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TUBE WEANING IN DENMARK The 3 rd Nordic Conference on Feeding Disorder of Infancy and early Childhood The 7 th and 8 th of October 2013 Karen Noes Pedersen.

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Presentation on theme: "TUBE WEANING IN DENMARK The 3 rd Nordic Conference on Feeding Disorder of Infancy and early Childhood The 7 th and 8 th of October 2013 Karen Noes Pedersen."— Presentation transcript:

1 TUBE WEANING IN DENMARK The 3 rd Nordic Conference 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

2 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: QUESTIONS TO THE TEAMS

3 Tube weaning in Denmark  View over hospitals in Denmark, which have an interdisciplinary 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  “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: Overlæge Birgitte Hertz børneafd Regionshospitalet Viborg Regionshospitalet Viborg Børneafdelingen

5  ”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: Yrsa Lauridtsen sp på afd C2 Hospitalsenheden Vest Børneafdeling C2 Herning Sygehus

6  Spædbørnsafsnittet afs. 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: Børne og Ungdomspsykiatrisk Regionscenter Risskov

7  ”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 Bechmann Zaupper Kolding Sygehus Kolding Sygehus Børneafdelingen

8  ”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 Odense University Hospital

9  ”Småbørnsgruppen” team since 2011  Nurses, social-healthcare assistants, play therapist, psychologist, pediatrician and 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: psykolog Lene Renée Hansen Holbæk Sygehus Børneafdelingen

10  192 Ambulatorium for spæd-og småbørn (1992) 2003  Paediatrician, nurse, physiotherapist, oral/motoric team, psychologist  Tube weaning, relations between child/parents, severe eating disorders  Psychiatric diagnosis, emotional and relation dysfunctions  0-3 years or older  Individual plan up to 3 months as out-patient in day hospital (5 hours a day 4 days a week)  Tube weaning app. 3-4 out of 25 children per year  Eating habits, well-being, growth Kilde: Overlæge Marla Moszkowicz Bispebjerg Hospital 192 Ambulatorium for spæd- og småbørn

11  B102 åbent døgnafsnit for spiseforstyrrelser  Severe eating disorders and psychiatric comorbidity tube weaning as part of comorbidity with an autism diagnosis  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: Bispebjerg Hospital Børne og Ungdomspsykiatrisk Center BUC- Bispebjerg

12  Spæd- og småbørnspsykiatrisk afs 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, treatment modules of 4 weeks hereafter (often 12-16 weeks)  Follow–up 3 months  Aproximately 20 children a year with eating disorders are succesfully treated. Further 16 children are tube weaned, and about 13 children are not tube weaned primarily because of complex somatic diseases.  OM: Growth, comfortable atmosphere during meal times, the child thriving Kilde: Overlæge Anne Lise Olsen, klinisk Sygepleje Specialist Dorthe Holst Glostrup Hospital Børne og Ungdomspsykiatrisk Center

13  Socialpædiatrisk afsnit 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  Often day hospital from monday – friday, but individuel  ? All children treated together with Mini Q eating, exept one  OM: weight, eating habits, thriving in daily life with parents, institution and school Kilde: overlæge Bodil Moltesen Herlev Hospital Børneafdelingen

14  ”SOFUS” Sikker Overgang til Familieliv Uden Sonde/ Svære Spiseproblemer 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 Rigshospitalet SOFUS Ambulatoriet

15  Skejby Sygehus: 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  Hammel Neurocenter: tube weaning as part of rehabilitation of children with traumas and neurological damage  Ålborg Sygehus, Vensyssel og Hillerød Hospital: no systematic treatment by interdisciplinary team at the moment. Tube weaning is done ad hoc Others

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

17  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 Conclusion

18 Thank you!

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