Getting The Timing Right: When to Wean a Tube in Complex Patients

April 21, 2022 1:00 pm

This presentation will describe the intradisciplinary collaboration in creating the successful decision making pathway to identify patients appropriate for tube weaning. We will discuss the multiple factors the pathway highlights to identify the patients who are appropriate for a tube wean attempt. The factors include the potential for oral skill development, growth. It also takes into consideration variables such as medical procedures and the time of year. We manage a medically complex patient cohort within the Complex Care Hub at the Royal Children’s Hospital in Melbourne. In our patient group, it is not unusual for babies and children to have long-term placement (e.g. > 6 months) of naso-gastric tubes (NGT). We treat dysphagia, aversion, paediatric feeding disorders to achieve independence with eating and drinking. Our role with our patients is to promote optimal growth and development, including oral skills. Our presentation will outline the decision making pathway in its entirety; including its application.

Learning Objective
Participants will be able to:

  • Demonstrate the decision-making pathway for optimal success in outpatient-based paediatric tube weaning complex medical patients.


  • Sarah James, Speech Pathologist

    Sarah is a Speech Pathologist who graduated from La Trobe University in Melbourne in 2003 and has since gained broad experience in dysphagia and feeding while working in London and Melbourne and now specialises in paediatrics.  Sarah has been the Complex Care Speech Pathologist at the Royal Children’s Hospital for the past 4 years where she has focussed on a medically complex patient cohort with a special interest in paediatric feeding disorders and tube weaning.  Sarah, with her colleague Rachael Martin (Dietitian), developed the ‘Tube Weaning & Complex Feeding Service’ at the Royal Children’s Hospital which has resulted in streamlined consistent therapy with improved feeding outcomes for the complex care hub patient group.

    Financial Disclosures: Sarah James receives a salary from Royal Children’s Hospital.
    Non-Financial Disclosures: None

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  • Rachael Martin, Dietitian

    Rachael Martin is a senior paediatric dietitian currently working at the Royal Children’s Hospital (RCH) in Melbourne and has extensive experience as a clinical dietitian and has worked in paediatrics for over 18 years.  During this time, she has managed workloads in many clinical areas, and currently works within the RCH Complex Care Hub.  This unit was developed over 6 years ago to streamline the care required by the state’s medically complex and fragile children.  Majority of the complex care hub patients require nutrition intervention, which is primarily via a feeding tube as either a supplement to oral intake or for full nutrition support.  Rachael, along with her colleague Sarah James, a speech pathologist, developed a complex feeding service 4 years ago with a focus on actively tube weaning complex patients and supporting therapy to reduce aversions.

    Financial Disclosures: Rachael Martin receives a salary from Royal Children’s Hospital​.
    Non-Financial Disclosures: None

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