Abstract:
Children who do not consume enough nutrition orally may require the use of feeding tubes. Tube dependency, which refers to prolonged tube-feeding that exceeds medical necessity, is associated with multiple serious risks. The complex maintaining factors of tube dependency require the involvement of a multidisciplinary team. Behavioural treatment, as part of the multidisciplinary approach, has shown its effectiveness in numerous studies. However, most studies were conducted in controlled clinic settings with well-trained behavioural therapists, outside New Zealand. There is a lack of reports on the transition to home settings with caregivers continuing the meals.
The present study aimed to assess generalization, provide parent support and facilitate further skill advancement following intensive behavioural treatment for two children with tube dependency. While one child progressed through the intensive intervention to the follow-up period, the intensive intervention for the other child was delayed due to COVID-19. An individualized treatment package was applied to each participant in the caregiver-led meals. Ongoing caregiver trainings were provided and caregiver treatment integrity and adherence were measured. Behavioural measures as well as nutritional and growth outcomes for both children were collected. The study highlights that while consequence-based behavioural interventions are necessary, certain mealtime environments may be crucial as well. While both children showed improvements in food consumption, tube feeding was ceased for one child. Potential mechanisms underlying the treatment effects, limitations and future directions are discussed.
