Teaching Project: The Tube-Fed Children’s Parents Research Paper

Children with postnatal abnormalities, mental conditions, and complicated anamneses can experience serious feeding issues. In this case, feeding tubes can prove the most optimal solution. But weaning the children from the tube can present more issues than actually using the tube. Thus, the aim of the following paper is to develop a teaching tool on how to educate the tube-fed children’s parents on tube weaning. (65)

A pilot research by Kindermann et al. (2008) concerned the problem of tube weaning in children 2 years old or younger. The researchers have set a goal to test if a combined multidisciplinary approach would be effective in discontinuing tube feeding. The sample included 10 children (3 male and 7 female) younger than 2 years, particularly those who have developed tube feeding dependency. The minimal dependency variable was 3 months, and the maximum tube-feeding period was 19 months. Another variable was the period of hospital stay, which was from 9 up to 33 days. The methods of the study included a three-step intervention program that would provoke hunger and make the children more willing to consume food orally.

At the first stage, the children were given only a half of their daily caloric intake by the tube. At the second one, the children were introduced to the food to be consumed orally, and the calories they could not manage to take through the mouth were given to them by the tube. The supplementary feeding continued up to the fifth stage. At stage five, the children were already consuming food orally, and the feeding went under parental control. At the end of the intervention, nine out of 10 children were clinically stable.

The same nine children began to eat real food in one week after the beginning of the program. On average, the group lost about 9% of weight. One of the children had to stop the program mainly because they lost too much weight. A follow-up showed that eight out of ten were still eating orally. The authors conclude that a multidisciplinary hunger provocation program is effective for tube weaning (Kindermann et al., 2008).

A crossover study conducted by Hartdorff et al. (2015) was aimed at revealing which was more effective: a shorter inpatient weaning program or a longer outpatient one. The program was basically the same but the participants were distributed into two groups; group A were treated in hospital during two weeks, and group B were prescribed outpatient treatment which lasted for four weeks. The sample included 22 children under two years old. The methods included random distribution between the groups A and B. In both groups, the calorie intake and the types of foods were recommended and controlled by a dietician. In the intervention group A, the feedings occurred on regular basis, 4-5 times a day, with 15% weight loss regarded as acceptable.

The average weight loss was adequate in both groups. As a result, hunger provocation was more effective in the intervention group than in the control group. In fact, the success rate in group A was 9 to 1 while in group B only one of the participants could eat orally by the end of the program. These were later transferred to the intervention group and eventually started eating. Discussing the results, the authors assume that traditional outpatient tube weaning can be effective in the long run. Inpatient weaning program, on the other hand, takes less time but more effort because the group has to be constantly monitored by the interdisciplinary team. However, the effectiveness of a shorter program is obvious. One of the reasons may be that children are not controlled by their parents and the parents’ habits. Also, the children received more assistance from proficient nurses, which made the parents more confident and prevented interference (Hartdorff et al., 2015).

The inpatient tube weaning program using hunger provocation was proved effective and evidenced by Brown et al. (2014). The program is constituted by many factors and consists of various interventions. It is a 19-day procedure when patients are hospitalized and treated using a multidisciplinary approach. Within the frames of this approach, the members of the team work in collaboration to address each patient individually. An individual-based care treatment plan is then developed. The patient is also constantly monitored.

The program involves people who feed the patients; in case of children, the feeder is commonly one of the parents. The feeders stay in hospital with their children throughout the program. As part of the treatment, the amount of food taken via the tube is gradually cut down to provoke hunger; the percentage of the tube-delivered food to be reduced is prescribed individually, as well as the proportion of tube food to orally consumed food. The food intakes are also limited in time to boost appetite.

Most importantly, the therapists gradually cease to attend the feedings to improve interaction between the children and parents; by the third week, the therapist usually does not attend the feedings at all. Depending on how the children and parents progress, the parents and children can be encouraged to have meals out of the hospital premises to project their cooperation skills into new environment. Upon discharge, the patients and their parents are also encouraged to contact their practitioners and receive outpatient support. After the discharge, the patients and parents are supposed to implement the skills they have acquired during the program in real life. Such program has proved to be the most effective long-term.

From these articles, we have learned that inpatient treatment is the most effective way to wean children from their feeding tubes. Also, and more importantly, we have acknowledged the importance of parental involvement in the program. The parents have to be educated on how to interact with their children at the mealtime, learn not to be overprotective when it comes to hunger, and use the skills post-discharge.

Considering that tube dependency usually affects children, our hypothetic patients can be described as a child of any gender, up to 3 years of age, suffering some postnatal abnormalities or mental conditions, including eating disorders. However, children of that age are not the main students; rather, the teaching should be targeted at their parents.

Let us assume the primary feeder is the child’s parent. A parent can be either mother or father but we shall stop on women. For a child of 3, the age can vary; let us suppose the mother will be 25-40 years of age. As said, the mothers need to be informed about the program, taught to interact with their children and use the skills post-discharge because the goal of the program is to wean the children off of the tube. At that, the mother can be informed of possible complications, such as bleeding, infections, and mouth cavity issues. For a person of that age, interactive education tools and methods would be the most appropriate.

The source that we have encountered is a website that offers many opportunities for parental education on how to wean their children off of tubes. The site is named “NoTube” and is an interactive platform with external links to some useful materials, applications, stories that other parents share, and education programs. The method that best corresponds with the evidence from the research is the “Eating School” (Eating Schools, 2016). The program duration is 2 weeks, which is the average time it takes to wean a child off of the tube in hospital.

The main difference that Eating School makes is the environment, which is friendly and open. The children get the chance to interact with their peers, and the parents are free to ask questions and attend learning sessions. The team takes an interdisciplinary approach that we have reviewed. It provides parents and children with pediatrician’s, dietician’s, therapist’s, and psychologist’s assistance, as well as friendly atmosphere of learning through play (Eating Schools, 2016).

A program such as this would quite strike us off the budget, which is why, currently, we concentrate on more feasible tools. A brochure in which the possible effects of tube dependency and the benefits of the program are described would be the most appropriate. At that, the brochure would be supplementary to a good web source which is the Feeding Tube Awareness Foundation. The website provides a collection of useful materials, myths and facts, and weaning programs (Feeding Tube Awareness Foundation, 2016). Considering that the brochure would be parent-oriented, it should be comprehensibly formatted and informative. The only instructions that the parents are to follow is to read the brochure and visit the website where more information is given. Some points to include in the brochure are:

• Basic facts that should be communicated to parents who are new to tube-feeding;
• Some problems with G-tubes and how to fix them;
• Information about the weaning programs and their efficiency;
• Feeding Tube Awareness Foundation website and other links.

Based on the brochure, the mothers are to get a teaching session to receive detailed explanation and have their questions answered.

The teaching plan can be described as follows:

The target age can be 25-40, and the most effective presentation method is group discussion. A brochure is the most optimal tool since it is illustrative and concise, providing the learners with the basics ad directing their further search.

References

Brown, J., Kim, C., Lim, A., Brown, S., Desai, H., Volker, L., & Katz, M. (2014). Successful

gastrostomy tube weaning program using an intensive multidisciplinary team approach. Journal of Pediatric Gastroenterology and Nutrition, 58(6), 743-749. doi:10.1097/MPG.0000000000000336

Feeding Tube Awareness Foundation. (2016)

Hartdorff, C. M., Kneepkens, C. M. F., Stok-Akerboom, A. M., van Dijk-Lokkart, E. M.,

Engels, M. A. H., & Kindermann, A. (2015). Clinical Tube Weaning Supported by Hunger Provocation in Fully-Tube-Fed Children. Journal of Pediatric Gastroenterology and Nutrition, 60(4), 538-543. doi:10.1097/MPG.0000000000000647

Kindermann, A., Kneepkens, C. M. F., Stok, A., van Dijk, A. E. M., Engels, M. A. H., &

Douwes, A. C. (2008). Discontinuation of tube feeding in young children by hunger provocation. Journal of Pediatric Gastroenterology and Nutrition, 47(1), 87-91. doi: 10.1097/MPG.0b013e3181615ccb

Eating Schools. (2016).