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A little background...our daughter has been in a residential treatment center here in the US.  This is her third stay (different places each time).  She has been there since Oct 31, and is scheduled to start PHP next Saturday (the 17th) until Dec 31, when she will be released to come home.  During her stay there she has gained about 20 lb, and has about 20 lb to go to be in the middle of her range.

I just got this email from her dietitian.  Does anyone have any experience with tube feedings for nights only?  She is currently taking in 4250-4350 calories a day on her current meal plan.  Here is the email (of course I changed her name to Daughter):  

I just wanted to check in after (Daughter)'s session today. (Daughter) attempted to discuss her goal weight once during session and continued to report resistance to continued treatment/meal plan increases/weight gain. With some encouragement she was agreeable to an additional meal plan increase. She reported quite a bit of distress related to the meal plan, mostly emotional distress but also physical discomfort. I discussed the option of nocturnal tube feedings to alleviate some of the physical discomfort. At first she was completely against this option, reporting the she's not "sick enough" for that, and mentioned concerns that her family would look at her differently. I explained to her the tube is often a sign that a patient is accepting nutrition and accepting treatment and should be viewed as a tool to complete the meal plan/continue toward recovery. I also told her that most often, nutrition through the tube is easier for the body to utilize, which often leads to quicker/easier weight gain. Even a few weeks of using the tube can make a big difference.


By the end of the session she was open to thinking about this option. I told her that she can continue to complete the meal plan orally if she prefers, but wanted to let her know all of the options. If we do use tube feeding, she would still have an oral meal plan, but the portions would be smaller and easier to tolerate. We discussed the likelihood of continued meal plan increases and the possible benefits of incorporating some nocturnal feeds. I let her know that if she chooses to have a tube then she cannot participate in fitness activities due to the medical risk, but that otherwise no changes would be made to her privileges.


I imagine (Daughter) will bring this up sometime this weekend and I didn't it to catch you off guard. Let me know what your thoughts are and if you have any questions. She's planning to try the next meal plan increase this weekend and will let me know next week if she thinks the tube is needed.

My D only had night feedings via tube on one occasion. Most of the time the tube was used to give supplements for meals if she was unable to take it. Firstly I would say it is great that the place your D is in is still seriously looking at increasing weight gain. She is on a relatively high intake and depending on how this is presented she is likely to find it hard to see that she could physically eat more than she is at present. A night feed would help that, and I would have no hesitation in agreeing to this if that means the nutrition is going in. My only hesitation would be the planned timing of discharge, given she still has significant weight gain to go and she will need to be on similar caloric intake for months after discharge, how on earth is that going to be managed at home. 
D diagnosed restrictive AN June 2010 age 13. Mostly recovered 10 years later.  Treatment: multiple hospitalisations and individual and family therapy.
I was completely on board until I got to this:
byebyeED wrote:
If we do use tube feeding, she would still have an oral meal plan, but the portions would be smaller and easier to tolerate. 

I'm wondering ... smaller than what?  Not smaller than they are now, I hope?

If she means that the oral portions would remain the same and the nighttime feed would be instead of an increased oral feed, well that makes sense to me.  But if she wants to reduce the current oral meal plan, well, I'd have a lot of questions and apprehension about that.

Please keep us posted. xx

"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
It may be that your dietitian is talking about the higher calorie but smaller volume night feed that my d does.this feed has twice the calories and goes for nine hours only,so it goes overnight.
However, my d still has a shortfall of calories so she tops up by having two fortisip a day plus whatever food she can manage.she has started making gains on this.
I think it is worth a try.the only thing I don't see here is your ds awareness that she will need to keep her Ng tube in regardless ,even if it is not attached to a feed as constant removal and reinsertion every night would be both impractical and potentially lead to her getting sores or sore throats.
Hope this helps,
My daughter did night time tube feeds because she needed 6000+ calories to gain and as we probably all have found out, hospitals are not great at providing high calorie foods.  They tend to want to do low fat "heathy" meals that are not geared towards weight gain.  She truly could not eat 6000+ calories with the food they served so we did night time tube feeds to get weight on.  At home she has not needed them because I use recipes and high calorie snacks I found here on this forum.  If she did though, I wouldn't hesitate.