Author: Benoit, D., Wang, & EL, Zlotkin, SH
Source: The Journal of Pediatrics 2000; Oct: 498-503
Objective : A frequent complication of enteral (tube) feeding is oral aversion, or resistance to oral feeding. While a variety of techniques have been used (reinstating hunger cues, feeding reflexes, oral motor skills, caregiver?s attitudes) to restore a child?s interest in eating, outcomes have been inconsistent and variable.
This study was performed to determine whether one technique, behavioral therapy, was more effective than nutritional therapy alone in eliminating the need for enteral feeding in infants who had shown resistance to feeding by mouth.
Methods: The researchers took 64 children (ages 4 ? 36 months) who were tube fed and had a resistance to oral feedings and randomly assigned them to receive either nutritional or behavioral interventions. The nutritional intervention provided structured schedules and routines to stimulate the hunger/fullness cycle. The behavioral intervention provided the same schedules and routines but added a behavior therapy. This approach involved placing a small amount of food directly on the child?s mouth which often caused them to become anxious. Instead of stopping the feeding because the child was anxious, the feeders reassured them but continued to place food on their lips or mouth every 5-10 seconds. If food was not swallowed then a dry spoon was used. For 7 weeks, subjects and feeders in both groups attended a weekly clinic with 1-2 dieticians followed by 4 monthly follow-up visits.
Results: While 15 (47%) of 32 children in the behavioral group no longer required tube feeding at the 3rd follow-up visit 4 ? months after the start of the trial, none of the children in the nutritional group were as successful.
Conclusion : Adding behavioral therapy to nutritional conseling is more effective in eliminating the need for tube feeding than nutritional counseling alone. The authors stated that due to the brief nature of this study, long term effects could not be examined.
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