title: Successful gastrostomy tube weaning program using an intensive multidisciplinary team approach.
abstract: OBJECTIVE
  The present study evaluated the effectiveness of a multidisciplinary intensive inpatient model for gastrostomy tube (GT) weaning.
  
  
  METHODS
  A retrospective chart review was completed on 30 GT-dependent children, ages 3.9 (±1.4) years, admitted to the inpatient feeding program (length of stay 19 days) from May 2009 to December 2011. Administered GT calories were decreased on admission by an average of 73% from home regimen. Patients were offered 3 meals and 2 to 3 snacks/day, including 3 intensive feeding therapy sessions (Monday to Friday), along with psychosocial support, nutrition guidance, and behavioral therapy. Daily calorie counts and weights were recorded. Patients returned for a postdischarge feeding evaluation at an average of 4 months and a clinic visit at 1 year. Data were analyzed using paired samples t tests.
  
  
  RESULTS
  Before admission, patients received 69% (±25) of goal calories by GT and 22% (±19) of goal calories orally. During admission, average caloric intake by mouth as a percentage of goal increased during the course of weeks 1, 2, and 3 (68%, 77%, and 82%, respectively), with a statistically significant increase between weeks 1 and 2 (P = 0.001) and 1 and 3 (P = 0.011). At discharge, 90% had discontinued GT feedings. Average percent weight change during admission was 0.2% (±4). At 1 year follow-up, 83% remained successfully off GT feedings.
  
  
  CONCLUSIONS
  Children who are GT dependent can be weaned off GT feedings during a 3-week admission using a multidisciplinary feeding model. The therapeutic gains were maintained at 1 year postdischarge.
authors: *Department of Clinical Nutrition and Lactation †Department of Psychology ‡Department of Rehabilitation §Department of Social Services ||Division of Pediatric Gastroenterology and Nutrition, Children's Hospital of Orange County, Orange, CA.
authors: Jessica
authors: J
authors: Brown
authors: Cindy
authors: C
authors: Kim
authors: Audrey
authors: A
authors: Lim
authors: Shonda
authors: S
authors: Brown
authors: Hema
authors: H
authors: Desai
authors: Leigh
authors: L
authors: Volker
authors: Mitchell
authors: M
authors: Katz
mesh_terms: D001521:Behavior Therapy; D002648:Child; D002675:Child, Preschool; D004435:Eating; D002149:Energy Intake; D004750:Enteral Nutrition; D005247:Feeding Behavior; D019959:Feeding and Eating Disorders of Childhood / Q000628:therapy; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D008297:Male; D062407:Meals; D010348:Patient Care Team; D012189:Retrospective Studies; D014886:Weaning; D015430:Weight Gain