Weight loss during ambulatory tube weaning: don’t put the feeds back up

Abstract

ObjectiveTo describe the prevalence of weight loss during tube weaning and its impact on wean duration and growth.SettingTertiary feeding clinic, UK.PatientsAll children seen for weaning from long-term enteral feeding between 2008 and 2016.InterventionsOutpatient withdrawal of enteral feeding.DesignCase series of children being weaned from tube feeding, documenting clinical details, periods of weight loss and timing of feed changes, as well as height and weight at baseline and within 1 year after feed cessation.Main outcome measuresAmount and frequency of weight loss, wean duration, change in body mass index (BMI) and height SD z score.ResultsWeaning was attempted in 58 children, median age 2.7 years, and 90% had stopped feeds after median (range) 5.9 (1–40) months. Weight loss was seen in 51 (88%) children and was more common and severe in children with initially higher BMI. Time to feed cessation reduced by median 4.9 months between 2008–2011 and 2012–2016, while having feeds increased prolonged the wean duration, by median 13 months. After feed cessation, mean (95% CI) BMI had dropped by 0.84 (0.5 to 1.2) z scores, but neither change in BMI, nor the amount and frequency of weight loss, related to growth.ConclusionsShort-term weight loss is to be expected during tube weaning and is not associated with compromised growth. It is important to avoid overfeeding enterally fed children and not to increase feeds again in response to weight loss.