Graduate Student Clinician Rush University Chicago, Illinois, United States
Background: Approximately 4 per 100,000 children need tube feeding to ensure they meet nutritional needs necessary for development, yet most will not require this technology life-long. There are not standard guidelines for the approach to transition from tube feeding to oral feeding to inform practitioners on optimal strategies. Objective: To complete a scoping review of feeding interventions for transitioning children from tube to oral feeding and characterize: demographic and clinical characteristics of the patients, settings, interventionists, treatment strategies, and assessment tools. Design/Methods: The Joanna Briggs Institute methodology was used, and screening was completed in accordance with PRISMA-SCR standards. Full-text publications were included if focused on feeding interventions for children < 18 years of age with direct outcomes related to tube weaning and/or promotion of oral feeds, indexed in Pubmed, Ovid Medline, Cochrane Library, Embase, and Google Scholar. Articles were excluded if the intervention had not been completed, a dietetic, pharmacological, or surgical intervention was utilized, or the population focused on anorexia nervosa. Intervention characteristics were extracted: study design, participants (number, age, clinical characteristics, inclusion & exclusion criteria), measurements (primary & secondary), methodology (strategy, setting & interventionist), and intervention outcomes. Results: After 4,619 initial results, 223 full text articles were retrieved and assessed for eligibility. A final sample of 94 articles were included in the review. The most salient feeding tube weaning interventions used: (1) a sensory stimulation approach, where intervention targeted hearing, touch, olfaction, and gustation via a multitude of platforms; (2) a hunger-based approach, where clinicians decreased the amount of tube feeds infants received to provoke hunger; (3) a behavioral approach where reinforcements and punishments were enacted; and (4) a cue-based approach, where clinicians centered the care around the infants’ signals to feed. Interventions took place across inpatient, outpatient, home, telemedicine, school environments or a combination of settings. Study populations, criteria, measurements, and definitions of success differed between studies.
Conclusion(s): Successful tube weaning interventions have been demonstrated across multiple settings with a variety of strategies utilized. An interdisciplinary team has shown to enable optimal outcomes. Future investigations ought to standardize measurement tools to optimize comparisons across interventions and populations and determine best practices.
