Parent Stress Reduces Over Time When Weaning Child Off Tube Feeding with Hide Okuno, MS

The iKanEat study showed parent stress decreased over time for those who successfully weaned their child off tube feeding. Preliminary data from this study were presented at the 2024 Annual North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Meeting in Hollywood, Florida, from November 7 to 9, 2024. HCPLive spoke with Hide Okuno, MS, a resident student in the PhD program at the University of Kansas, about the study’s findings.

Approximately 1 in 23 children have feeding disorders, causing the child to struggle to eat, chew, and swallow—and can even lead to choking, gagging, coughing, holding food in cheek pockets, spitting food out, and mashing or sucking on food. With this disorder, a child may not receive adequate nutrition, prompting a parent to choose tube feeding. Although live-saving, tube feeding can be taxing to families, hence why many intend to eventually wean from feeding tubes once it is no longer necessary.

Investigators hypothesized that parents’ stress levels and mental health symptoms will reduce once their child completes the treatment for Pediatric Feeding Disorders and weans off tube feeding. To evaluate this, the team examined the change in parent stress and mental health symptoms, such as depression and anxiety, in 29 families (parent: mean age, 36.76 years, 82.8% females; child: mean age 4.46 years, 55.2% female) during the 24-week intervention.

Parent stress was assessed using the Pediatric Inventory for Parents, which included four domains: Communication, Emotional Distress, Medical Care, and Role Function. Changes in anxiety and depression were assessed using the General Anxiety Disorder-7 and Patient Health Questionnaire-9, respectively.

Changes in parent stress and mental health symptoms were examined at 4 time points: week 0 (baseline), week 10 (prior to the wean), week 14 (post-wean), and week 24 (follow-up). The intervention included bi-weekly behavioral health coaching video calls, 4 medical visits, and a reduction of tube feeding over 10 days at week 10 from ≥ 80% to 0% of calories through the tube.

In the study, scores for anxiety and depression had a downward trend, showing reductions from baseline through week 24, but the changes were not statistically significant.

“When we looked at depression and anxiety, those were not significant in terms of the reduction throughout the 24 weeks, but there is a downward trajectory on those, so we were thinking maybe because the participant number was really low when we're looking at it,” Okuno said. “We're still investigating what would that be.”

Weaning off tube feeding significantly reduced stress, with all domains and scales for the Pediatric Inventory for Patients demonstrating statistically significant changes across the 4-time points (P < .003).

Post-hoc analyses revealed all domains on the Difficulties scale on the Pediatric Inventory for Parents reduced significantly from baseline to week 14 (P < .03) and to week 24 (P < .04), but there were no significant decreases from week 10 to week 24, except for emotional distress (P = .01). Analyses also showed that Frequencies scores for the domains of Communication, Medical Care, and total Frequencies significantly reduced from baseline to week 10 (P < .04), excluding Emotional Distress and Role Functioning.

“The major findings that we have, even though it's preliminary and we need to dig in a little bit more about the data, is that there are nuances in parental stress throughout stress level change throughout 24 weeks,” Okuno said. “One of the things that we sort of realized is that it's not like the parental stress changed throughout the week or throughout the 24 weeks. It's mainly the medical care function as well as the emotional distress. Those are two main reductions in stress from week 0 or the baseline to week 24.”

References

1. ^{Okuno, H, Wallisch, A, Harris, T, et al. CHANGES IN PARENT STRESS AND MENTAL HEALTH CONCERNS THROUGHOUT IKANEAT PEDIATRIC TUBE WEANING INTERVENTION. Presented at NASPHGAN 2024 in Hollywood, Florida, from November 7 – November 9, 2024.}
2. ^{What Is Pediatric Feeding Disorder? Nationwide Children’s. https://www.nationwidechildrens.org/conditions/pediatric-feeding-disorder#:~:text=Your%20child%20may%20have%20a,or%20struggling%20with%20certain%20textures. Accessed November 15, 2024.}