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Prevention and Treatment of Tube Dependency in Infancy and Early Childhood

University Children's Hospital, Graz, MUG, Austria, Marguerite.dunitz{at}klinikum-graz.at

Arie Levine, MD

The Wolfson Medical Centre, Holon, Israel

Yehuda Roth, MD

The Wolfson Medical Centre, Holon, Israel

Elisabeth Kratky

University Children's Hospital, Graz, MUG, Austria

Hannes Beckenbach, PhD

University Children's Hospital, Graz, MUG, Austria

Christian Braegger, MD

KISPI, Kinderspital Zürich, Switzerland

Almuthe Hauer, MD

University Children's Hospital, Graz, MUG, Austria

Markus Wilken, PhD

University Children's Hospital, Graz, MUG, Austria

Jean Wittenberg, MD

Sick Children's Hospital, Toronto

Thomas Trabi, MD

University Children's Hospital, Graz, MUG, Austria

Peter Jaron Scheer, MD

University Children's Hospital, Graz, MUG, Austria

Tube dependency is recognized as an unintended result of long-term tube feeding in infants and young children. The condition involves disturbing side effects such as vomiting, gagging, and active food refusal. It prevents infants from making the transition from tube to oral feeding and from starting to learn to eat in the absence of any medical indication for continuation of enteral feeding. Tube dependency can have a destructive impact on the child's development, even in cases when the nutritional influence might be beneficial. The authors set up recommendations for the prevention of tube dependency and suggest guidelines for weaning tube-dependent children based on the results of the Graz program and satellite programs using a similar model. A sample of 221 tube-dependent patients aged 4 months to 15 years of age provided the clinical study group on which this article is based. Begun in 1987, a comprehensive tube-weaning program was developed on the basis of clinical experience and encounters with more than 430 tube-dependent children in 20 years, resulting in a success rate of 78/81 (96% for 2007) and 79/84 (94% for 2008). Placement must be preceded by clear criteria and a decision as to the indicated nutritional goal and time of use. The placement of a temporary tube must generate a plan covering maintenance issues, including time, method, and team for weaning. Aspects of tube feeding that go beyond purely medical and nutritional issues need to be considered to minimize the frequency and severity of unintended tube dependency in early childhood.

Key Words: gastrostomy • enteral feeding • nasogastric tube • child • disability • dysphagia • infantile feeding disorders • food refusal

ICAN: Infant, Child, & Adolescent Nutrition, Vol. 1, No. 2, 73-82 (2009)
DOI: 10.1177/1941406409333988


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