Moving from tube to oral feeding in medically fragile nonverbal toddlers

Area of Science:

• Pediatric Gastroenterology
• Clinical Nutrition
• Feeding Therapy

Background:

• Many toddlers with medical complications require gastrostomy tubes for nutrition.
• Transitioning these children to oral feeding presents significant challenges.
• Existing protocols for tube weaning are often lengthy and may not address underlying issues.

Purpose of the Study:

• To describe a novel 14-week outpatient protocol for transitioning toddlers from gastrostomy tubes to oral feeding.
• To evaluate the efficacy of a combined approach involving nutritional support, medication, and hunger provocation.
• To assess the success rate of achieving exclusive or partial oral feeding.

Main Methods:

• A 14-week outpatient protocol was implemented.
• Initial phase focused on mastering oral eating skills.
• Subsequent 8 weeks involved continuous gastrojejunal drip feedings with low-dose tricyclic antidepressants and/or gabapentin.
• Final 6 weeks included megestrol for hunger provocation during tube feeding withdrawal.

Main Results:

• A chart review was conducted post-treatment.
• Out of 10 subjects, 9 were eating exclusively orally.
• One subject achieved 50% oral intake.

Conclusions:

• The described 14-week protocol is effective for transitioning toddlers with medical complications from gastrostomy tubes to oral feeding.
• The combination of nutritional support, pharmacotherapy, and appetite stimulation facilitates successful oral intake.
• This protocol offers a promising approach for improving feeding outcomes in a challenging pediatric population.