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TUBE WEANING IN DENMARK

TUBE WEANING IN DENMARK. The 3 rd Nordic C onference on Feeding Disorder of Infancy and early Childhood The 7 th and 8 th of October 2013 Karen Noes Pedersen Clinical dietician SOFUS team Pediatric Nutrition Unit Rigshospitalet. QUESTIONS TO THE TEAMS. The Team:

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TUBE WEANING IN DENMARK

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  1. TUBE WEANING IN DENMARK The 3rd Nordic Conference on Feeding Disorder of Infancy and early Childhood The 7th and 8th of October 2013 Karen Noes Pedersen Clinical dietician SOFUS team Pediatric Nutrition Unit Rigshospitalet

  2. QUESTIONS TO THE TEAMS The Team: • Name, placement, year of foundation, professionals in team? The Child: • Who can refer the child to the team? • Children´s diagnosis and age? • Tests/examinations required by team before tube weaning? The Treatment: questions focused on tube weaning • Planned as in or outpatient? Time frame and standard plan for tube weaning? Follow- up: • Number of tube weaned children? • Success rate? Outcome measurement (OM)? Other relevant information:

  3. Tube weaning in Denmark • View over hospitals in Denmark, which have aninterdisciplinary set-up treatment for children who need to be tube weaned, treated for eating disorders, selective food habits or reduced growth • The treatment can be planned as in or out patient

  4. RegionshospitaletViborgBørneafdelingen “Spiseteament” 2006 Paediatrician, physiotherapist, occupational therapist, play therapist, psychologist Tube weaning earlier, now preventing tube by early interaction Premature, children with syndromes and very reduced growth 0-5 years mainly Planned as individual outpatient 1-2 weeks (patienthotel) 3 children tube weaned. Success rate 100 % OM: Eating habits, growth, parents comfort during mealtimes Kilde: OverlægeBirgitte Hertz børneafdRegionshospitaletViborg

  5. Hospitalsenheden Vest Børneafdeling C2 Herning Sygehus ”Trivsels/sondeafvænningsteamet” 2008 Paediatrician, occupational therapist, nurse and ad hoc dietician Tube weaning by Graz model and eating disorders Premature and children with somatic diseases (syndromes/heart) 0-4 years Planned 2-3 weeks as inpatient (Tolerate 10% weight loss), individual follow-up 10-12 children have been tube weaned, one still partly tube fed OM: child's wellbeing when eating, parent’s confidence Kilde: YrsaLauridtsensppåafd C2

  6. Børne og Ungdomspsykiatrisk Regionscenter Risskov Spædbørnsafsnittetafs. A project 2004 > permanent 2008 Psychologists, paediatrician, and play therapist Tube weaning, severe eating problems and disorders, selective eating Premature with eating problems and children with psychiatric difficulties and or relation problems including children with eating disorders 0-3 years Individual outpatient treatment, long individual follow up 3 children tube weaned, 10- 12 treated for severe eating disorders OM: All thriving, some still with poor appetite Kilde:

  7. Kolding SygehusBørneafdelingen ”Spiseteamet” 2004/ 05 structure change ongoing Play therapist, psychologist, dietician, physiotherapist, pediatrician, occupational therapist and ad hoc nurse and social worker Somatic diseases, sensory interaction problems,children with extreme selective food habits 0-3 years 1 day observation as in-patient, food registration, assessment of oral motor skills, ad hoc physiotherapist, and psychologist 2 weeks planned as in patient or outpatient, individual plan Follow-up: 6-12 months as outpatient App. 20 children have been tube weaned, app. 100 % success rate OM: Growth, variation in nutrition intake related to the child ´s age Kilde: Louise BechmannZaupper Kolding Sygehus

  8. Odense University Hospital ”Gå glad til mad” 2005 Highly specialized function Pediatrician, occupational therapist, nurse, play therapist, psychologist, social and healthcare assistant and ad hoc dietitian Mainly tube weaning, few eating disorders, extreme selective eating 6 month and up 2/3 have a diagnosis 4 weeks planned as in-patient , follow-up 3-4 months A yearly follow-up day where all families and staff are invited 48-50 children tube weaned, app. 95- 100% success rate OM: child eating by itself, growth Kilde: overlæge Karin Lassen OUH

  9. Holbæk SygehusBørneafdelingen ”Småbørnsgruppen” team since 2011 Nurses,social-healthcare assistants, play therapist, psychologist, pediatricianand hoc dietician and occupational therapist Tube weaning and prevention and treatment of eating disorders Somatic diagnosis, eating disorders, selective eating habits 0- 6 years Individual inpatient plan, individual follow–up 1-2 tube weaned per year, all eating OM: Eating habits Kilde: psykologLene Renée Hansen

  10. Bispebjerg Hospital192 Ambulatorium for spæd- ogsmåbørn 192 Ambulatorium for spæd-og småbørn (1992) 2003 Paediatrician, nurse, physiotherapist, oral/motoric team, psychologist Tube weaning, relations betweenchild/parents, severeeatingdisorders Psychiatricdiagnosis, emotional and relation dysfunctions 0-3 yearsor older Individual plan up to 3 months as out-patient in day hospital (5 hours a day 4 days a week) Tube weaningapp. 3-4 out of 25 children per year Eating habits, well-being, growth Kilde: Overlæge Marla Moszkowicz

  11. Bispebjerg HospitalBørne og Ungdomspsykiatrisk CenterBUC- Bispebjerg B102 åbent døgnafsnit for spiseforstyrrelser Severe eating disorders and psychiatric comorbidity tube weaning as part of comorbidity with an autismdiagnosis 9- 18 years Individual plan as in-patient for a periode of 3 months Out-patient follow up Almost 100 % tube weaned OM: all eating by themselves Kilde:

  12. Glostrup HospitalBørne og Ungdomspsykiatrisk Center Spæd- ogsmåbørnspsykiatriskafs B290 /Mini Q 1997 Highly specialized function Child psychiatrist, consultant pediatrician, psychologists, nurses/ healthcare nurses, play therapists and ad hoc social worker Eating disorders, neuroregulatoric disorders, pervasive developmental disorders, emotional, and relationship disorders (parents/child) 0-3 years 2 weeks of examination, 2 weeks of intervention, treatmentmodules of 4 weekshereafter (often 12-16 weeks) Follow–up 3 months Aproximately 20 children a year with eatingdisordersaresuccesfullytreated. Further16 childrenare tube weaned, and about 13 childrenarenot tube weanedprimarilybecause of complexsomaticdiseases. OM: Growth, comfortableatmosphereduringmeal times, the childthriving Kilde: Overlæge Anne Lise Olsen, klinisk Sygepleje Specialist Dorthe Holst

  13. Herlev HospitalBørneafdelingen • Socialpædiatriskafsnit 2003 • Paediatrician, play therapist, occupational therapist • Children with eating disorders/problems (some referred to Glostrup Mini Q, close contact), few children with tube • Reduced growth, premature, children with eating disorders (mild) • 0- ? Years • Oftenday hospital from monday – friday, but individuel • ? All childrentreatedtogether with Mini Q eating , exeptone • OM: weight, eating habits, thriving in dailylifewith parents, institution and school Kilde: overlæge Bodil Moltesen

  14. Rigshospitalet SOFUS Ambulatoriet ”SOFUS” SikkerOvergangtilFamilielivUdenSonde/ SværeSpiseproblemer ultimo 2011 Highly specialized function Pediatrician, specialist nurse(s), occupational therapist, dietician, psychologist and social worker Mainly tube weaning, few with eating disorders Mostly somatic diagnosis (app.10 % no diagnosis) 0-6 years Inpatient 3-4 weeks, outpatient individual plan Follow-op: weekly > monthly / individual 9 patients tube weaned OM: all eating, thriving and growing Kilde: SOFUS TEAM, Rigshospitalet

  15. Others SkejbySygehus:describing and systemizing treatment of children with eating disorders and children who need to be tube weaned. Organizing a team, to be able to establish a center (highly specialized function) for children with eating disorders HammelNeurocenter: tube weaning as part of rehabilitation of children with traumas and neurological damage ÅlborgSygehus, VensysselogHillerød Hospital: no systematic treatment by interdisciplinary team at the moment. Tube weaning is done ad hoc

  16. Tube weaningoffered by private persons There are at least 3 private firms/ professionals in Denmark, that offer tube weaning.

  17. Conclusion At least 11 Danish hospitals do/ have done tube weaning in children by interdisciplinary teams (3 highly specialized). The teams treat mainly eating disorders, reduced growth, selective eating habits and tube weaning 2-3 Teams focus on mainly tube weaning Referral mainly by pediatricians, general practitioners, health visitors All teams offer interview with the family before treatment Tube weaning treatment: no systemized general methods in treatment. Difference in regard to diagnosis, in/outpatient treatment, timeframe, and pre examination/test of the child Follow-up: no general standards, different outcome measurements used Comments from parents: relieve parents of responsibility, focus on normality, see the family as a hole, do active listening Comments from the teams: coordinating the all treatments, support families with low levels of competence in several ways

  18. Thank you!

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