Abstract:
We conducted a systematic review of treatment approaches to transition children from tube to oral feeding. We evaluated the evidence across varied experimental designs including randomized and non-randomized group designs, and single-subject experimental designs. We aimed to identify the key characteristics of participants and treatments, as well as compare treatment outcomes across different approaches. We included 46 studies: 20 group designs, and 26 single-subject experimental designs. Treatment approaches were categorized as behavioural, hunger provocation, or a combination of the two. Across all approaches, treatment commonly required a controlled setting with a high intensity of treatment sessions, a multidisciplinary team, and a systematic approach to caregiver training. All treatment approaches showed positive effects in at least one behavioural or nutritional outcome. However, the variability in participant characteristics and reported outcomes affect conclusions regarding the most effective and acceptable treatment approach. Behavioural intervention was the most consistently reported and measured approach. These studies showed large improvements in feeding behaviours, but the reporting of nutritional outcomes was limited. In contrast, hunger provocation approaches reported wide variations in the rate of tube feeding reductions and the use of mealtime treatment components. Hunger provocation approaches focussed on the reduction in tube feeding but also reported weight losses. Future research should work towards clearer reporting of participant characteristics and treatment procedures, standardized behavioural and nutritional outcomes, and the evaluation of treatment acceptability.
