Abstract:
Objective To evaluate a home-based behavioral treatment model for children with tube dependency. Methods Nine children (aged 4–14 years) dependent on nasogastric and gastrostomy tubes were consecutively admitted into a home-based behavioral treatment program. A psychologist specializing in applied behavior analysis led the assessment and treatment phases with the support of caregivers and a multidisciplinary team. Caregivers participated in a caregiver training program and continued the intervention once the service was discontinued. We conducted follow-up visits up to 12 months after treatment. The program was evaluated with a multiple-baseline across participants design. We computed on-treatment and intention-to-treat effects according to the Hedges–Pustejovsky–Shadish model. We monitored behavioral (food acceptance and swallowing) and nutritional outcomes (body weight, oral intake, and tube intake), treatment acceptability and satisfaction, caregiver stress, and estimated treatment cost savings. Results Food acceptance, swallowing, oral intake, and tube intake demonstrated large treatment gains relative to pretreatment levels (effect size range of the intention-to-treat analysis = 0.74–2.1). All participants maintained or increased their body weight. Follow-up effect sizes indicated further improvements. By the final follow-up assessment, six out of the nine children had ceased tube feeding, and one had tube feeds reduced. Caregivers and health professionals provided strong ratings of treatment satisfaction. The cost-savings analysis suggested that a home-based treatment may be a cost-effective alternative to prolonged tube feeding as well as to other treatment approaches. Conclusions This study provides evidence supporting home-based multicomponent behavioral interventions in the treatment of pediatric feeding disorders.
