The Association of Tube Weaning and Oral Skill Development in Infants With Tube Dependency: A Prospective Study.

OBJECTIVE: This study was the first of its kind by assessing oral skills development during and after applying the "Graz Model" of tube weaning. METHODS: This prospective case series study included data of 67 (35 females, 32 males, treated from March 2018 to April 2019) tube dependent children, who participated in the effective "Graz Model" of tube weaning. Parents filled out the standardized Pediatric Assessment Scale for Severe Feeding Problems (PASSFP) prior to and immediately after completion of the program. Paired sample t tests were conducted to examine pre-to-post changes in the children's oral skills. RESULTS: The study showed that oral skills increased significantly during tube weaning PASSFP score of 24.76 (standard deviation, SD = 12.38) prior to versus 47.97 (SD = 6.98) after completion of the program. Furthermore, significant changes in their sensory and tactile perception and in their general eating behavior were observed. Children also showed reduced oral aversion symptoms and food pocketing, could enjoy their meals, and increased their food repertoire. Mealtime duration could be decreased, and parents were less anxious about their infants' intake and less frustrated because of their children's eating behavior. CONCLUSION: The results of this study demonstrated for the first time that tube dependent children can improve their oral skills significantly during and after their participation in the child-led approach of the "Graz model" of tube weaning.

Significant decrease of subcutaneous body fat during tube-weaning from enteral feeding.

BACKGROUND: The aim of this paper was to evaluate anthropometry and subcutaneous body fat on long-term enterally-fed children during tube weaning through a prospective cohort study with a pre-post-test design. METHODS: The LIPOMETER, an optical device, was used to measure the thickness of subcutaneous adipose tissue (SAT) layers (in mm). The specification of 15 evenly-distributed body sites allows for a precise measurement of subcutaneous body fat distribution, known as subcutaneous adipose tissue topography (SAT-Top). Anthropometry and SAT-Top were determined in long-term enterally fed children in the pre- and post-tube weaning phase of a 3-week tube weaning program. The results of the SAT-Top measurements are presented on three levels: 15 body sites, four body regions and SAT-total. RESULTS: The sample size consisted of 30 long-term tube-fed children (13 girls and 17 boys). Both sexes demonstrated a clear decrease of anthropometry and subcutaneous body fat during tube weaning. Girls lost -26.1 mm, -30.7%, (P=0.002) of their initial fat mass and boys -12.5 mm, -18.4%, (P<0.001). In general, girls had thicker SAT layers in all SAT-Top measurements and a higher reduction of subcutaneous body fat during the intervention. At the end of the tube weaning program girls and boys demonstrated similar results of subcutaneous body fat on the three observed levels: 15 body sites, four body regions and SAT-total. Upon discharge, total subcutaneous body fat of girls and boys was 58.9 mm and 55.5 mm, respectively. CONCLUSION: This study presents a basic documentation of changes in anthropometry and subcutaneous body fat during tube weaning and could potentially be used to help create guidelines for safe tube weaning.

Decrease of total subcutaneous adipose tissue from infancy to childhood.

OBJECTIVES: The observation and research of body composition is a topic of present interest. For the assessment of health and variables influencing growth and nutrition, it is of utmost interest to focus on the population of young children. SUBJECTS AND METHODS: The measurements of subcutaneous body fat distribution in a sample of clinically healthy children ages 0 to 7 years were examined. The optical device LIPOMETER was applied to measure the thickness of subcutaneous adipose tissue layers (in millimeters) at 15 well-defined body sites. This set of measurement points defines the subcutaneous adipose tissue topography. In the present study, subcutaneous adipose tissue topography was determined in 275 healthy children (128 girls and 147 boys) divided into 3 age groups. RESULTS: The results of the measurements are presented in 3 levels: total subcutaneous adipose tissue, 4 body regions, and 15 body sites. Our results show a clear physiological decrease in subcutaneous body fat in boys (-43.8%) and girls (-39.8%). One interesting finding was that the decrease occurs mainly in the trunk, abdomen, and lower extremities, whereas the body fat distribution of the upper extremities did not differ. Furthermore, slight subcutaneous adipose tissue topography differences between both sexes were found. CONCLUSIONS: The present study provides basic documentation of subcutaneous adipose tissue topography in healthy children ages 0 to 7 years. An accurate description of subcutaneous adipose tissue topography in healthy subjects could help to characterize various diseases in relation to overnutrition and malnutrition throughout childhood.

[On the way to telemedicine]. / Auf dem Weg zur Telemedizin: Erkenntnisse aus 28 Jahren psychosomatischer Medizin.

This article is based on the script of my farewell-speech at the University Hospital for Children and Adolescents in 2012. I served for 28 years as Head of the Psychosomatic and Psychotherapeutic unit as part of the Division for General Pediatrics, which was imbedded in the Department for Pediatrics. In these years I learned to focus on the triangle between doctor, parents, and child: To observe and recognize the verbal and non-verbal expressions of the children, the parents, and also his own is one of the doctor's key tasks. Within this process of acting and treating, practising medicine should become part of a commonly lived experience. This requires sensitivity as well as self-criticism and respect for the families, who entrust themselves to us. We have been able to implement this with children who suffer from eating disorders or tube dependency. As a continuation of the long-standing activity at the Medical University of Graz the spin-off firm Notube.com is presented, which offers treatment for children from 0 to 8 years of age suffering from eating disorders of all kinds. The experience of psychosomatic understanding and treatment acquired at the clinic can thus-even after retirement-continue to benefit hundreds of families. By establishing an outpatient clinic and by offering telemedical support to families this is a medicine that points the way to the future, especially in times of the Covid 19 pandemic.

Inpatient tube weaning in children with long-term feeding tube dependency: A retrospective analysis.

This study investigates the outcome of an intervention program to establish oral feeding after prolonged tube feeding in children. The intervention is based on supervised reduction of enteral formula within a few days supported by a 3-week program of speech therapy, occupational therapy, psychoanalytically based eating therapy, physical therapy, psychodynamic coaching, and nutritional counseling of the infant and his or her parents. Two hundred twenty-one cases were included in this study. All patients had been severely ill or were handicapped and had been exclusively fed by tube for most of their lives. The major outcome variable was complete discontinuation of tube feeding with sufficient oral feeding after treatment, defined as the child's ability to sustain stable body weight by self-motivated oral feeding. Two hundred three patients (92%) were completely fed orally after treatment. Tube feeding was discontinued completely within 8 days in mean, and mean in-patient treatment time was 21.6 days. The current method can be used by a trained and experienced team to wean tube-dependent children from prolonged tube feeding. Tube weaning should be addressed from the beginning of tube feeding in all children who are expected to restore oral feeding after the phase of nutritional stabilization. Since successful programs are rare, we were motivated to present our results of this elaborate program in this article.

Tube dependency as a result of prematurity.

BACKGROUND: Enteral nutrition support (ENS) is a standard of care in all NICUs. As a result of long-term ENS, tube dependency can develop. Tube dependency is an inability to make the transition from tube to oral feeds despite the absence of medical reasons for ENS and might lead to symptoms like oral aversion and food refusal. This study aims to evaluate the prevalence of prematurity in a large cohort of tube dependent children. METHODS: Prospectively collected data on tube dependent children who participated in a program based on the "Graz Model of tube weaning" from January 2009 to December 2015 was analysed quantitatively. RESULTS: The study cohort consisted of 711 tube dependent children. Using ICD-10 classification, 378 children (53.2%) were born prematurely, with 103 extremely preterm infants (EPI; including children <29 weeks of gestational age and 275 preterm infants (PI; between 29 and 36+6 weeks of gestational age). More than half (55.4%) of all included patients were female, 51.8% were tube fed via a percutaneous endoscopic gastrostomy (PEG-) tube, 45.8% had a nasogastric (NG-) tube and 2.4% were tube fed via Jejunal (J-) tube. 66% of all EPI and 63.3% of all PI were tube fed since birth. 83.5% of all EPI had no additional diagnoses beyond their extreme prematurity. No differences in tube weaning outcomes between preterm and full term infants were shown. CONCLUSION: Prematurity, especially extreme prematurity, is associated with an increased risk for development of tube dependency. Preventive measures for this specific group of children should be considered.