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Pediatric Tube Weaning: A Meta-Analysis of Factors Contributing to Success

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Abstract

Approximately 3–10% of children have severe feeding issues, and some require enteral/tube nutrition to grow and thrive. For many children, tube feeding is temporary, making efficacious interventions for tube weaning essential. We conducted a systematic review and meta-analysis of tube weaning treatments. Outcomes included percentage of participants completely weaned from the tube, and mean percentage of kilocalories consumed orally following treatment. Data were extracted from 42 studies, including cohort studies and single-subject research design studies. We evaluated moderators of treatment success, including treatment setting, use of behavioral approaches, use of hunger provocation, and use of a multidisciplinary approach. Results indicated that, after treatment, children received significantly more calories orally, and 67–69% of children were fully weaned. These analyses suggest that current interventions are generally effective; however, variability within treatments exist. Prospective randomized clinical trials are needed to understand effective components of weaning interventions.

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Acknowledgements

We would like to dedicate this manuscript to the late R. Mathew Alderson who was a champion of child health and a passionate educator on the use of scientific tools, such as systematic reviews and meta-analyses, to improve clinical care for all children.

Funding

This work was supported by NIH R01 HD093933 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. This work was also supported by a CTSA grant from NCATS awarded to Frontiers Clinical and Translational Science Institute # KL2TR002367. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NCATS.

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Authors and Affiliations

  1. Department of Psychology, University of Missouri–Kansas City, 5030 Cherry St, Kansas City, MO, USA

    Haley J. Killian

  2. Division of Developmental and Behavioral Health, Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO, USA

    Haley J. Killian

  3. Division of Pediatric Gastroenterology, University of Missouri–Kansas City, 2411 Holmes, Kansas City, MO, 64108, USA

    Dana M. Bakula & Sarah T. Edwards

  4. School of Medicine, University of Missouri–Kansas City, 2411 Holmes, Kansas City, MO, 64108, USA

    Dana M. Bakula & Sarah T. Edwards

  5. Center for Children’s Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO, USA

    Dana M. Bakula, Sarah T. Edwards, Amanda S. Bruce & Ann M. Davis

  6. Juniper Gardens Children’s Project, University of Kansas, 444 Minnesota Ave #300, Kansas City, KS, USA

    Anna Wallisch

  7. Life Span Institute, Dole Human Development Center, University of Kansas, 1000 Sunnyside Ave, Lawrence, KS, USA

    Rebecca Swinburn Romine & Kandace Fleming

  8. Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, USA

    Amanda S. Bruce & Ann M. Davis

  9. Department of Foundations of Education, School of Education, Virginia Commonwealth University, 1015 W. Main Street, PO Box 842020, Richmond, VA, USA

    Chi-Ning Chang

  10. Division of Gastroenterology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA

    Hayat Mousa

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  1. Haley J. Killian
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Contributions

HJK: Conceptualization, Methodology, Data Curation, Writing—Original Draft, Writing—Review & Editing, and Project Administration. DB: Conceptualization, Methodology, Data Curation, Writing—Original Draft, Writing—Review & Editing, and Project Administration. AW: Conceptualization, Methodology, Data Curation, Writing—Original Draft, and Writing—Review & Editing. RSR: Formal Analysis and Writing—Review & Editing. KF: Formal Analysis, Writing—Original Draft, Writing—Review & Editing, and Visualization. STE: Writing—Original Draft and Writing—Review & Editing. ASB: Writing—Original Draft and Writing—Review & Editing. CNC: Writing—Review & Editing and Visualization. HM: Writing—Original Draft and Writing—Review & Editing. AMD: Conceptualization, Methodology, Resources, Data Curation, Writing—Original Draft, Writing—Review & Editing, Project Administration, Supervision, and Funding acquisition.

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Haley J. Killian, Dana M. Bakula, Anna Wallisch, Rebecca Swinburn Romine, Kandace Fleming, Sarah T. Edwards, Amanda S. Bruce, Chi-Ning Chang, Hayat Mousa and Ann M. Davis have not disclosed any competing interests.

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Killian, H.J., Bakula, D.M., Wallisch, A. et al. Pediatric Tube Weaning: A Meta-Analysis of Factors Contributing to Success. J Clin Psychol Med Settings 30, 753–769 (2023). https://doi.org/10.1007/s10880-023-09948-2

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