Medical Professional Publications

Research Now: Overcoming Chronic Food Aversion in Tube-Fed Children

Dr. Hayat Mousa, physician in Gastroenterology, Hepatology & Nutrition at Nationwide Children's and affiliate faculty member of the Center of Clinical and Translational Research, is conducting a research project on children with feeding difficulties.  In collaboration with two other national centers, she designed a randomized-controlled, prospective study using amitriptyline in transitioning children from tube to oral feedings. This National Institutes of Health funded study involves children who consume 50 percent or more of their caloric needs by gastrostomy tube (G-tube) for at least three months. Participants must demonstrate physical and behavioral capacity for proper oral intake.

In this study, Dr. Mousa provides a multidisciplinary approach to children with feeding difficulties, which can comprise a heterogeneous assortment of problems grouped together because of the common result. Feeding problems are often the “tip of the iceberg,” while below the surface lie factors including medical diagnoses, learning, developmental stage, nutritional status and their environment. The multifactorial nature of feeding difficulties necessitates the use of multidisciplinary treatments.

Dr. Mousa’s 24-week protocol involves a weekly clinic visit for the first four weeks, then once every four weeks for the remaining 20 weeks. During these visits, detailed patient information is evaluated: medical history, ECG, vital signs (height, weight), and blood components. Behavior is assessed using questionnaires, video recordings of meal times and family feedback. Phone visits are conducted on weeks without clinic visits to evaluate general health and behavior. To ensure the well-being of participants, they may be removed from the study if they experience pre-calculated unsafe weight loss and/or negative behavioral changes, as reported by the primary caregiver.  

Gastrostomy tube placement is an excellent short-term solution to problems with oral nutrition and usually improves children’s health status and overall development, in addition to the quality of life of the family. However, delaying the transition from tube to oral feeding has negative medical, emotional and economic consequences.  Children who are fed via gastrostomy tube often fail to develop age-appropriate mealtime socializations. As the prevalence of tube feeding has increased, so have the challenges associated with transitioning a child from tube to oral feeding.  Developing effective treatments to facilitate this transition from gastrostomy to oral feeding is a critical step in health care for affected individuals and can promote life-long benefits for the child and family.

Contact: Hayat Mousa, MD

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