Related Experiment Videos
Helping children stop or avoid enteral feeding
Insights
A multidisciplinary feeding clinic successfully weaned 67% of children from tube or oral supplements, reducing feeding duration and demonstrating significant cost-effectiveness for the NHS.
Area of Science:
- Pediatrics
- Clinical Nutrition
- Health Services Research
Background:
- Long-term enteral feeding is crucial for children unable to feed orally, but transitioning to a normal diet can be challenging.
- Neurodisability can necessitate tube feeding later in childhood, yet identifying suitable candidates is complex.
- The Royal Hospital for Sick Children, Yorkhill established a multidisciplinary feeding team to optimize care and minimize unnecessary tube feeding.
Purpose of the Study:
- To evaluate the effectiveness and cost-effectiveness of a multidisciplinary feeding clinic in managing complex pediatric feeding problems.
- To reduce the duration of artificial feeding (enteral or oral supplements) in children.
- To improve the overall care and outcomes for children with severe nutritional problems or those requiring artificial feeding.
Main Methods:
- A specialized team comprising a clinical psychologist, paediatric dietitian, and consultant paediatrician managed referred cases.
- Inclusion criteria focused on artificially fed children or those with severe nutritional issues, following failed uni-disciplinary management.
- Data collection involved tracking patient feeding status, duration of feeds, and outcomes post-intervention over a ten-year period.
Main Results:
- Over ten years, 67% of 222 patients transitioned from tube or oral supplement feeding to normal diets.
- The median duration of tube feeding decreased significantly from seven years in the initial three years to 2.7 years subsequently.
- Of 53 children referred for potential tube feeding, 60% remained on a normal diet, and only 19% required tube feeding.
Conclusions:
- A multidisciplinary feeding clinic is highly effective in weaning children from artificial feeding and improving dietary independence.
- The service demonstrates significant cost-effectiveness, saving the National Health Service substantial resources by reducing feeding duration.
- Early intervention and specialized, multidisciplinary care can optimize outcomes for children with complex feeding difficulties.
Abstract:
Long term enteral feeding is widely used to provides vital support for infants and children unable to feed orally, but once medically stable the transition to a normal diet can be difficult. Other children may need to commence tube feeding later in childhood because of difficulties associated with neurodisability, but recognising which children will benefit from tube feed is not straightforward. The Royal Hospital for Sick Children, Yorkhill set up a multidisciplinary feeding team in 2002 to help avoid unnecessary tube feeding. We accept only children who are either artificially fed or with severe nutritional problems and only after attempted uni-disciplinary management. The team members are a clinical psychologist, paediatric dietitian and consultant paediatrician, supported by a specialist paediatric registrar, assistant psychologist and administrative support. We can see only a small proportion of all with complex feeding problems, but aim to improve the care of such children generally. We disseminate the lessons learned within the Feeding Clinic via education locally and nationally and have an active programme of research. Over the first ten years of the clinic we have seen 222 patients of whom 67% were initially either tube or oral supplement fed, while only 29% remain so at follow up. In the first three years of the clinic tube fed children had spent a median of seven years on feeds before they were successfully weaned, but since then that has fallen to a median of 2.7 years. Of 53 other children referred for possibly tube feeding, 32 (60%) remain well on a normal diet and only ten (19%) have needed to start tube feeding. The service is highly cost effective. Salary costs are only around £65,000 per year, while weaning five children per year, reducing their years on feeds by four years, saves the NHS £130,000.