Interprofessional Approach to Tube Weaning in the Pediatric Population: Challenges and Successes

Abstract: Tube feeding is essential for many infants and children but weaning off tube feeds and transitioning to oral feeds can be challenging. This session will discuss the benefit of an interprofessional tube weaning program at a pediatric medical facility. Specific topics will include the value of each team member in the tube weaning process, the barriers and challenges in program development, and the importance of supporting the child and family to optimize outcomes during the tube weaning journey. Case studies and pertinent research will be discussed with an emphasis on how multi-cultural mealtime practices are considered during the tube weaning process.

Description: Tube feeding is essential for many infants and children but weaning off tube feeds and transitioning to oral feeds can be challenging. Children who have been enterally fed since early infancy have often missed the usual transitions to complementary feeding, tend to lack feeding skills, and may not have experienced hunger (Wright 2022). Parents and caregivers report anxiety around oral and enteral feedings, weight gain, and psychosocial impacts of tube feeding. They feel they are not always being given information on the prognosis and consequences of long-term and short-term tube feeding and sense a lack of communication between providers (Remijin 2022).

There is an invaluable advantage for using an interprofessional team when approaching tube weaning. Interprofessional Collaborative Practice is defined as “multiple health workers from different professional backgrounds work together with patients, families, and communities to deliver highest quality of care” (WHO, 2010). “Interprofessional collaborative practice is the key to safe, high quality, accessible, patient-centered care desired by all” (IPEC, 2011).

The need for an interprofessional program to help guide families through the tube weaning process was identified at our tertiary pediatric hospital. Patients were not progressing in their feeding therapy and caregivers were becoming frustrated at the lack of guidance in helping their child progress with oral feeds. Providers often did not feel comfortable or knowledgeable about effectively weaning tube feeds.

Interprofessional tube weaning teams can look different at various institutions. Dunitz-Scheer 2022 states “tube weaning is invasive and needs to be respected and treated accordingly.” The Tube Weaning Program at our facility includes Gastroenterologists, Registered Dietitians, and Speech-Language Pathologists. The team provides medical and therapeutic assessment to help determine the best path for tube weaning and works with the family to determine an individualized plan of care based on the family’s goals for their child. From the development of our program in late 2020 to date, our program has seen 65 patients with 27 of these having been weaned from their feeding tubes.

Our presentation will describe the interprofessional tube weaning program at our pediatric medical facility. We will highlight the essential components of our team and value of each team member. Successes and challenges of working within an interprofessional team with be reviewed including the need for establishing team member roles and responsibilities and developing program goals together as a team.

An emphasis will be placed on the importance of including caregivers and patients as members of the interprofessional team. “Active participation of patients and their families as members of the healthcare team is clearly among the goals, values, and vision of interprofessional collaboration. The clear intent is that the care must be provided together with rather than for patients” (Slusser et al., 2019). We will use case studies to highlight how to support multi-cultural mealtime practices through the tube weaning process.

We will further discuss the barriers and challenges faced, including patient and family readiness and compliance, changes in patients’ medical statuses, and navigating cultural differences and how the program has evolved to meet the varying needs of our patients and families. We will conclude our presentation by emphasizing the individualized approach used for our patients that has led to our successes and outcomes.

Case studies and pertinent research will be reviewed throughout the presentation to support learning.

Supporting Research: Reference 1: Abdelhadi, Rempel, G., Sevilla, W., Turner, J. M., Quet, J., Nelson, A., Rahe, K., Wilhelm, R., Larocque, J., & Guenter, P. (2021). Transitioning From Nasogastric Feeding Tube to Gastrostomy Tube in Pediatric Patients: A Survey on Decision‐Making and Practice. Nutrition in Clinical Practice, 36(3), 654–664.

Supporting Research: Reference 2: Dunitz-Scheer, & Scheer, P. J. (2022). Child-led Tube-management and Tube-weaning (1st ed. 2022.). Springer International Publishing.

Supporting Research: Reference 3: Palmer, M. M. (1998). Weaning from Gastrostomy Tube Feeding: Commentary on Oral Aversion. Pediatric Nursing, 23 (6): 475-478.

Supporting Research: Reference 4: Remijn, Kalsbeek, C. J. C., Platteel, V., & Kindermann, A. (2022). How to support parents and healthcare professionals in the decision-making process of tube feeding in children? Disability and Health Journal, 15(2), 101261–101261.

Supporting Research: Reference 5: Wilken, Markus. “The Impact of Child Tube Feeding on Maternal Emotional State and Identity: A Qualitative Meta-Analysis.” Journal of Pediatric Nursing (2012);27: 248-255.