Transitioning from Tube Feeding to Oral Eating
Tube feeding ensures that children are getting adequate nutrition to grow big and strong. However, since this form of nutrition isn’t always a long-term solution, the goal for many families is to transition their child from tube feeding to oral eating. This process is known as weaning. Weaning can look different to everyone based on different medical needs. Most children go through this process gradually over months or years, while others require doctor-led schedules or feeding programs. This blog focuses on gradual, child-led weaning where tube-fed children start to taste, try new textures, and practice chewing. Learning more about weaning your child off tube feeding can help create a smooth transition to oral eating. If you feel like your child may be ready to start this process, here are some steps you should take:
CONSULT WITH YOUR DOCTOR, DIETITIAN, OR FEEDING THERAPIST
Make sure you consult with your doctor and dietitian when deciding to start the transition to oral eating. Your doctor can confirm if your child is ready and guide you through the weaning process. It is important to stay in close contact with your doctor through this process to ask any questions and address any concerns.
According to The Oley Foundation, some questions to ask yourself before weaning your child off tube feeding include:
Does your child tolerate bolus tube feedings (where the amount of formula for the total feeding is given over a period of 20 to 30 minutes) without vomiting or other kinds of stress (for example, gagging or retching during or after tube feedings)?
Does your child have gastroesophageal reflux (GER) or some other GI tract problem?
Does your child have frequented respiratory problems?
Has your child been made NPO (nothing by mouth)? Does he drool frequently, or does he consistently swallow saliva?
Does your child show interest in different tastes? Is he/she interested in food or liquid other family members have?
These are common questions that you should address with your doctor, along with any other specific concerns that relate to you and your child. Asking questions and gaining a full understanding of the transition can help ensure a successful transition to oral eating. After you and your doctor agree your child is ready, your doctor, dietitian, and/or feeding therapist will work with you to begin the weaning process. This often involves creating a treatment plan that will be shared and taught to you or the primary caregiver. It’s important to work as a team with your provider and receive adequate training in the various techniques they recommend.
TECHNIQUES FOR WEANING
Techniques for weaning off tube feedings will look different for every child, especially if a child has never eaten orally. Most of the time, this process is started right after a feeding tube is placed and continues over a long period of time. Therefore, patience is key when it comes to this transition to oral eating. Here are some common techniques that can help your child’s weaning off tube feeding process:
GET COMFORTABLE WITH ORAL UTENSILS
Start with objects that don’t relate to food, such as teethers or a toothbrush.
If your child is scared to have anything near their mouth, start by touching an arm and then working up to the face. Continue to encourage your child even with the slow progress they may be making.
TASTE
Remember that oral eating is a foreign process for your child at this stage and you want to make them feel as comfortable as possible when transitioning to oral eating.
Start with some flavored water or translucent fruit juices without pulp, such as apple, cranberry, and grape.
Try different yogurts, pureed foods, or anything that comes off as texture-less.
Ensuring that the first foods they try are completely smooth will help them become familiar with oral eating and create positive habits.
If your child feels full quickly, try to consume protein-rich foods first to ensure your child is receiving the adequate nutrition they need. Use a modular (additive) in order to increase calories with less volume.
TEXTURE
It’s important to introduce many textures throughout the transition to oral eating because children can be sensitive to different food textures.
If you notice your child is not responding well to certain foods by gagging at the sight, smell, or taste, they are likely sensitive to the texture, and you will want to try other food options.
When your child seems to be adapting to new textures, make sure you have continued exposure to these foods, allowing your child to develop a positive relationship and food tolerance.
APPETITE TIMING
Most children with feeding tubes don’t understand appetite. Talk to your doctor and dietitian about changing feeds to match oral eating times. As this continues, you will slowly be able to decrease tube feeding and increase oral intake.
Drink oral nutritional supplements between meals and not with your food to help your child get in the rhythm of oral intake. If your doctor and/or dietitian recommend an oral supplement for your child, reach out to us at Sentido Health to set up monthly deliveries through your qualifying insurance. We carry over 400 nutritional products from many different brands including Nutricia ®, Abbott ®, Nestle ®, and Kate Farms ®. Ask about our sampling program to test one out.
CHEWING
Make sure it is safe for your child to try solid food and consult with your doctor if you feel your child is uncomfortable or unwilling to start the chewing process.
If hard foods are still difficult for your child to chew, swallow, and digest, consider trying more pureed, texture-less foods as an intermediate stage.
Just like walking and talking, you can teach your child to chew too! It might help to demonstrate how to chew food to guide your child through the process.
Eating small, frequent meals (about 5 to 6 per day) may help with food tolerance and help overall with weaning off tube feeding.
If you are having difficulties, ask your healthcare provider about getting started with a feeding therapist. Feeding therapist services are offered in an outpatient facility or an in-home setting via a private pediatric therapy company.
PATIENCE
This process can take a considerable amount of time and it may take repeated attempts to successfully wean your child off tube feeding.
Make sure you are taking the process slow and listening to your child.
Avoid rushing through meals to ensure your child is chewing well and taking their time. This will help create a positive atmosphere for mealtimes for both you and your child.
Pay attention to how your child is adapting and tolerating oral feeds and communicate regularly with your doctor, dietitian and/or feeding therapist.
DOCUMENT THE PROCESS
Write down all the progress you make throughout your child’s transition to oral eating. Keep track of how much formula is given and how many times you can successfully administer oral eating. Keep track of oral food tolerances such as likes/dislikes that your child has and use this as a tool. If your child is having more success with specific tastes or textures, continue to explore other related food options to help continue the weaning off tube feeding process. To download a simple transitioning to oral eating/ weaning tracker click HERE.
Additionally, you should also track your child’s weight. If you notice an impromptu weight loss of 3% of your child’s bodyweight, please contact your doctor.
For example:
If your child weighs 80 pounds, 3% of your body weight would be 2 ½ pounds
If your child weighs 100 pounds, 3% of the body weight would be 3 pounds.
Also, if you notice any drastic changes in your child’s behavior, physical or mental state, do not hesitate to discuss these concerns with your doctor. Having detailed documentation of the process can help your doctor pinpoint the problems.
For more encouragement on the weaning process, click HERE to see the Tube Feeding Awareness Foundation’s successful weaning off tube feeding stories!