Marina Keating1, Olivia Naylor1, Linda Correia1
1Perth Children’s Hospital, Nedlands, Australia
Feeding a baby or child is a major aspect of parenting. For parents of children with feeding difficulties who require tube feeding, feeding their child is anything but ‘natural’ or easy. The number of children receiving tube feeds at home has increased over the past 20 years, involving a significant shift in care and responsibility from hospital, to home and family. This shift has emotional, physical and psychosocial implications for the caregiver and their family. Tube dependency is a condition with negative impacts on a child’s growth, health and typical development. It is highly stressful & anxiety provoking for the child & their family and is an economic burden to the Australian healthcare system.
Prior to 2014, there was no formalised tube-weaning program or associated clinical guideline at Perth Children’s Hospital (PCH). Funding supported the development of an evidenced-based clinical guideline for tube-weaning and external training for the multi-disciplinary team. An internal audit of 40 PCH patients was used to examine the impact of implementing the guideline on reducing tube dependency between 2014-2017. The audit also compared the number of Emergency Department (ED) presentations, inpatient admissions and length of stay pre and post tube-wean.
The audit indicated that 98% of patients undergoing a tube-feed wean at PCH had a successful wean (i.e. successful transition to full oral feeding). The audit also indicated that post tube-wean there was an 82% reduction in ED visits, a 94% reduction in inpatient admissions and a 98% reduction in inpatient length of stay.
These outcomes translated to reduced cost for PCH and less distress for patients and families. The results of this audit have implications for the management of tube dependency in an acute hospital setting, and will be of interest to clinicians involved in tube weaning or considering implementing a tube weaning service.
Marina Keating (APD) is a Paediatric Dietitian at PCH who has worked as a clinical paediatric senior dietitian and dietitian for 23 years specialising predominantly in feeding difficulties and infant, neonatal, surgical and critical care tertiary nutrition.
Olivia Naylor is a Senior Occupational Therapist and Clinical Coordinator (Early Intervention and KKIND- Keeping Kids in No Distress) at PCH. Her current clinical role includes working with infants & their families as well as in the NICU.
Linda Correia is a Senior Speech Pathologist at PCH working with tertiary complex neonates, infants and young children and their families who are experiencing feeding difficulties.