Failure to wean?

摘要

Enteral feeding is a life-saver at the right time, but costs the NHS many thousands of pounds a year: ￡6500 in feeds and consumables alone for a 4-year-old child.1 Yet many children who can eat remain tube fed for lack of help in feed withdrawal.Wilken and colleagues2 describe a case series of children who took part in a two-week home-based tube weaning programme where feeds were withdrawn over a matter of days. Rapid weaning is a controversial approach and this is probably the first article to describe longer term results for such children so thoroughly. It was not a trial, so cannot prove the relative effectiveness of the techniques used, but it does provide some much needed information on safety. The children's growth patterns were reassuringly steady and the number of total treatment failures was small. These are surprising results since fast weaning is an extreme approach that potentially places a major physical stress on the child. However, this programme involved much more than just rapid tube withdrawal. Children were carefully vetted Sin advance, seen daily by a paediatrician and the freelance psychologist lived nearby throughout the programme and undertook an intensive feeding behaviour regime with the family.So, is this an option more mainstream services should consider? A very intensive short-term professional involvement is required, which would be difficult for most UK units to accommodate, although there are a few specialist services worldwide that are specifically set up to work in this way.3 4 Our experience in Glasgow has been that parents are very anxious about feed withdrawal5 and that few would be willing to allow their child to be weaned so quickly. However in our case series, half the preschool children had been successfully weaned within 6 months and Wilken's paper raises the question whether some of these children at least could have been freed from the constraints of tube feeding even faster.