The Graz tube weaning model is a clinical protocol and interdisciplinary therapeutic approach designed to transition infants and children from enteral nutrition (tube feeding) to age-appropriate oral intake. Developed at the Medical University of Graz in Austria, primarily by Marguerite Dunitz-Scheer and Benno Scheer, the model is specifically intended for children who have become "tube dependent." Tube dependency occurs when a child remains reliant on a feeding tube despite being medically stable and physically capable of oral feeding, often due to a lack of appetite or oral aversion.
The model is based on the principle of "hunger provocation," which involves a controlled and medically supervised reduction of the volume of enteral nutrition to stimulate the child’s natural hunger and thirst. This physiological drive is utilized as a primary motivator for the child to begin or increase oral intake. The process is supported by an interdisciplinary team that typically includes pediatricians, psychologists, occupational therapists, and speech-language pathologists.
Key components of the Graz tube weaning model include:
- Interdisciplinary Support: Addressing the medical, nutritional, and psychological aspects of feeding simultaneously.
- Parental Involvement: Training caregivers to manage the child's feeding behaviors and to reduce the anxiety often associated with the weaning process.
- Play-Based Therapy: Using non-pressured environments to encourage the child to explore food and oral sensations.
- Monitoring: Continuous medical supervision to ensure the child remains hydrated and safe during the reduction of tube feeds.
The model is applied in various clinical settings, including intensive inpatient programs and specialized telemedical outpatient programs (sometimes referred to as "Net-Feeding"). In these programs, the transition usually occurs over a period of several weeks.
While the Graz model has reported high success rates in transitioning long-term tube-fed children to oral nutrition, it is also a subject of clinical discussion. Some practitioners emphasize the necessity of the intensive psychological support provided by the model, while others focus on the physiological management of hunger. The model is recognized in pediatric gastroenterology and developmental psychology as an established framework for treating pediatric feeding disorders and tube dependency.