Safety of Appetite Manipulation in Children with Feeding Disorders Admitted to an Inpatient Feeding Program.

Journal Article (Journal Article)

OBJECTIVE: Appetite manipulation can be effective in weaning children off gastrostomy tube feeding dependence but can cause dehydration, hypoglycaemia, and ketone body production, which is anorexigenic. As the safety of this approach has not been described, our aim was to describe adverse events observed when weaning children from G-tube dependence using our appetite manipulation protocol. METHODS: This was a retrospective study of prospectively collected data of patients who completed our inpatient tube-weaning protocol. Daily safety parameters included twice-daily urine specific gravities and urine ketones and fasting capillary blood glucose. Graded clinical interventions to manage adverse events were collected. RESULTS: A total of 143 children with a mean age of 4.8 ± 2.4 years were seen in the inpatient feeding program of which 74 (51.7%) were male. The children were hospitalized 10.1 ± 2.5 days with the vast majority being discharged between days 11 and 14. Overall, 78.2% of patients experienced at least 1 adverse event: urine specific gravity >1.020 was seen in 60.5%, ketonuria in 48.9%, and hypoglycemia (≤60 mg/dL) in 13.4%. Only 2 children had blood glucose levels <40 mg/dL and these were corrected with oral supplementation. Graded clinical interventions to manage adverse events included oral rehydration in 89.9% of children and supplemental tube feeding in 25.2%. CONCLUSIONS: Adverse effects are common when appetite manipulation is used to wean children off G-tube dependence. Anticipating, monitoring, and having a clear intervention plan in a closely monitored setting are necessary to safely use this method.

Full Text

Duke Authors

Cited Authors

  • Pollow, AS; Karls, CA; Witzlib, M; Noel, RJ; Goday, PS; Silverman, AH

Published Date

  • May 2018

Published In

Volume / Issue

  • 66 / 5

Start / End Page

  • e127 - e130

PubMed ID

  • 29210920

Electronic International Standard Serial Number (EISSN)

  • 1536-4801

Digital Object Identifier (DOI)

  • 10.1097/MPG.0000000000001849


  • eng

Conference Location

  • United States