Evaluation of an intensive desensitisation, oral tolerance therapy and hunger provocation program for children who have had prolonged periods of tube feeds

摘要

Background: Some children with early feeding difficulties may require nasogastric, (NG) tube feeding or insertion of a percutaneous endoscopic gastrostomy, (PEG) from a young age. A small cohort of these children can develop severe oral aversions that can delay the re-introduction of oral feeding. Multi-disciplinary approaches that provide an intensive approach are deemed the most effective method of intervention to reduce NG and PEG dependency.\ud\udMethod: Two children and their parents received an Intensive Approach to reduce PEG feeds, (Child A and Child B), whilst one child and her parents elected to receive a Traditional Feeding Clinic Approach, (Child C). The mean age of the participants was 4 years 4 months.\ud \udResults: Child A initially took 500 kcal (440% daily nutritional requirement) via her PEG, and 750 kcal (60% daily nutritional requirement) orally one week prior to the intensive programme, and Child B took 1200 kcal (100% daily nutritional requirement) via his PEG and O Kcal orally. Three months post the intervention, Child A took 100%all of her nutritional requirements orally, (1300 kcal/ 100% daily nutritional requirement), and Child B had reduced PEG requirement significantly to 38% oftook 500 kcal ( 50% daily nutritional requirement.) via his PEG, and 500 kcal orally. Child C showed no changes in PEG versus oral intake. \udChildren who received the intervention were able to remain focused on mealtimes for longermore, with fewer instances ofand did not leavinge the table. Parents altered their language styles post coaching on the intensive intervention with using fewer reprimands. No changes with these behaviours were noted with Child C.\ud\udConclusions: Although this was a small pilot study, there are some strategies used within an intensive multi-disciplinary context that can enable children to reduce their reliance on PEG feeds significantly.