Characteristics and health service utilization of children most at risk for prolonged temporary tube feeding.

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.

A natural history of temporary tube feeding care at a children's hospital: A prospective audit of medical records.

This chart audit characterized the natural history of temporary tube feeding use at a children's hospital between 1 November 2018 and 30 November 2019. Data were collected from the decision-making phase until tube removal or 4 months post-tube insertion. Children's tube feeding journeys were described, and associations determined between patient and service-related variables and outcomes of tube feeding duration and being discharged with a feeding tube. Four hundred and 94 patients were followed with a median age of 1.0 years (IQR 3.6). Many had respiratory illnesses (n = 213, 43%) and received feeding tubes for inadequate oral intake related to acute illness (n = 279, 57%). Seventy-one new feeding tubes were inserted per month (SD 27.63). Fifty-nine per cent of patients (n = 290) received allied health consults. Although 40% of patients (n = 199) experienced complications, most patients (n = 460, 93%) ceased tube feeding within 4 months. Outcomes were associated with age, medical condition, reflux, primary reason for tube feeding, allied health consult, complication type, tube weaning plans and referral for longer-term feeding devices. Results highlighted a critical need for risk identification from the decision-making stage and standardization of practices during all phases of temporary tube feeding care.

Paediatric tube-feeding: An agenda for care improvement and research.

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.

Temporary feeding tube dependency in pediatric patients: A retrospective analysis of risk factors and preventative practices.

BACKGROUND & AIMS: Prolonged temporary tube feeding places pediatric patients at risk of tube dependency. This chart audit aimed to identify current temporary tube feeding practice within an Australian tertiary hospital, risk factors of prolonged temporary tube feeding, and the likelihood of high risk patients receiving tube dependency preventative practices. METHODS: A retrospective chart audit was conducted of the medical records of 187 pediatric inpatients who had temporary feeding tubes placed in an Australian tertiary hospital between November 2014 and March 2017. Information was collected on patient demographics and tube feeding practices. The Kaplan Meier estimate, Cox regression and logistic regression were used to determine the median time until feeding tube removal, predictors of prolonged temporary tube feeding, and the relationship between these predictors and utilization of preventative practices. RESULTS: The Kaplan Meier estimate of median tube feeding duration was 6.43 months (95% CI: 5.17-7.90). Predictors of prolonged tube feeding were prematurity (p = 0.003), feeding difficulties requiring speech pathology referral (p = 0.002), and referral for long-term feeding tubes (p = 0.002). There was a low prevalence of preventative clinical practices including documentation of tube exit plans (5.3%, n = 10) and referral for long-term feeding tubes (27.3%, n = 51). Exhibiting risk factors for prolonged tube feeding did not increase the likelihood of receiving preventative clinical practices. CONCLUSIONS: The prolonged duration of temporary tube feeding within this sample highlights the need for improved utilization of tube dependency preventative practices within high risk groups.

Weaning children from temporary tube feeding: Staff survey of knowledge and practices.

AIM: To explore the understanding of and practices of health-care workers in weaning children from feeding tubes. METHODS: An electronic survey of doctors, nurses, and allied health professionals at Children's Health Queensland obtained demographic information and awareness of various areas of tube feeding management particularly tube weaning. RESULTS: The 155 health-care providers formed three well-matched groups in terms of number and years of experience. Only 18 had formal training in tube weaning. Participants had high levels of knowledge regarding reasons for commencing and possible complications associated with tube feeding. However, health-care providers generally were found to have limited to no knowledge of tube weaning practices. Nearly half of participants (46%) did not know the best time to plan for a tube wean and only 16 indicated that they or their work units documented tube exit plans, regardless of type of feeding tube, in children's medical charts. Time frames were rarely included as part of tube exit plans. Participants ranked medical stability and presence of a safe swallow most highly as important indicators for successful tube weaning. Multidisciplinary management was also identified as valuable. Tube weaning was predominately managed by children's primary health unit/service and largely involved a medical officer and dietician. CONCLUSIONS: Poor awareness of tube weaning practices such as tube exit strategies may be impacting on the quality of care received by children who are tube fed. Future research should be directed towards developing and evaluating guidelines accompanied by educational resources to further advance tube weaning practices.

Characterisation of information Hospitals Provide Parents on Tube Feeding, Including Tube Weaning.

PURPOSE: The purpose of this study was to characterise the content of hospital parent guides related to pediatric tube feeding. DESIGN AND METHODS: A naturalistic search strategy was used to retrieve parent guides produced by hospitals using Google. Guides were analysed and content identified as being associated with codes which were derived from previous research into the education of parents on tube feeding and the prevention and treatment of tube feeding dependency and tube weaning. RESULTS: Of the 17 collected guides from Australia, New Zealand, the United Kingdom, the United States of America, and Canada, most (64.7%) were published between 2009 and 2016. The guides provided comprehensive information regarding the reasons for and types of tube feeding, details of multidisciplinary teams and the practical management of tube feeding. All guides covered common medical problems and trouble-shooting solutions. Yet there was infrequent coverage of goal setting, risks and prevention of oral aversion and tube feeding dependency, social and emotional management of tube feeding and tube exit planning including tube weaning. CONCLUSIONS: A gap exists in the education of families regarding psychosocial implications of tube feeding, oral aversion and tube feeding dependency and prevention, and tube exit planning. PRACTICE IMPLICATIONS: Improvements need to be implemented in the development of education materials for families of children who require tube feeding. Families need information on all aspects of tube feeding including practical, social, and emotional management as well as advice on tube exit planning including tube weaning.

Pre-linguistic communication skill development in an infant with a diagnosis of galactosaemia.

BACKGROUND: Neonatal screening for galactosaemia (GAL) identifies the condition early, but subsequent biomedical and genetic testing fails to identify which subgroup of infants with GAL are at most risk of the language disorders associated with the condition. This study aims to present preliminary data on an infant with GAL based on assessment of pre-linguistic communication behaviours known to underpin language development. METHODS: This single case-control study profiles the pre-linguistic skills of a 13-month-old infant with GAL. The Index Infant's performance was descriptively compared to that of a typically developing, suitably matched control infant. RESULTS: The Index Infant was identified as presenting with clinically significant delays on 9 of the 11 pre-linguistic skills assessed. DISCUSSION AND CONCLUSION: The early identification of risk of developmental language difficulties in the Index Infant allows for the implementation of early intervention using the infant's parents as facilitators of language stimulation. Monitoring of the infant's progress is warranted.