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 PedersenClinical dietician

SOFUS teamPediatric Nutrition Unit

Rigshospitalet

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

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

“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 ViborgBørneafdelingen

”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

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 appetiteKilde:

Børne og Ungdomspsykiatrisk Regionscenter Risskov

”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 ageKilde: Louise Bechmann Zaupper Kolding Sygehus

Kolding SygehusBørneafdelingen

”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

”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 SygehusBørneafdelingen

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 Hospital192 Ambulatorium for spæd- og småbørn

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 HospitalBørne og Ungdomspsykiatrisk Center

BUC- Bispebjerg

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 HospitalBørne og Ungdomspsykiatrisk Center

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 HospitalBørneafdelingen

”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

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

There are at least 3 private firms/ professionals in Denmark, that offer tube weaning.

Tube weaning offered by private persons

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

Thank you!