P2.056: Interdisciplinary Virtual Therapy Program to Promote Oral Feeding in Children with Feeding Tubes and Tracheostomies

Background: Pediatric Feeding Disorders (PFDs) and long-term feeding tube use (FTs) are highly prevalent in children with tracheostomies as a result of prematurity, delayed feeding experiences and past medical trauma. Despite families prioritizing eating by mouth, due to respiratory vulnerabilities including risk of aspiration pneumonia, families and providers are often hesitant to advance oral feeding without expert guidance. Children with FTs and tracheostomies often do not receive needed therapies in the community through early intervention. Travel to tertiary care centers for therapies can be challenging for families of children with medical technologies, and therefore an approach which incorporates virtual therapies is the most feasible habilitative therapy model. To our knowledge, there are no studies which examine feeding interventions specifically for children with tracheostomies.

Methods: Children with FTs and tracheostomies 0-3 years of age were recruited through a state-wide agency and subspecialty clinics to participate in a randomized controlled trial of an interdisciplinary virtual therapy model. The coordinated, expert intervention team included a speech therapist, an occupational therapist, registered dietitian, and a developmental and behavioral pediatrician. All existing community therapies were continued. Intervention group participants received biweekly telehealth support using a parent coaching model to promote responsive feeding interactions, engage in meaningful sensory play, promote skill development, and support mealtime participation. The study team actively managed oral and tube feeding recommendations for children in the intervention group. Both intervention and control participants were invited to weekly virtual feeding support groups. Children were assessed in the home at enrollment and virtually every 3 months while in the 1-year intervention using clinical assessment and validated survey tools.

Results: Recruitment and participation are ongoing. Sixteen children enrolled in the study and were randomized to equal groups. Half are male, 50% Non-Hispanic Black and 31% Hispanic. The average (range) age of children at enrollment was 24 (16-35) months. Their median(range) National Area Deprivation Index was 52(10-92). At baseline, 15 (94%) of children were taking >80% of calories by feeding tube and 75% had received prior feeding therapy. Of those who completed 6-month follow-up (n=10), 2 of 6 children in the treatment group transitioned to all calories taken by mouth; 6 of 6 had reduced tube feeding volumes. No children in the control group had weaned from tube feeding and all 4 had increased tube feeding volumes as recommended by their existing care teams.

Conclusion: Our study is early and ongoing and therefore broad conclusions are premature before the full cohort and final outcomes are collected. However, our intervention shows promise of acceptability and retention of children with FTs and tracheostomies in a virtual intervention. Early findings suggest this model may have success over traditional approaches for weaning FTs in a medically complex and hard-to-reach population.