Tube weaning in denmark
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TUBE WEANING IN DENMARK. The 3 rd Nordic C onference 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. QUESTIONS TO THE TEAMS. The Team:

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TUBE WEANING IN DENMARK

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Tube weaning in denmark

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 Pedersen

Clinical dietician

SOFUS team

Pediatric Nutrition Unit

Rigshospitalet


Questions to the teams

QUESTIONS TO THE TEAMS

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:


Tube weaning in denmark1

Tube weaning in Denmark

  • View over hospitals in Denmark, which have aninterdisciplinary 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


Regionshospitalet viborg b rneafdelingen

RegionshospitaletViborgBørneafdelingen

“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: OverlægeBirgitte Hertz børneafdRegionshospitaletViborg


Hospitalsenheden vest b rneafdeling c2 herning sygehus

Hospitalsenheden Vest Børneafdeling C2 Herning Sygehus

”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: YrsaLauridtsensppåafd C2


B rne og ungdomspsykiatrisk regionscenter risskov

Børne og Ungdomspsykiatrisk Regionscenter Risskov

Spædbørnsafsnittetafs. 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:


Kolding sygehus b rneafdelingen

Kolding SygehusBørneafdelingen

”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 BechmannZaupper Kolding Sygehus


Odense university hospital

Odense University Hospital

”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


Holb k sygehus b rneafdelingen

Holbæk SygehusBørneafdelingen

”Småbørnsgruppen” team since 2011

Nurses,social-healthcare assistants, play therapist, psychologist, pediatricianand 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: psykologLene Renée Hansen


Bispebjerg hospital 192 ambulatorium for sp d og sm b rn

Bispebjerg Hospital192 Ambulatorium for spæd- ogsmåbørn

192 Ambulatorium for spæd-og småbørn (1992) 2003

Paediatrician, nurse, physiotherapist, oral/motoric team, psychologist

Tube weaning, relations betweenchild/parents, severeeatingdisorders

Psychiatricdiagnosis, emotional and relation dysfunctions

0-3 yearsor older

Individual plan up to 3 months as out-patient in day hospital (5 hours a day 4 days a week)

Tube weaningapp. 3-4 out of 25 children per year

Eating habits, well-being, growth

Kilde: Overlæge Marla Moszkowicz


Bispebjerg hospital b rne og ungdomspsykiatrisk center buc bispebjerg

Bispebjerg HospitalBørne og Ungdomspsykiatrisk CenterBUC- Bispebjerg

B102 åbent døgnafsnit for spiseforstyrrelser

Severe eating disorders and psychiatric comorbidity tube weaning as part of comorbidity with an autismdiagnosis

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:


Glostrup hospital b rne og ungdomspsykiatrisk center

Glostrup HospitalBørne og Ungdomspsykiatrisk Center

Spæd- ogsmåbørnspsykiatriskafs 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, treatmentmodules of 4 weekshereafter (often 12-16 weeks)

Follow–up 3 months

Aproximately 20 children a year with eatingdisordersaresuccesfullytreated. Further16 childrenare tube weaned, and about 13 childrenarenot tube weanedprimarilybecause of complexsomaticdiseases.

OM: Growth, comfortableatmosphereduringmeal times, the childthriving

Kilde: Overlæge Anne Lise Olsen, klinisk Sygepleje Specialist Dorthe Holst


Herlev hospital b rneafdelingen

Herlev HospitalBørneafdelingen

  • Socialpædiatriskafsnit 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

  • Oftenday hospital from monday – friday, but individuel

  • ? All childrentreatedtogether with Mini Q eating , exeptone

  • OM: weight, eating habits, thriving in dailylifewith parents, institution and school

    Kilde: overlæge Bodil Moltesen


Rigshospitalet sofus ambulatoriet

Rigshospitalet SOFUS Ambulatoriet

”SOFUS” SikkerOvergangtilFamilielivUdenSonde/ SværeSpiseproblemer 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


Others

Others

SkejbySygehus: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

HammelNeurocenter: tube weaning as part of rehabilitation of children with traumas and neurological damage

ÅlborgSygehus, VensysselogHillerød Hospital: no systematic treatment by interdisciplinary team at the moment. Tube weaning is done ad hoc


Tube weaning offered by private persons

Tube weaningoffered by private persons

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


C onclusion

Conclusion

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


Tube weaning in denmark

Thank you!


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