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

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.

Keywords: Meta-Analysis; Percent Weaned; Weaning from G and/or J tubes.

Fig. 1

Study flow (PRISMA) diagram. PRISMA represents Preferred Reporting Items for Systematic Reviews and Meta-analysis

Fig. 2

Contour-enhanced funnel plots. a Cohort studies: change in probability weaned outcome (Egger’s regression test: z = −2.27, p = .02). b Cohort studies: change in kilocalories consumed orally outcome (Egger’s regression test: z = −1.21, p = .23). c Single-subject research design studies: change in probability weaned outcome (Egger’s regression test: z = −1.23, p = .21). d Single-subject research design studies: change in kilocalories consumed orally outcome (Egger’s regression test: z = 1.84, p = .07). Note. p > .05 (white area); .01 < p < .05 (dark gray area); p < .01(light gray area) (Color figure online)