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Right now you feel that you and your child are ready to begin tube weaning and that NoTube may be the best source of help and support to enable this. So what can you do now to help get the evaluation process started smoothly? Here’s a brief description to get your child started on the path to happy, healthy eating.
1. If your child has a complex medical history it is especially important that you send us all documents which are necessary to assess your child’s medical history. These include letters from different doctors and, if applicable, a swallowing study. Ideally you should send us a doctor’s letter from the period after the birth and about any significant medical interventions; as well as the most current diagnostics. Please send us scanned copies of these and any diagnostics which you have at home for the pre-assessment.
Furthermore we need a short video that shows your child trying to eat or playing, in order to evaluate the child’s developmental stage.
The video will be evaluated by our pediatricians in order to determine your child’s suitability for taking part in one of our programs.
2. If your child has largely been healthy so far and “only” has an eating problem, the medical check-ups prescribed by law and a video are sufficient.
3. We ask that a medical questionnaire is completed for all children as part of the pre-assessment. This questionnaire includes all the necessary questions for participation in NoTube’s programs.
If you choose to receive a free evaluation, our colleagues at NoTube are happy to discuss the history of your child and the possibilities at NoTube with you during an initial interview.
Further topics for the free evaluation would be: What do you think of a participation in the Netcoaching program? Have you had the chance to become familiar with our method? Do you know how we facilitate the transition of your child to oral eating? Do you have any concerns?
Two diagnostic tests are often mentioned in the pre-assessment and are also discussed in our e-book “7 critical concerns when considering tube weaning”. These are tests used when a child has dysphagia to rule out aspiration; which is where there is concern that food, drinks or medicine could end up entering the child’s lungs and causing pneumonia. It is more common in children who are premature or born with a defect. In order to rule this out a video laryngoscopy or swallow study is commonly carried out.
Video laryngoscopy consists of inserting a camera tube with optics into the larynx and watching the child swallow colored liquid. We have lots of experience with this test from our ENT specialists and are skeptical about it’s effectiveness. As you can imagine it can be traumatic for the child and they usually cry, they are also commonly given local anesthetic which also reduces the accuracy of the results. While it looks elegant on paper, it has poor diagnostic ability.especially in young children and with inexperienced clinicians.
The swallowing study (MDP) uses contrast agents (liquids which show up on x-ray, usually containing barium or gastromiro) and the child is forced to swallow a pulpy liquid while being fixed and rotated in a bulky x-ray machine so that a series of pictures can be taken. The children are often uneasy, the parents are anxious and cannot reach the child due to radiation rules. Results can be contradictory and vary depending on the consistency of the food given and the child’s level of distress.
Therefore, none of these two diagnostic tests are mandatory at NoTube.
We would rather ask you specifically what your child is able to do, observe in the video how your child eats and drinks; and read the diagnostics you have.
As a result, we recommend the following procedure: Please register for a free evaluation (a free 20-minute evaluation call with an experienced NoTube colleague) and afterwards for a pre-assessment. We will get to know you and your child much better in this process, which we take very seriously. If we have doubts concerning the child’s ability to learn to eat, we will discuss them with you and your doctors.
This way, there’s enough time to make up for possibly necessary examinations.
Thanks to Birgit Geher and Sabine Marinschek for their assistance with this article.