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Syrmis M, Reilly C, Frederiksen N, Bell KL. Characteristics and health service utilization of children most at risk for prolonged temporary tube feeding. Nutr Clin Pract 2023; 38:1154-1166. [PMID: 37017937 DOI: 10.1002/ncp.10981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND This study aimed to describe children at risk of prolonged temporary tube feeding and evaluate associations between tube feeding duration and child and health service variables. METHODS A prospective medical hospital records audit was conducted between November 1, 2018, and November 30, 2019. Children at risk of prolonged temporary tube feeding were identified as having a tube feeding duration of >5 days. Information was collected on patient characteristics (eg, age) and service delivery provision (eg, tube exit plans). Data were collected from the pretube decision-making phase until tube removal (if applicable) or until 4 months after tube insertion. RESULTS Descriptively, 211 at-risk children (median, 3.7 years; interquartile range [IQR], 0.4-7.7) differed from 283 not-at-risk children (median age, 0.9 years; IQR, 0.4-1.8) in terms of age, geographical location of residence, and tube exit planning. Medical diagnoses of neoplasms, congenital abnormalities, perinatal problems, and digestive system diseases in the at-risk group were individually associated with longer than average tube feeding duration, as were the primary reasons for tube feeding of nonorganic growth faltering and inadequate oral intake related to neoplasms. Yet, variables independently associated with greater odds of lengthier tube feeding durations were consultations with a dietitian, speech pathologist, or interdisciplinary feeding team. CONCLUSION Children at risk of prolonged temporary tube feeding access interdisciplinary management because of their complexity. Identified descriptive differences between at-risk and not-at-risk children may be useful when selecting patients for tube exit planning and developing tube feeding management education programs for health professionals.
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Affiliation(s)
- Maryanne Syrmis
- Department of Speech Pathology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Claire Reilly
- Department of Dietetics and Food Services, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, South Brisbane, Queensland, Australia
| | - Nadine Frederiksen
- Department of Occupational Therapy, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Kristie L Bell
- Department of Dietetics and Food Services, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Centre for Child Health Research, The University of Queensland, South Brisbane, Queensland, Australia
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2
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Lively EJ, McAllister S, Doeltgen SH. Parents' experiences of their child's transition from tube to oral feeding during an intensive intervention programme. Child Care Health Dev 2022. [PMID: 36478601 DOI: 10.1111/cch.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/21/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Persistent enteral tube feeding beyond the point of medical and/or physical necessity provides important nutrition to a child but may have implications for their development, gastrointestinal tract and quality of life. Tube dependency can affect parent-child relationships and sibling and family dynamics and place additional medical demands upon parents. It is therefore important to transition children from tube to oral eating and drinking as soon as is medically safe to do so. Tube weaning requires a skilled team to support the transition to oral intake; however, access to experienced teams is inconsistent. Without transparent discussions with their treating teams, many parents are left to navigate tube weaning options independently. METHODS Fourteen parents were interviewed using semi-structured interviews. We explored the experiences of parents across their child's progression towards oral feeding, from the decision-making process to undertaking an intensive multi-disciplinary tube weaning programme. Thematic analysis of the parents' stories shaped the development of seven themes. RESULTS Parents were unaware that tube weaning would be required and how that would be facilitated. They expressed a strong belief that their child could learn to eat-if afforded an opportunity. Furthermore, parents are prepared to disengage from current services if they feel they are not respected members of their child's therapeutic team. Three key learnings were identified relating to the need for tube exit plans, parents as key team members and parents as change agents. CONCLUSIONS Parenting a tube-fed child, initiating and engaging in tube weaning, is a stressful and emotional journey. However, by establishing care partnerships, parents are willing to put trust in a process if provided with options and afforded autonomy, empowerment, acknowledgement and relevant support.
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Affiliation(s)
- Emily Jane Lively
- Swallowing Neurorehabilitation Research Laboratory, Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Sue McAllister
- Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Sebastian Heinrich Doeltgen
- Swallowing Neurorehabilitation Research Laboratory, Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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3
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Wilken M, Hesse M, Jockenhöfer A, Pohl N. Are feeding disorders and feeding tube dependency the same?: A discrimination study between feeding disorders, feeding tube dependency and healthy eaters. J Paediatr Child Health 2022; 58:63-68. [PMID: 34449108 DOI: 10.1111/jpc.15641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Abstract
AIM Feeding disorders (FD) and feeding tube dependency (FTD) are defined by a persistent pattern of food aversion, but data regarding the frequency of food aversion symptoms are scarce. In this study, the frequency of aversion symptoms for FD, FTD and healthy eaters (HE) were compared. METHODS We compared the frequency of food aversion symptoms in a group with FD (n = 32) and FTD (n = 39) to HE (n = 38) using the AFT questionnaire. This includes growth data as well as the feeding aversion scale and the frequency of food aversion symptoms. RESULTS HE were reported to have minor frequency of symptoms, while FD children were reported to have daily aversive symptoms. FTD patients had the highest frequency in total. There were significant differences between FD and FTD regarding the frequency of food refusal, vomiting and bizarre eating patterns, and there were different correlative patterns of food aversion. CONCLUSIONS Children with FD and FTD show significantly different patterns of feeding behaviour compared to healthy norms as well as to each other. This suggests individualised assessment and treatment programs may be most beneficial for the needs of children with FD and FTD.
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Affiliation(s)
| | | | | | - Nadine Pohl
- Feeding Tube Dependency Institute, Essen, Germany
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4
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How to support parents and healthcare professionals in the decision-making process of tube feeding in children? Disabil Health J 2021; 15:101261. [PMID: 35022149 DOI: 10.1016/j.dhjo.2021.101261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tube feeding in children has a severe psychosocial impact on children and their families. Parents also feel that they have limited communication with healthcare professionals (HCPs) about decision-making and the implications of tube feeding. OBJECTIVE This study focussed on the parents' experiences and expectations about tube feeding of children and a solution to improve the management and communication of it. METHODS We applied a design thinking method in two parts. First, focus groups and individual interviews were conducted with parents of children aged 0-10 years who are or had been tube fed and HCPs. Thereafter, two sounding boards with HCPs and parents were convened to discuss improvements in the management of tube feeding. RESULTS In total, 17 parents participated in the study. Two main topics derived from the focus groups and interviews: psychosocial impact and communication with HCPs. The sounding boards (five HCPs and two parents) divided the challenges of tube feeding into three stages: the moment tube feeding is considered, the insertion of the tube in the hospital, and transfer to the domestic environment and follow-up. Interview topics were used to develop a communication sheet to support the decision process of tube feeding. CONCLUSIONS The empowerment of parents in the process of tube feeding is important. More attention should be paid to alternatives, consequences, and planning for the long term. The developed communication sheet offers suggestions for issues to discuss and could support communication between parents and HCPs about tube feeding.
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5
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Dadich A, Hockey K, Kaplun C, Fleming C, Hopwood N, Moraby K, Elliot C. Clinician and carer moral concerns when caring for children who tube-feed. J Child Health Care 2021:13674935211052842. [PMID: 34696607 DOI: 10.1177/13674935211052842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Child healthcare can be vexed by moral concerns - this extends to the care of children who tube-feed. Children who tube-feed often receive care from family members and clinicians of various disciplines. Each brings expertise, experiences, values, and views to a situation, prioritising the child's needs while attending to those they deem important in potentially disparate ways. Their understanding of a situation is shaped by beliefs, feelings, and perceptions. How then are key decisions made about the care of a child who tube-feeds? This article explores clinicians' and carers' moral concerns when caring for children who tube-feed. Interviews with clinicians (n = 9) and carers (n = 9) clarified three findings: first, there are often disparate beliefs about the need for tube-feeding; second, tube-feeding can evoke strong emotions; and third, it can be difficult to normalise tube-feeding. This article demonstrates how challenges can emerge when relationships between clinicians and carers diverge. Furthermore, it establishes how an ethic of care can bring different interests together to bolster the relationships required to optimise feeding care and promote health outcomes among children who tube-feed and their carers. This requires improved dialogue between and among clinicians and carers to create shared understandings of what is, what should be, and how to benefit children who tube-feed.
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Affiliation(s)
- Ann Dadich
- School of Business, 6489Western Sydney University, Penrith South, NSW, Australia
| | - Kaitlyn Hockey
- School of Business, 6489Western Sydney University, Penrith South, NSW, Australia
| | - Cathy Kaplun
- School of Nursing and Midwifery, 6489Western Sydney University, Penrith South, NSW, Australia
| | - Catharine Fleming
- School of Science and Health, 6489Western Sydney University, Penrith South, NSW, Australia
| | - Nick Hopwood
- Faculty of Arts and Social Science, 1994University of Technology Sydney, Sydney, NSW, Australia
| | - Khadeejah Moraby
- SA Health, 1050Central Early Childhood and Families Service, Women's and Children's Health Network, Adelaide, SA, Australia
| | - Chris Elliot
- Department of Paediatrics, 90135Saint George Private Hospital, Kogarah, NSW, Australia
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Backman E, Granlund M, Karlsson AK. Parental Perspectives on Family Mealtimes Related to Gastrostomy Tube Feeding in Children. QUALITATIVE HEALTH RESEARCH 2021; 31:1596-1608. [PMID: 33666118 PMCID: PMC8438777 DOI: 10.1177/1049732321997133] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Built on the important functions daily routines serve families and child health, this study aimed to explore parents' descriptions of mealtimes and food-related challenges when living with a child using a gastrostomy feeding tube. The study was informed by ecocultural theory and based on in-depth interviews combined with stimulated recall. The interviews of 10 parents were inductively analyzed by means of qualitative content analysis. Four main categories comprised the parents' descriptions: "One situation, different functions," "On the child's terms," "Doing something to me," and "An unpredictable pattern," with one overarching theme. The analyses showed that the parents strived to establish mealtimes in line with their cultural context, although they struggled to reach a point of satisfaction. The study highlights the importance of health care professionals to address the medical aspects of caring for a child with a G-tube, but also the potential psychological and social consequences for ordinary family life.
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Affiliation(s)
- Ellen Backman
- Halmstad University, Halmstad, Sweden
- Region Halland, Kungsbacka, Sweden
- Ellen Backman, School of Health and Welfare, Halmstad University, Box 823, 301 18 Halmstad, Sweden.
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Hopwood N, Moraby K, Dadich A, Gowans J, Pointon K, Ierardo A, Reilly C, Syrmis M, Frederiksen N, Disher-Quill K, Scheuring N, Heves R, Elliot C. Paediatric tube-feeding: An agenda for care improvement and research. J Paediatr Child Health 2021; 57:182-187. [PMID: 33277951 DOI: 10.1111/jpc.15286] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
This article presents an agenda to improve the care and wellbeing of children with paediatric feeding disorder who require tube feeding (PFD-T). PFD-T requires urgent attention in practice and research. Priorities include: routine collection of PFD-T data in health-care records; addressing the tube-feeding lifecycle; and reducing the severity and duration of disruption caused by PFD-T where possible. This work should be underpinned by principles of involving, respecting and connecting families.
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Affiliation(s)
- Nick Hopwood
- School of International Studies and Education, University of Technology Sydney, Broadway, New South Wales, Australia.,Department of Curriculum Studies, University of Stellenbosch, Stellenbosch, South Africa
| | - Khadeejah Moraby
- Central Early Childhood and Families Service, Allied Health, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Sydney, New South Wales, Australia
| | - Jessica Gowans
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Keren Pointon
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Anna Ierardo
- Department of Paediatrics, St George Hospital, Sydney, New South Wales, Australia
| | - Claire Reilly
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Maryanne Syrmis
- Speech Pathology Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Nadine Frederiksen
- Department of Occupational Therapy and Music Therapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Kate Disher-Quill
- Department of Paediatrics, St George Hospital, Sydney, New South Wales, Australia
| | - Noémi Scheuring
- Department of Pediatrics, Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Rudolf Heves
- Educational Technology, Web-Medu Health and Lifestyle Consulting Private Limited Company (Member of Rufusz Group), Budapest, Hungary
| | - Chris Elliot
- Department of Paediatrics, St George Hospital, Sydney, New South Wales, Australia.,Department of Community Child Health, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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8
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Hopwood N, Elliot C, Pointon K. Changing the World for Children with Complex Feeding Difficulties: Cultural-Historical Analyses of Transformative Agency. CULTURAL-HISTORICAL PSYCHOLOGY 2021. [DOI: 10.17759/chp.2021170215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
How to bring about positive change is a key concern in cultural-historical theory. There is an urgent imperative to address questions of transformation at the nexus of the individual and the social. One way to approach this is through the concept of agency, the means through which people go beyond coping with problems or adapting to the status quo, instead striving to make the future that ought to be a reality. This paper takes up ideas from Stetsenko’s transformative activist stance (TAS), Sannino’s transformative agency by double stimulation (TADS), and Edwards’ relational agency, tracing the emergence and enactment of agency among parents of children with complex feeding difficulties. These children were unable to eat orally, instead using a tube to feed. Each family strived towards, and realised, futures where their child was able to feed orally, without a tube. Parents acted agentically in ways that were contingent upon relevant cultural tools. Such tools are key to futures that are more inclusive, equitable and nurturing for all children and their families. The paper highlights the value of contemporary cultural-historical approaches to agency in understanding and provoking transformation at the nexus of the individual and social.
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