Rashelle Berry: From Tube to Taste

We had a terrific lecture given to our group by Rashelle Berry. She is a pediatric dietitian specializing in feeding disorders, enteral nutrition, and tube weaning. She practices within the Feeding Program at Children’s Healthcare of Atlanta, partnering closely with a wide variety of disciplines to care for children with significant feeding challenges and GI-related nutrition concerns. My notes below may contain errors in transcription and in omission.

Key Points:

Families expectations are often at odds with dealing with tube feeding which makes it more difficult
Parents have strong desire to achieve all oral feedings and often look for advice outside of clinical visits
Hunger alone is not sufficient to transition off tube feedings
Prior to attempts to stop tube feedings, it is important to assess safety and to align feeding patterns to be more physiologic. This includes offering feeds via bolus typically every 3 hours and stopping continuous feedings
Hyperosmolar feedings can contribute to GI symptoms
Changing formula to improve tolerance can result in quick symptom improvement (1-2 days)
Many children with tube feedings are overfed. This can contribute to poor hunger as well as initial weight loss when transitioning off tube feeds
Two main options to advance oral feedings: 1. Offer oral feeds prior to tube feeds and reduce tube feedings based on oral intake 2. Plan to reduce tube feedings by a set amount, typically 10-30% and follow to see if oral intake improves
Expect some weight loss during transition; if mild weight loss, most often continue to follow closely