Outcomes of a Medical Multidisciplinary Outpatient Intensive Feeding Therapy Program Compared to Traditional Weekly Feeding Therapy

SIGNIFICANCE: Literature shows that feeding disturbances are multifactorial in etiology (anatomic, medical, oral motor, sensory, behavioral, and social/environmental) and affect 25% to 35% of typically developing children and up to 80% of children with prematurity, developmental delays, or a chronic medical conditions. These feeding disturbances pose adverse effects on a child’s physical growth, cognitive development, and psychological well-being, and they also create psychosocial stress within a family and are a significant cost burden on the health care system (>$40,000 annually). Patients with gastrostomy tubes (GTs) require more than double the resources and treatment time than their non-GT peers.

INNOVATION: In this study, we compared outcomes from our 5-wk multidisciplinary intensive feeding therapy (IFT) program to determine reduction of enteral tube nutrition (ETN) dependence and increase of age-appropriate feeding in medically complex children with dysphagia compared with age-matched children undergoing traditional once-weekly feeding therapy (TT).

APPROACH: We attempted to answer the following research question: Does a medically based, multidisciplinary intensive feeding program support faster and more effective weaning from tube feeding dependence than TT? Data will be used to lobby insurance companies and to advocate for coverage of IFT for the increasing demand.

METHOD: We used a retrospective cohort design with institutional( IRB) approval. Statistical analysis was performed with the Mann–Whitney U test to compare the mean ranks of the two groups. IFT was composed of 25 daily sessions of feeding therapy lasting 5 wk. The control TT group was selected from patients who had at least 25 weekly sessions at our large metropolitan children’s hospital. Participants included 23 IFT and 22 TT patients who were comparable in age, associated comorbidities, nutritional status, and duration of ETN at the time of start of therapy.

Full medical chart review, demographics, and nutritional parameters at baseline were recorded, and measured variables were reviewed (enteral tube energy intake as a percentage of daily energy goal, percentage ideal body weight, volume of oral intake, number and variety of oral foods).

RESULTS: Duration of 25 sessions of TT spanned over 40 to 60 wk as compared to 5 wk for IFT. Reduction of ETN (measured as percentage of daily calorie goal) was three times greater for IFT than TT patients (p < .0003). Half of IFT patients no longer required ETN by the end of the 5 wk compared with no TT patients. Elimination of ETN is projected at 4 mo in IFT versus 3 yr in TT patients, resulting in significant reductions of ENT-associated comorbidities and health care costs. IFT patients increased both the number and variety of foods, with the average addition of 13 new foods and 5 varieties over the 5-wk course of therapy, and they reported decreased stress with mealtime. The only IFT patient without ETN reduction also had active oral aspiration, which appears to be a comorbidity associated with a negative outcome.

CONCLUSION: The IFT program resulted in significant reduction in ETN in children with complex medical conditions over a 5-wk period compared with children in TT. Treatment of dysphagia and feeding disturbances in ETN-dependent young children by a multidisciplinary team has superior outcomes to the traditional model of feeding therapy alone.