title: Gastrostomy Tube Weaning and Treatment of Severe Selective Eating in Childhood: Experience in Israel Using an Intensive Three Week Program.
abstract: BACKGROUND
  Children dependent on gastrostomy tube feeding and those with extremely selective eating comprise the most challenging groups of early childhood eating disorders. We established, for the first time in Israel, a 3 week intensive weaning and treatment program for these patients based on the "Graz model."
  
  
  OBJECTIVE
  To investigate the Graz model for tube weaning and for treating severe selective eating disorders in one center in Israel.
  
  
  METHODS
  Pre-program assessment of patients' suitability to participate was performed 3 months prior to the study, and a treatment goal was set for each patient. The program included a multidisciplinary outpatient or inpatient 3 week treatment course. The major outcome measures were achievement of the target goal of complete or partial tube weaning for those with tube dependency, and expansion of the child's nutritional diversity for those with selective eating.
  
  
  RESULTS
  Thirty-four children, 28 with tube dependency and 6 with selective eating, participated in four programs conducted over 24 months. Their mean age was 4.3 ± 0.37 years. Of all patients, 29 (85%) achieved the target goal (24 who were tube-dependent and 5 selective eaters). One patient was excluded due to aspiration pneumonia. After 6 months follow-up, 24 of 26 available patients (92%) maintained their target or improved.
  
  
  CONCLUSIONS
  This intensive 3 week program was highly effective in weaning children with gastrostomy tube dependency and ameliorating severe selective eating. Preliminary evaluation of the family is necessary for completion of the program and achieving the child's personal goal, as are an experienced multidisciplinary team and the appropriate hospital setup, i.e., inpatient or outpatient.
authors.forename: Tzippora
authors.initials: T
authors.lastname: Shalem
authors.forename: Akiva
authors.initials: A
authors.lastname: Fradkin
authors.forename: Marguerite
authors.initials: M
authors.lastname: Dunitz-Scheer
authors.forename: Tal
authors.initials: T
authors.lastname: Sadeh-Kon
authors.forename: Tali
authors.initials: T
authors.lastname: Goz-Gulik
authors.forename: Yael
authors.initials: Y
authors.lastname: Fishler
authors.forename: Batia
authors.initials: B
authors.lastname: Weiss
mesh_terms: D002675:Child, Preschool; D003131:Combined Modality Therapy; D020878:Device Removal / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation; D004435:Eating / Q000502:physiology / Q000523:psychology; D004750:Enteral Nutrition / Q000379:methods / Q000523:psychology; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation / Q000379:methods / Q000534:rehabilitation; D006801:Humans; D007557:Israel; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D015397:Program Evaluation; D012189:Retrospective Studies; D012944:Social Support; D014886:Weaning