title: Caring for Tube-Fed Children: A Review of Management, Tube Weaning, and Emotional Considerations.
abstract: Enteral nutrition is the practice of delivering nutrition to the gut either orally or through a tube or other device. Many children are reliant on enteral feedings to either supplement their nutrition or as a complete source of their nutrition. Managing children on tube feedings requires a team of providers to work through such dilemmas as feeding schedules, weaning from tube feeding, sensory implications of tube feeding, treatment of pain or nausea associated with eating, oral-motor issues, and behavioral issues in the child and family. The purpose of the current review is to summarize the multidisciplinary aspects of enteral feeding. The multidisciplinary team consists of a variable combination of an occupational therapist, speech-language pathologist, gastroenterologist, psychologist, nurse, pharmacist, and dietitian. Children who have minimal oral feeding experience and are fed via a nasogastric or gastrostomy tube often develop oral aversions. Limited data support that children with feeding disorders are more likely to have sensory impairment and that early life pain experiences contribute to feeding refusal. There are inpatient and outpatient programs for weaning patients from tube feeding to eating. The parent-child interaction is an important part of the assessment and treatment of the tube-fed child. This review also points out many information gaps, including data on feeding schedules, blenderized tube feedings, the best methods for weaning children off enteral feedings, the efficacy of chronic pain medications with tube-fed children, and, finally, the necessity of the assessment of parental stress among all parents of children who are tube fed.
authors: Children's Mercy Hospital and Clinics, Kansas City, MO sedwards1@cmh.edu.
authors: Sarah
authors: S
authors: Edwards
authors: Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas Center for Children's Healthy Lifestyles & Nutrition, Kansas City, Missouri.
authors: Ann M
authors: AM
authors: Davis
authors: Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas Center for Children's Healthy Lifestyles & Nutrition, Kansas City, Missouri.
authors: Amanda
authors: A
authors: Bruce
authors: Nationwide Children's Hospital.
authors: Hayat
authors: H
authors: Mousa
authors: Children's Mercy Hospital and Clinics, Kansas City, MO.
authors: Beth
authors: B
authors: Lyman
authors: Children's Mercy Hospital and Clinics, Kansas City, MO.
authors: Jose
authors: J
authors: Cocjin
authors: Children's Mercy Hospital and Clinics, Kansas City, MO.
authors: Kelsey
authors: K
authors: Dean
authors: Children's Mercy Hospital and Clinics, Kansas City, MO.
authors: Linda
authors: L
authors: Ernst
authors: Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas.
authors: Osama
authors: O
authors: Almadhoun
authors: New Orleans Children's Hospital, New Orleans, Louisiana.
authors: Paul
authors: P
authors: Hyman
mesh_terms: D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D059350:Chronic Pain; D004644:Emotions; D004750:Enteral Nutrition / Q000379:methods* / Q000523:psychology*; D005247:Feeding Behavior; D001068:Feeding and Eating Disorders; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D033183:Interdisciplinary Communication; D007441:Intubation, Gastrointestinal; D010287:Parent-Child Relations; D012677:Sensation
keywords: eating behaviors; enteral nutrition; multidisciplinary; pain; tube feeding