Discontinuation of tube feeding in young children by hunger provocation.
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.
Kindermann
Angelika
A
Department of Paediatric Gastroenterology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands. a.kindermann@amc.uva.nl
Kneepkens
Corneille Marie Francois
CM
Stok
Anita
A
van Dijk
Elisabeth Maria
EM
Engels
Michelle
M
Douwes
Adriaan Cornelis
AC
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