BACKGROUND: Enteral feeding is vital for sick infants, but the transition to normal diet may be difficult. The authors describe a feeding team which provides multidisciplinary management of 'hard to wean' children within a large children's hospital, using reduction of feed volume to stimulate hunger, combined with psychological input to improve mealtime interactions and relieve parental anxiety. AIMS: To assess the impact of feed reduction on growth and identify factors associated with successful feed cessation. SUBJECTS AND METHODS: Clinical and anthropometric data retrieved from case notes and clinic database for all 41 children referred for feed withdrawal over a 5-year period. RESULTS: The children were aged median 4.0 (range 0.7-15) years when first seen; 27 (66%) were male and before reduction they received a median of 3766 (range 1987-9728) kJ daily from enteral feeds. Parents were often extremely anxious about weight loss and needed considerable support to make feed reductions. After follow-up for median (range) 1.7 (0.4-5.4) years, 32 (78%) were on solely normal diet, seven were still enterally fed and two were reliant on oral supplement drinks. Those referred after age 5 years were more likely to still be on artificial feeds (OR 7.4 (1.3-42); p=0.025) or to have taken more than a year to stop (OR 6.9 (1.1-43); p=0.04). Feed reduction was commonly followed by a decline in body mass index, but this was not associated with slow growth. CONCLUSIONS: A majority of children eventually ceased feeds successfully, but slow and failed weaning is more likely after age 5 years.
BACKGROUND: Enteral feeding is vital for sick infants, but the transition to normal diet may be difficult. The authors describe a feeding team which provides multidisciplinary management of 'hard to wean' children within a large children's hospital, using reduction of feed volume to stimulate hunger, combined with psychological input to improve mealtime interactions and relieve parental anxiety. AIMS: To assess the impact of feed reduction on growth and identify factors associated with successful feed cessation. SUBJECTS AND METHODS: Clinical and anthropometric data retrieved from case notes and clinic database for all 41 children referred for feed withdrawal over a 5-year period. RESULTS: The children were aged median 4.0 (range 0.7-15) years when first seen; 27 (66%) were male and before reduction they received a median of 3766 (range 1987-9728) kJ daily from enteral feeds. Parents were often extremely anxious about weight loss and needed considerable support to make feed reductions. After follow-up for median (range) 1.7 (0.4-5.4) years, 32 (78%) were on solely normal diet, seven were still enterally fed and two were reliant on oral supplement drinks. Those referred after age 5 years were more likely to still be on artificial feeds (OR 7.4 (1.3-42); p=0.025) or to have taken more than a year to stop (OR 6.9 (1.1-43); p=0.04). Feed reduction was commonly followed by a decline in body mass index, but this was not associated with slow growth. CONCLUSIONS: A majority of children eventually ceased feeds successfully, but slow and failed weaning is more likely after age 5 years.