Outcomes for Feeding Tube-Dependent Children With Oral Aversion in an Intensive Interdisciplinary Treatment Program

Intensive Multidisciplinary Feeding Day Programs in the United States: A Report Regarding the Treatment Landscape

Intensive multidisciplinary intervention is increasingly recognized as the standard of care for children with complex feeding problems. Much, however, remains unknown about this treatment model. This current qualitative, prospective study sought to identify intensive multidisciplinary day hospital programs operating in the US, describe the treatment approach, and summarize current capacity.

Nutritional and feeding challenges in aerodigestive patients

PURPOSE OF REVIEW

Aerodigestive disorders encompass conditions that affect both the airway and gastrointestinal tract. These include conditions such as acquired and congenital defects of the airway and esophagus as well as neuromuscular disorders. Patients often suffer from dysphagia, aspiration, and respiratory disorders. This article will provide a review of current practices in the management of feeding disorders, oropharyngeal dysphagia, and nutritional support in the aerodigestive population.

RECENT FINDINGS

Oral aversion, aspiration, and feeding-tube dependence are all commonly encountered problems in the aerodigestive population. Intensive inpatient and outpatient programs along with use of appetite stimulants and psychotropic medications may help to improve feeding-related disorders. Aspiration affects many patients and requires close monitoring of clinical symptoms along with routine assessment with video fluoroscopy. Developments in blenderized feeds and formula supplementation have also provided new options for patients with feeding intolerance.

SUMMARY

Patients with aerodigestive disorders require complex medical care, and multidisciplinary teams are the most effective in addressing their medical needs. Advances in feeding, occupational, and pharmacologic therapy have allowed healthcare providers to better address the needs of these patients.

The Association of Tube Weaning and Oral Skill Development in Infants With Tube Dependency: A Prospective Study

OBJECTIVE

This study was the first of its kind by assessing oral skills development during and after applying the "Graz Model" of tube weaning.

METHODS

This prospective case series study included data of 67 (35 females, 32 males, treated from March 2018 to April 2019) tube dependent children, who participated in the effective "Graz Model" of tube weaning. Parents filled out the standardized Pediatric Assessment Scale for Severe Feeding Problems (PASSFP) prior to and immediately after completion of the program. Paired sample t tests were conducted to examine pre-to-post changes in the children's oral skills.

RESULTS

The study showed that oral skills increased significantly during tube weaning PASSFP score of 24.76 (standard deviation, SD = 12.38) prior to versus 47.97 (SD = 6.98) after completion of the program. Furthermore, significant changes in their sensory and tactile perception and in their general eating behavior were observed. Children also showed reduced oral aversion symptoms and food pocketing, could enjoy their meals, and increased their food repertoire. Mealtime duration could be decreased, and parents were less anxious about their infants' intake and less frustrated because of their children's eating behavior.

CONCLUSION

The results of this study demonstrated for the first time that tube dependent children can improve their oral skills significantly during and after their participation in the child-led approach of the "Graz model" of tube weaning.

Standardizing and optimizing nutrition evaluation frequency of enterally fed patients in an ambulatory pediatric gastroenterology practice: A single-center study

BACKGROUND

Nutrition monitoring is essential in feeding tube-dependent patients receiving home enteral nutrition (HEN). We identified lack of consistency in dietitian evaluations for our pediatric patients receiving HEN. Consequently, after establishing an institutional standard for nutrition reassessment intervals, we underwent a quality improvement (QI) initiative to improve rates of adherence to standard frequency of dietitian consults and referrals among patients receiving HEN.

METHODS

A prospective QI initiative from April 2021 to December 2021 was performed using multiple plan-do-study-act (PDSA) cycles. Interventions included (1) a reminder placard, (2) the display of feeding tube status and date of the last dietitian note in the electronic health record (EHR) clinic schedule dashboard, and (3) an autotext smart element to the EHR default clinic note template. The goal was to enable clinicians to quickly identify the need for nutrition evaluation with either a same-day dietitian consult or a referral to nutrition clinic.

RESULTS

Among 111 HEN patients with >6 months since last nutrition encounter, the dietitian referral/consult rate prior to any interventions was 58%. The placard (PDSA 1) was abandoned before obtaining reportable data because of sampling bias and clinic workflow inefficiencies. The clinic schedule dashboard modification (PDSA 2) improved the dietitian referral/consult rate to 66%. Subsequently, the clinic note smart element (PDSA 3) increased the rate to 77%. An 8-week postintervention check revealed a compliance rate of 78%.

CONCLUSION

Implementation of minimally interruptive EHR enhancements showed a sustained increase in dietitian referrals and consults for patients receiving HEN, which may improve nutrition outcomes.

A Literature Review of Feeding Disorders in Children with Tracheostomies and Ventilators

Feeding disorders and gastrostomy use are highly prevalent in children with invasive mechanical ventilation (IMV) due to both common risk factors (eg, prematurity, neurological disorders) and resultant experiential deprivation (eg, long hospitalizations, delayed feeding experiences). Feeding in children with IMV is complicated by the presence of a tracheostomy, lung vulnerability, and medical complexity. The potential comorbidity of swallowing difficulties (dysphagia) and atypical early feeding experiences can result in complex feeding disorders. In this review of pediatric feeding disorders in children with invasive mechanical ventilation (IMV), we identify gaps in clinical translational research for this patient population and opportunities for improving evidence-based management. To improve long-term feeding outcomes and maximize oral feeding in this vulnerable population, children would benefit from earlier feeding opportunities during critical developmental windows, standardized protocols for advancing oral feeding, and involvement of intensive, comprehensive therapies throughout hospitalizations and early childhood. [Pediatr Ann. 2022;51(7):e291-e296.].

Behavior Analytic Feeding Interventions: Current State of the Literature

The purpose of this paper was to review the current state of the behavior analytic feeding intervention literature. We highlight studies that we found to be important contributions to the recent literature in the following areas: food selectivity, chewing, packing, and food refusal/tube weaning and provide suggestions for future research and clinical work in these areas. We also discuss several current topics relevant to the field in hopes to further advance research and clinical practice. These topics include considering the benefits of innovative models of service delivery such as telehealth and caregiver-implemented interventions, the importance of evaluating long-term outcomes of behavioral feeding interventions, and lastly, ethical issues to consider in the designing and implementation of behavioral feeding interventions and training of practitioners in our field.