Tube Dependence

Abstract

This article focuses on the issue of tube dependence (TD) in infancy and early childhood. The condition occurs in patients after temporary tube feeding and must be considered as an unintended side effect of modern treatment practices affecting young patients reactively. Whereas some recent literature has described small samples of enterally fed children being exposed to certain weaning programs, the particular phenomenon of unintentional dependence has not been discussed. A tube-dependent child remains tube fed although his/her medical condition and developmental potential would allow the transition to oral nutrition. Children with TD show characteristic symptoms such as food refusal and opposition to any oral feeding attempts. They often suffer from additional episodes of vomiting, nausea, gagging, and retching and in some cases develop severe failure to thrive. Parents of affected children get involved as codependents engaged in constant preparations of the next tube feeds. In this situation, families can become obsessed about wanting their child to learn to eat by himself/herself, ending up in intrusive feeding patterns. Professionals tend to make parents responsible for the behavioral aspects of the condition, but the diagnostic shift of TD into a behavioral category will not help solve the problem. The development of TD can be prevented if typical symptoms are recognized early and effective tube weaning is implemented. Because therapeutic programs exist, the fate of remaining tube dependence should be prevented. This article presents a first overview of a large sample of tube-dependent infants who had been referred specifically for the exclusive sake of tube weaning.