Evaluation of a Home-Based Behavioral Treatment Model for Children With Tube Dependency
Sarah Taylor1, Suzanne C Purdy1, Bianca Jackson1
1University of Auckland.
Insights
A home-based behavioral intervention effectively treated pediatric tube dependency, leading to significant improvements in feeding and weight for children. Most children were weaned off feeding tubes, showing this model
Area of Science:
- Pediatric Gastroenterology
- Behavioral Psychology
- Child Health
Background:
- Tube dependency in children presents significant challenges for feeding and development.
- Existing treatments for pediatric feeding disorders can be intensive and costly.
- Home-based interventions offer a potentially more accessible and cost-effective approach.
Purpose of the Study:
- To evaluate the efficacy of a home-based behavioral treatment model for children with tube dependency.
- To assess improvements in feeding behaviors, nutritional status, and caregiver well-being.
- To analyze the cost-effectiveness of the home-based intervention.
Main Methods:
- A cohort of nine children (4-14 years) dependent on nasogastric or gastrostomy tubes participated.
- A psychologist-led, multidisciplinary team implemented a home-based applied behavior analysis program.
- A multiple-baseline across participants design evaluated behavioral and nutritional outcomes, caregiver stress, and costs.
Main Results:
- Significant improvements were observed in food acceptance, swallowing, and oral intake (intention-to-treat effect size 0.74-2.1).
- All participants maintained or increased body weight; six of nine children were weaned off feeding tubes by follow-up.
- High treatment satisfaction was reported by caregivers and professionals, with cost-saving potential identified.
Conclusions:
- Home-based, multicomponent behavioral interventions are effective for pediatric feeding disorders.
- This model supports successful weaning from tube feeding and improves nutritional outcomes.
- The intervention demonstrates a cost-effective alternative to traditional treatment approaches.
Objective:
To evaluate a home-based behavioral treatment model for children with tube dependency.
Methods:
Nine children (aged 4-14 years) dependent on nasogastric and gastrostomy tubes were consecutively admitted into a home-based behavioral treatment program. A psychologist specializing in applied behavior analysis led the assessment and treatment phases with the support of caregivers and a multidisciplinary team. Caregivers participated in a caregiver training program and continued the intervention once the service was discontinued. We conducted follow-up visits up to 12 months after treatment. The program was evaluated with a multiple-baseline across participants design. We computed on-treatment and intention-to-treat effects according to the Hedges-Pustejovsky-Shadish model. We monitored behavioral (food acceptance and swallowing) and nutritional outcomes (body weight, oral intake, and tube intake), treatment acceptability and satisfaction, caregiver stress, and estimated treatment cost savings.
Results:
Food acceptance, swallowing, oral intake, and tube intake demonstrated large treatment gains relative to pretreatment levels (effect size range of the intention-to-treat analysis = 0.74-2.1). All participants maintained or increased their body weight. Follow-up effect sizes indicated further improvements. By the final follow-up assessment, six out of the nine children had ceased tube feeding, and one had tube feeds reduced. Caregivers and health professionals provided strong ratings of treatment satisfaction. The cost-savings analysis suggested that a home-based treatment may be a cost-effective alternative to prolonged tube feeding as well as to other treatment approaches.
Conclusions:
This study provides evidence supporting home-based multicomponent behavioral interventions in the treatment of pediatric feeding disorders.
Clinical Trial Identifier:
ACTRN12614001127695, https://goo.gl/XSQ4ZH.
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Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....


