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Background: Children with congenital malformations, mental retardation, and complex early medical history frequently have feeding problems. Although tube feeding is effective in providing the necessary energy and nutrients, it decreases the child’s motivation to eat and may lead to oral aversion. In this study, we sought to confirm our previous results, showing that a multidisciplinary clinical hunger provocation program may lead to quick resumption of oral feeding. Methods: In a crossover study, 22 children of 9 to 24 months of age who were fully dependent on tube feeding were randomly assigned to one of two groups: group A, intervention group (2-week multidisciplinary clinical hunger provocation program); and group B, control group (4-week outpatient treatment by the same multidisciplinary team). Patients failing one treatment were reassigned to the other treatment group. Primary outcome measures were at least 75% orally fed at the conclusion of the intervention and fully orally fed and gaining weight 6 months after the intervention. Results: In group A, 9/11 patients were successfully weaned from tube feeding (2 failures: 1 developed ulcerative colitis, 1 drop-out). In group B, only 1 patient was weaned successfully; 10/11 were reassigned to the clinical hunger provocation program, all being weaned successfully. Six months after the intervention, 1 patient had to resume tube feeding. In total, in the control group, 1/11 (9%) was weaned successfully as compared with 18/21 (86%) in the hunger provocation group (P < 0.001). Conclusions: Multidisciplinary clinical hunger provocation is an effective short-term intervention for weaning young children from tube feeding.

OBJECTIVES: Pathological food refusal (PFR) is not rare in young children with chronic conditions requiring prolonged tube feeding. We investigated whether these children could be weaned from tube feeding with a multidisciplinary hunger provocation program. PATIENTS AND METHODS: The study included children younger than 2 years with PFR who had been dependent on tube feeding for at least 3 months. They followed a multidisciplinary in-hospital program. During step 1, only 50% of the normal allowance was given by tube. During step 2, oral feeding was offered and completed up to 50% with tube feeding afterwards. During step 3, supplementary tube feeding was given at night. During step 4, only insensible loss (400 mL/m2), was replaced. When the child had started eating, parents took over feeding (step 5). Primary endpoints were eating without tube feeding while gaining weight at 3 and 6 months after discharge. RESULTS: Ten children (age 9-21 months; 7 girls) were exclusively tube fed for 7 to 19 months. Hospital stay lasted 9 to 33 days (mean 17.3 days). All children but 1 remained in clinically stable condition and started to eat within 1 week. Weight loss was 3.7% to 15.6% (mean 9.2%); in 1 child, the program was discontinued because of excessive weight loss. At follow-up after 3 and 6 months, 9 of 10 and 8 of 10 children, respectively, were eating adequately and gaining weight without tube feeding. Two children with recurrent infections resumed partial (25%-50%) tube feeding during follow-up. CONCLUSIONS: The multidisciplinary hunger provocation program seems to be a promising method to promote discontinuation of tube feeding in young children