started eating, parents took over feeding (step 5). Primary endpoints were eating without tube feeding while gaining weight at 3 and 6 months after discharge.
  
  
  RESULTS
  Ten children (age 9-21 months; 7 girls) were exclusively tube fed for 7 to 19 months. Hospital stay lasted 9 to 33 days (mean 17.3 days). All children but 1 remained in clinically stable condition and started to eat within 1 week. Weight loss was 3.7% to 15.6% (mean 9.2%); in 1 child, the program was discontinued because of excessive weight loss. At follow-up after 3 and 6 months, 9 of 10 and 8 of 10 children, respectively, were eating adequately and gaining weight without tube feeding. Two children with recurrent infections resumed partial (25%-50%) tube feeding during follow-up.
  
  
  CONCLUSIONS
  The multidisciplinary hunger provocation program seems to be a promising method to promote discontinuation of tube feeding in young children.
authors.affiliation: Department of Paediatric Gastroenterology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands. a.kindermann@amc.uva.nl
authors.forename: Angelika
authors.initials: A
authors.lastname: Kindermann
authors.forename: Corneille Marie Francois
authors.initials: CM
authors.lastname: Kneepkens
authors.forename: Anita
authors.initials: A
authors.lastname: Stok
authors.forename: Elisabeth Maria
authors.initials: EM
authors.lastname: van Dijk
authors.forename: Michelle
authors.initials: M
authors.lastname: Engels
authors.forename: Adriaan Cornelis
authors.initials: AC
authors.lastname: Douwes
mesh_terms: D004435:Eating / Q000502:physiology*; D004750:Enteral Nutrition / Q000379:methods*; D005247:Feeding Behavior; D005260:Female; D006760:Hospitalization; D006801:Humans; D006815:Hunger / Q000502:physiology*; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology*; D008297:Male; D013997:Time Factors; D015430:Weight Gain; D015431:Weight Loss