Author: Emily-Jane Lively
Lively, Emily-Jane, 2023 Optimising paediatric tube weaning practices, Flinders University, College of Nursing and Health Sciences
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Introduction
Infants born with complex medical conditions or children experiencing adverse diagnoses are surviving, partly due to tube feeding providing essential nutrition while they are unable to eat and drink orally (Miller, 2009). Although alleviating one challenge (i.e., lifesaving nutrition), perpetuating tube feeding, may lead to ongoing psychological, physical, and financial costs (Smith, Bryant & Hemsley, 2021; Stewart et al., 2022). Persistent tube feeding may result from the child’s reduced opportunity for time-critical skill development, pain or medical trauma causing anxiety to eat and drink, or trauma impacting parental capacity to support their child’s learning.
Improvements in child development, social inclusion and child and parent wellbeing have been reported once children transition from tube to oral intake (Cipolla, Reeves-Latour, Ramsay & Li, 2022; Lively, McAllister & Doeltgen., 2022). A range of approaches are utilised to (re)habilitate eating and drinking, with no consensus yet on best practices. Published weaning programs report varying strategies and outcome measures, making it challenging for parents and health professionals to understand best practice tube weaning.
Hence, the aims of this research program were threefold: first, to document the philosophies underpinning published tube weaning practices to guide parental decision-making; second, to explore the outcomes of a weaning program to determine whether physiological factors influence or predict weaning time and readiness; and third, to inform and improve clinical practice through understanding the parental tube-weaning experience.
Methods
This thesis comprises three research projects, specifically a (i) scoping literature review, (ii) quantitative retrospective case note analysis of variables thought to influence weaning and (iii) qualitative parent interview with thematic analysis of their tube weaning experiences.
Results
Research Project 1 identified three predominant weaning approaches: behavioural; biomedical and child- and family-centred. Numerous intervention variables were identified, with parent involvement and hunger provocation being key differences between approaches. Comparison of effectiveness across programs was limited due to the variation in outcomes measured, reinforcing the requirement for evidence-based clinical practice and research guidelines in this area.
Research Project 2 audited outcome data to determine if biological factors influence weaning time. Findings revealed which biological factors were predictive of time taken to tube wean and which were not, and therefore should not be used to determine weaning readiness. As the audited program relies on parental engagement, it was postulated that psychosocial variables may mitigate impacting biological variables.
Despite their vital role, limited published information exists on the parents’ experience of tube-weaning, which subsequently informed Research Project 3. Seven overarching themes were identified relating to the barriers, facilitators, decision-making, learning and emotional journey of parents during weaning. This information could contribute to frameworks of healthcare and support.
Conclusion
This research contributes to understanding the philosophies underpinning, and the psychosocial factors which may influence tube-weaning, including the emotional and physical challenges parents may experience. Developing health professionals’ understanding of how parents learn and how learning changes their behaviour will contribute to better understanding effective tube weaning. These findings informed the development of five key principles which may contribute to targeted and timely healthcare pathways for tube-fed children and their families.
Keywords: Paediatric enteral tube weaning, feeding tube dependence, tube feeding, enteral tube feeding, weaning from feeding tubes in children
Subject: Speech Pathology thesis
Thesis type: Doctor of Philosophy
Completed: 2023
School: College of Nursing and Health Sciences
Supervisor: Associate Professor Sebastian Doeltgen