title: Evaluation of an intensive desensitisation, oral tolerance therapy and hunger provocation program for children who have had prolonged periods of tube feeds.
abstract: BACKGROUND
  Some children with feeding difficulties may require nasogastric tube feeding or insertion of a percutaneous endoscopic gastrostomy (PEG) from a young age. A small cohort of these children can develop severe oral aversions that can delay the re-introduction of oral feeding. Multidisciplinary approaches that provide an intensive approach are deemed the most effective method of intervention to reduce nasogastric and PEG dependency.
  
  
  METHODS
  Two children and their parents received an intensive approach to reduce PEG feeds (Child A and Child B), while one child and her parents elected to receive a traditional feeding clinic approach (Child C). The mean age of the participants was 4 years 4 months.
  
  
  RESULTS
  Child A initially took 2090 kJ (44% daily nutritional requirement) via her PEG before the intensive program, and Child B took 100% daily nutritional requirement via his PEG. Three months post the intervention, Child A took 100% of her nutritional requirements orally and Child B had reduced PEG requirement significantly to 38% of daily nutritional requirement. Child C showed no changes in PEG versus oral intake. Children who received the intervention were able to remain focused on mealtimes for longer, with fewer instances of leaving the table. Parents altered their language styles post coaching on the intensive intervention using fewer reprimands. No changes with these behaviours were noted with Child C.
  
  
  CONCLUSIONS
  Although this was a small pilot study, there are some strategies used within an intensive multidisciplinary context that can enable children to reduce their reliance on PEG feeds significantly.
authors.affiliation: Department of Language and Communication Science, City University, Royal Free Hospital Chelsea and Westminster Hospital, Northampton Square, London, UK. c.harding@city.ac.uk
authors.forename: Celia
authors.initials: C
authors.lastname: Harding
authors.forename: Abi
authors.initials: A
authors.lastname: Faiman
authors.forename: Julie
authors.initials: J
authors.lastname: Wright
mesh_terms: D002652:Child Behavior; D002675:Child, Preschool; D004435:Eating; D004750:Enteral Nutrition / Q000379:methods*; D005247:Feeding Behavior; D019959:Feeding and Eating Disorders of Childhood / Q000209:etiology / Q000628:therapy*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D006815:Hunger; D008297:Male; D010287:Parent-Child Relations; D010865:Pilot Projects; D015397:Program Evaluation; D013997:Time Factors; D016896:Treatment Outcome