Abstract
We describe an innovative program that weans young children from their feeding tube. Our program focuses on making the children competent, normal-for-age eaters, promoting the child's strengths. All of the children were treated for 2 to 3 weeks by an interdisciplinary team in a family-centered care environment in a pediatric day treatment setting. The approach promoted oral competence and placed the responsibility of oral intake back on the child versus the family. The philosophy is fourfold in that children need to: (1) be immersed in oral experience (2) be taught to eat if they are not competent orally, (3) to have sensory systems that are organized and receptive to oral input, and (4) learn to act on their own internal motivation or hunger/satiety patterns. We individualized the treatment approach by recognizing 5 barriers to oral eating: disrupted hunger/satiety, inexperience, disordered contingency learning, sensory/anxiety, and the presence of psychosocial issues. During ongoing follow-up, we learned that 72% of the children were completely weaned from their tubes after an average of 5 to 7 months postdischarge. It appeared that creation of internal motivation, immersion into oral eating, and parent education regarding normal feeding behaviors were paramount to the long-term success of a weaning program. Classifying these children based on parent-reported information, and on written documentation from home therapists, allowed tube-weaning readiness to occur prior to their admission.