title: Withdrawing feeds from children on long term enteral feeding: factors associated with success and failure.
abstract: BACKGROUND
  Enteral feeding is vital for sick infants, but the transition to normal diet may be difficult. The authors describe a feeding team which provides multidisciplinary management of 'hard to wean' children within a large children's hospital, using reduction of feed volume to stimulate hunger, combined with psychological input to improve mealtime interactions and relieve parental anxiety.
  
  
  OBJECTIVE
  To assess the impact of feed reduction on growth and identify factors associated with successful feed cessation.
  
  
  METHODS
  Clinical and anthropometric data retrieved from case notes and clinic database for all 41 children referred for feed withdrawal over a 5-year period.
  
  
  RESULTS
  The children were aged median 4.0 (range 0.7-15) years when first seen; 27 (66%) were male and before reduction they received a median of 3766 (range 1987-9728) kJ daily from enteral feeds. Parents were often extremely anxious about weight loss and needed considerable support to make feed reductions. After follow-up for median (range) 1.7 (0.4-5.4) years, 32 (78%) were on solely normal diet, seven were still enterally fed and two were reliant on oral supplement drinks. Those referred after age 5 years were more likely to still be on artificial feeds (OR 7.4 (1.3-42); p=0.025) or to have taken more than a year to stop (OR 6.9 (1.1-43); p=0.04). Feed reduction was commonly followed by a decline in body mass index, but this was not associated with slow growth.
  
  
  CONCLUSIONS
  A majority of children eventually ceased feeds successfully, but slow and failed weaning is more likely after age 5 years.
authors.affiliation: Community Child Health, University of Glasgow, PEACH Unit, Yorkhill Hospitals, Glasgow, UK. cmw7a@clinmed.gla.ac.uk
authors.forename: Charlotte M
authors.initials: CM
authors.lastname: Wright
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Smith
authors.forename: Jill
authors.initials: J
authors.lastname: Morrison
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000886:Anthropometry / Q000379:methods; D001007:Anxiety / Q000209:etiology; D015992:Body Mass Index; D002648:Child; D002664:Child Nutritional Physiological Phenomena / Q000502:physiology*; D002675:Child, Preschool; D004032:Diet; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000209:etiology; D006801:Humans; D006815:Hunger; D007223:Infant; D008297:Male; D010290:Parents / Q000523:psychology; D010348:Patient Care Team; D010349:Patient Compliance; D011379:Prognosis; D016896:Treatment Outcome