title: Nutritional and psychosocial outcomes of gastrostomy tube-dependent children completing an intensive inpatient behavioral treatment program.
abstract: OBJECTIVE
  Limited published data describe the long-term effects of behavioral strategies to wean children from gastrostomy tube (GT) feeding dependence. This study presents data relating to nutritional and psychosocial outcomes observed during a 1-year period in medically complex GT feeding-dependent patients who completed an inpatient behavioral-based tube weaning protocol.
  
  
  METHODS
  This was a retrospective study of prospectively and retrospectively collected data associated with a clinical cohort of 77 children diagnosed as having a feeding disorder, GT feeding dependence (>1 year), and an inability to maintain acceptable growth via oral feeding completing an inpatient tube weaning protocol. Nutritional data (percentage of ideal body weight, and oral energy intake as percent ofenergy goal) and psychosocial data (mealtime behavior problems, quality of caregiver and child interactions, and parenting stress) were assessed pre- and post-hospitalization. Nutritional data were also monitored longitudinally at 1, 3, 6, and 12 months postreatment. Data were grouped for retrospective analysis.
  
  
  RESULTS
  Mealtime environment and feeding behaviors significantly improved, and all of the patients demonstrated reductions in tube dependence aside from 1 treatment failure. Fifty-one percent of patients were fully weaned from tube feeding after 2 weeks and an additional 12% completed weaning in the outpatient follow-up clinic within 1 year. Patients maintained nutritional stability at the 1-year posttreatment follow-up appointment.
  
  
  CONCLUSIONS
  Inpatient behavioral interventions are highly effective and safe for transitioning long-term tube feeding children to oral feeding.
authors.affiliation: *Division of Pediatric Gastroenterology, Medical College of Wisconsin †Division of Pediatric Psychiatry and Behavioral Medicine, Children's Hospital of Wisconsin, Milwaukee, WI ‡Department of Psychology, the University of Memphis, Memphis, TN.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Silverman
authors.forename: Midge
authors.initials: M
authors.lastname: Kirby
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Clifford
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fischer
authors.forename: Kristoffer S
authors.initials: KS
authors.lastname: Berlin
authors.forename: Colin D
authors.initials: CD
authors.lastname: Rudolph
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Noel
mesh_terms: D001521:Behavior Therapy; D002648:Child; D002652:Child Behavior; D002657:Child Development; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D015331:Cohort Studies; D005247:Feeding Behavior; D019959:Feeding and Eating Disorders of Childhood / Q000628:therapy*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000534:rehabilitation*; D006776:Hospitals, Pediatric; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009752:Nutritional Status; D010287:Parent-Child Relations; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014922:Wisconsin