Discontinuation of tube feeding in young children by hunger provocation

J Pediatr Gastroenterol Nutr. 2008 Jul;47(1):87-91. doi: 10.1097/MPG.0b013e3181615ccb.


Objectives: Pathological food refusal (PFR) is not rare in young children with chronic conditions requiring prolonged tube feeding. We investigated whether these children could be weaned from tube feeding with a multidisciplinary hunger provocation program.

Patients and methods: The study included children younger than 2 years with PFR who had been dependent on tube feeding for at least 3 months. They followed a multidisciplinary in-hospital program. During step 1, only 50% of the normal allowance was given by tube. During step 2, oral feeding was offered and completed up to 50% with tube feeding afterwards. During step 3, supplementary tube feeding was given at night. During step 4, only insensible loss (400 mL/m2), was replaced. When the child had started eating, parents took over feeding (step 5). Primary endpoints were eating without tube feeding while gaining weight at 3 and 6 months after discharge.

Results: Ten children (age 9-21 months; 7 girls) were exclusively tube fed for 7 to 19 months. Hospital stay lasted 9 to 33 days (mean 17.3 days). All children but 1 remained in clinically stable condition and started to eat within 1 week. Weight loss was 3.7% to 15.6% (mean 9.2%); in 1 child, the program was discontinued because of excessive weight loss. At follow-up after 3 and 6 months, 9 of 10 and 8 of 10 children, respectively, were eating adequately and gaining weight without tube feeding. Two children with recurrent infections resumed partial (25%-50%) tube feeding during follow-up.

Conclusions: The multidisciplinary hunger provocation program seems to be a promising method to promote discontinuation of tube feeding in young children.

MeSH terms

  • Eating / physiology*
  • Enteral Nutrition / methods*
  • Feeding Behavior
  • Female
  • Hospitalization
  • Humans
  • Hunger / physiology*
  • Infant
  • Infant Nutritional Physiological Phenomena / physiology*
  • Male
  • Time Factors
  • Weight Gain*
  • Weight Loss