Pediatric gastrostomy feeding tube weaning strategies: A scoping review

Pediatric feeding tubes (FTs) are used to support nutrition and hydration needs, but ought to be weaned when children are able to eat safely by mouth to maintain growth. We performed a scoping review of FT weaning interventions for children (<21 years) dependent on long-term FTs. Study design, patient characteristics, intervention strategies, setting, duration, interventionist(s), primary study measures, short-term and long-term outcomes are described. Two independent reviewers extracted all data and came to consensus using the Joanna Briggs Institute methodology; a third reviewer resolved discrepancies as needed. Forty-five articles met the inclusion criteria. Most interventions took place in outpatient or inpatient settings, although home, telemedicine, and school settings were also represented. The majority of interventions were led by interdisciplinary teams. Strategies varied and were used in combination, most commonly: parent training and/or education, hunger provocation, and behavioral approaches. Most interventions weaned a majority of children to oral feeding, often with additional success in follow-up; a handful of studies demonstrated that a minority of patients required resumption of FT after initially weaning. Successful programs weaning children from FTs to oral feeding have occurred across various environments involving heterogeneous teams and strategies. Nearly all interventions involve a combination of strategies, parent training and/or education, and three or more interventionists, demonstrating the complexity of weaning programs. To establish best practices for weaning children from FTs when medically safe to do so, future work ought to establish standard measurement tools for treatment outcomes.