Article Text

TUBE WEANING AND THERAPY OF FEEDING DISORDERS IN EARLY CHILDHOOD: A THERAPY CONCEPT FOCUSING ON SELF-REGULATION AND INTERACTION
  1. M Jotzo1,
  2. M Wilken2
  1. 1Ippska, Tuebingen, Germany
  2. 2Ippska, Siegburg, Germany

Abstract

Most infants born preterm or at risk find their way to oral feeding. However, feeding disorders after intensive care are increasing. A number of infants are tube fed beyond hospital discharge and some of them even for a number of years. Risk factors for prolonged tube feeding or severe feeding disorders are prematurity, severe peri or postnatal medical complications, former critical illness, developmental delay, mental or motor disabilities. The medical restrictions disturb the development of a normal feeding behaviour in the first months of life. After recovery, some infants refuse oral intake. Mostly, the infant’s refusal is connected to disturbed parent–infant interaction related to feeding.

Therefore, a home-based treatment programme for tube weaning and therapy of feeding disorders has been developed. Theoretical frameworks are the theory of self-regulation as well as concepts of trauma therapy with infants and parents. The tube weaning programme follows a therapy plan containing diagnostic and therapy preparation, nutrition reduction, tube weaning with medical monitoring and psychological treatment (5–14 days) and aftercare.

Figure 1

Connolly et al – – –♦– – – actual weight; – – –▪– – – advanced paediatric life support formulae; ––––▾–––– staff “guesstimates”; ––––×–––– Luscombe formula.

An evaluation including 21 tube-dependent premature infants showed that 20 (95%) were successfully weaned. In another study 77 (91%) of 85 tube-dependent infants with different diagnoses were successfully weaned.

This programme is a valuable alternative to therapy concepts focusing on behavioural therapy techniques and has been transferred successfully to a hospital setting. Regarding the increasing number of infants with feeding disorders and prolonged tube feeding it is indispensable to provide support and therapy for these infants and their families.

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