Tube Feeding Dependency

Pediatrician

Intake of adequate calories and nutrients is necessary in order to survive and grow. Many acute and chronic childhood illnesses can lead to nutritional deficiencies, and enteral feeding may be needed when nutritional measures are inadequate to meet the child's nutritional needs. Sometimes this need is supplemental, aiming to fill nutritional gaps while a child recovers from an injury or illness. Other times, a child may require all nutrition enterally due to chronic or severe illness or injury. 

According to the American Academy of Pediatrics, when a child is unable to eat or when dietary strategies are inadequate to meet nutritional needs by mouth alone, enteral tube feeding is indicated. It may also be needed when there is a high risk of aspiration, which is common in neuromuscular disorders, or following brain injuries or trauma. While in some cases, tube feeding can be utilized short term while a patient is recovering, there are times when tube feeding may persist for longer periods of time. In some situations, this  may lead to tube feeding dependence, even once there are no longer medical reasons to continue tube feeding.

Tube dependency is characterized as the active refusal to begin oral activities (eating or drinking), a lack of oral skills, and a lack of motivation or inability to learn after long-term enteral feeding. As a result, despite the fact that there are no medical reasons to continue tube feeding, the child remains reliant on it.

The majority of preterm infants, infants with neurological impairment, or babies in the postoperative period receive oral feeding without difficulty after a period of tube feeding, as long as the tube feeding does not last for more than 2-3 weeks. This is especially true when they are stimulated during tube feeding with a non-nutritive oral stimulation, such as sucking on a pacifier or mouthing toys or teethers. Weaning a baby from tube feeding can be difficult in infants and children whose tube feeding lasts longer (from 6 weeks to more than one year) without any oral stimulation program.

 

Causes and risk factors of tube dependency 

Tube placement at a young age, tube feeding during a vulnerable time for feeding skill development, and length of time dependent upon tube feeding are all risk factors for this development.

A number of factors contribute to tube dependence such as:

 

  • Decreased motivation to eat due to a poor perception of hunger and fullness

  • Negative experiences (such as nausea, vomiting) leading to oral aversion

  • Reduced positive oral stimulation or exposure for skill development (lack of experience).

 

Complications of tube dependency

Long-term tube feeding may have severe complications and side effects. Feeding-related anxiety is common among parents of children with feeding disorders, and mothers may exhibit greater attachment insecurity. Tube dependence can negatively impact one's health, psychosocial well-being, and financial well-being. As a result, tube feeding dependence is considered a severe feeding condition.
 

Complications of long-term dependence on tube feeding include:

  • Feeding disorders, selectivity

  • Increased risk of aspiration

  • Impaired development of important oral motor skills

  • Reflux, nausea, vomiting

  • Oppositional and aversive behavior

  • Possibility of Perforations

  • Leakage, Infections


 

Prevention of tube dependency

Weaning as soon as medically appropriate is advised. Although it is not always possible to wean tube feedings, maintaining oral skills by pursuing oral motor therapy and offering developmentally appropriate oral activities can improve quality of life and optimize progress towards oral feeding once the child is medically stable and appropriate. There are many guidelines for preventing tube dependence and providing normal feeding to tube-fed children. Parent education and support is a critical component to successful tube weaning regimens, as parents must be shown how to create an optimal feeding environment.  Schedule a consultation with a pediatric feeding therapist here.