Feeding, eating, and participating in mealtimes are occupations that people engage in on a daily basis as individuals and as families. Pediatric feeding tubes are increasingly becoming part of the mealtime context and daily routines of many caregivers. Families with a child receiving enteral nutrition display increased risk for isolation, leading to escalation of overall stress and decreased quality of life (Russell et al. 2018). Yet, little attention is given for how to return to oral feeding once the tube is no longer medically necessary. While for many children this transition occurs without great difficulty, other children may require the help of a professional team of experts. Research has shown that an interdisciplinary approach for pediatric feeding disorders, including tube weaning, positively impacts outcome, which can contribute to a significant improvement in overall health outcomes over time (Sharp et al., 2017). However, traditional strategies addressing the process of transitioning off enteral feedings to oral intake often focus only on specific information, such as caloric reduction, and fail to keep the broader feeding context in mind. Particular attention must be given to caregiver education regarding early signs of increased appetite and interest in food. Due to the increased likelihood of children on feeding tubes developing severe avoidance and food refusal patterns, both educational and intervention components of treatment should emphasize the child’s autonomy in the feeding situation. Feeding and eating techniques need to be scaled back to empower the child and decrease interventions from caregivers that the child may experience as intrusive. It is a dynamic process that requires careful consideration of all aspects of mealtime, including context and cues, to guide the caregivers and their child to the achievement of stable and sustainable self-regulated oral intake routines. The “Graz Model of Tube Weaning” attempts to bridge this gap, employing an interdisciplinary approach and treating the whole family unit as part of the transition process. The team is comprised of pediatricians, psychologists, and feeding therapists. Components of each discipline are integrated into the two main principles of the “Graz Model of Tube Weaning:” 1. Enable the child to feel hunger, 2. Enable the child’s sense of autonomy and encourage self-directed oral intake (Marinschek et al. 2020). Allowing the child to experience sensations related to appetite is an important step of the process and is always carefully supervised by the pediatrician in combination with the psychologist and feeding therapist.
By the end of this session, attendees will be able to:
- Identify strategies for interprofessional practice within the Graz Model of Tube Weaning
- Apply components of the Graz Model of Tube Weaning to telehealth practice
- Conceptualize barriers and facilitators to implementation of interprofessional practice in tube weaning via telehealth
Marion Russell, OTD, MOTR/L, SCFES
Dr. Russell is an assistant professor in the Occupational Therapy program at Creighton University and director of the Post-Professional Occupational Doctorate Program. She has taught evidence-based practice courses, practice and capstone in the Entry and PostProfessional Doctor of Occupational Therapy Programs, and mentors several student research projects. Prior to her position, she has taught pediatrics and theory courses at her alma mater, the University of Southern Maine, where she earned her Master of Occupational Therapy after finishing a Bachelor of Arts in English Literature and Psychology at Concordia University in Montreal, Canada. She is originally from Berlin, Germany and have experience working in private practice and clinical settings in the United States, Germany, and Austria.
Since 2016, she been a member of a specialized feeding and eating therapy team at the NoTube Interdisciplinary Therapy Center in Graz, Austria. Prior to that, she worked with medically fragile children at a special purpose private school in Scarborough, Maine. She is an American Occupational Therapy Association certified Eating, Feeding and Swallowing Therapist and continue to specialize in enteral tube weaning and telemedical services. In addition, she has successfully presented the telehealth model to health care teams in both the Netherlands and the US. Through these experiences, she has developed a unique expertise in provision of services via the telehealth model to a broad spectrum of populations. She is currently coinvestigator on a project funded by the Dr. George F. Haddix President’s Faculty Research Fund/Creighton University to develop a telehealth teaching module, introducing telehealth service delivery in occupational therapy curriculum.
Financial Disclosures: Contracted employee at NoTube non-profit LLC
Non-financial Disclosures: Nothing to disclose
Dr. Sabine Marinschek, MSc
Sabine Marinschek holds a master’s degree with distinction in psychology from the University of Vienna as well as a Doctor’s degree in medical sciences from the Medical University of Graz. Furthermore, she works as a research assistant at the University Hospital for Psychological and Psychiatric medicine of Graz. She is specialized in early infancy of childhood and has a certification in children, youth and family psychology as well as a certification in online psychological counseling. She has already written and published important research works on this subject as a research assistant at the University Children’s Clinic Graz. Sabine Marinschek is responsible for data analysis and research as well as the psychological coaching during the tube weaning process.
Financial Disclosures: Receives a salary from NoTube non-profit LLC
Non-financial Disclosures: Nothing to disclosure