6 Steps to Wean Your Child Off Tube Feeding
When the time is right, it is possible to stop enteral nutrition. Here’s your plan.-
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Starting your child on a feeding tube can be overwhelming and scary. Just as unsettling: stopping and returning to oral feedings.
Unless the child has a medical condition that requires the continuous use of a feeding tube, says Aubrey Phelps, MS, LDN, INFCP, registered pediatric nutritionist at Growing Independent Eaters, the treatment is meant to be temporary.
"Everybody's goal should be to get the child back to what his or her body should be capable of," she says.
Before considering the removal of a feeding tube, your medical team (especially your pediatric gastroenterologist) will first want to ensure your child is medically stable—growing well, healthy, and not experiencing any major complications, says Mel Heyman, M.D., professor of pediatrics, specialist in pediatric gastroenterology, hepatology, and nutrition at the University of California in San Francisco.
Your child also needs to be able to safely swallow. To assess that, your pediatrician will take X-ray images of your child eating to evaluate how the mouth and throat coordinate to swallow without foods or fluids getting into the lungs, says Dr. Heyman, who's also a member of the Nutrition4Kids Medical Advisory Board.
Once those two boxes are checked, it may be the right time to wean your child off of tube feeding. How long that process takes varies for each child, though Phelps says three months is average.
But success isn't only dependent on your medical team—parents play a large role too. Here are the six steps experts say parents should take to help successfully wean your child off tube feeding.
Step #1: Hire a Feeding Consultant
It's standard for hospitals to offer services from an inpatient feeding team, Phelps says. These specialists will work with your child for about a week, an intense time of provoking hunger and encouraging the consumption of high-calorie foods like, say, milkshakes.
While this protocol may be typical—and can be successful for some children—Phelps warns she often sees a high regression rate. "Children leave the hospital eating, but because they don't trust the process and haven't established a happy, normal eating experience, they often backslide once they get home."
As an alternative, Phelps suggests hiring a feeding consultant to develop a longer-term custom weaning plan. This expert will work with your child's medical team (usually your pediatric gastroenterologist and nutritionist), conduct video assessments, and identify obstacles that could impact the transition to solid foods.
From there, the feeding consultant will work with the rest of the team to create a tailored step-by-step plan that cuts calories at a pace suitable for your child, gradually opening up their appetite and establishing healthy eating habits.
"It takes about a week for appetite to fully bloom at each step of the weaning process," Phelps explains. "So we like to see what's happening week to week, to make sure we don't need to tweak anything, to confirm things are progressing the way they should be, and to ensure no bad habits are forming."
Step #2: Serve Small Meals or Snacks Every Few Hours
A part of normalizing your child's eating habits is helping them connect the dots between satisfying hunger cues with the actual act of eating, Dr. Heyman says.
One way to do that is to set a phone reminder for every two to three hours, and each time offer your child small, single portions of food, suggests the medical experts at Regions Hospital in Saint Paul, Minnesota.
A full bowl of soup, puree, or baby food may look overwhelming. A single-serve yogurt or oatmeal cup may feel more manageable—and the child can gradually chip away until it's gone.
One caveat: Don't force your child to eat. It's easy to fall into the habit of saying "eat one more bite" or "just give it a try." But Phelps says that inherently puts pressure on the child and can cause a refusal to eat.
The golden rule: Don't say anything to your child at the table that you wouldn't say to a dinner guest. That way, meals and snacks are about sharing time together, Phelps says. Commentary about the food is OK—"that's really crunchy" or "I love the pink color of that salmon"—but praise for swallowing or taking another bite is off limits.
Step #3: Start with Soft Foods That Are Easy to Swallow
Another adjustment from tube feeding: texture. Extra chewy or crunchy foods may be tough for a child to consume in the beginning, and the last thing you want to do is stir up any negative feelings during the weaning process.
The dietitians at Regions Hospital suggest opting for soft, moist foods when you can: Greek yogurt, applesauce, cottage cheese with diced fruit, mashed potatoes with gravy, or even kid-favorite macaroni and cheese.
Step #4: Choose High-Protein Foods
While high-calorie foods can help with weight gain, Phelps says you still want to establish healthy eating habits. Plus, snacks and meals that are high in both calories and protein mean your child could have an easier time hitting their daily calorie needs without having to eat as frequently.
Try adding cheese to scrambled eggs, blending avocado or nut butter into a smoothie, or pouring a cup of whole milk instead of 2%.
If your family's diet is plant-based, try soy or pea-protein milk, which have the same protein as cow's milk; or oat milk, which has nearly as many calories as whole fat cow's milk, though slightly less protein.
Step #5: Look for Signs of Success
While it's easy to associate success strictly with how much your child is (or isn't) eating, Phelps says that isn't the only marker to pay attention to.
"Some parents get really stressed out when volume hasn't increased, but it depends on where your child started," she explains.
Some children, for example, don't even want to come to the table, and being anywhere near food feels upsetting, Dr. Heyman says. For those kids, seeing them ask for a snack or run to the table when dinnertime is announced is a major win.
Look for any sign that suggests the relationship with food is being built the way you want. As your child learns to trust the eating process, the volume will come.
Your medical team will also keep a close eye on the child's weight, Dr. Heyman says. Some children may have struggled to gain previously; seeing them gradually add weight can be another big indicator that things are going well.
Step #6: Expect a Bit of a Rollercoaster
Weaning your child off a feeding tube is not a linear process. "Sometimes we have to step back, adding more calories back into the tube-feed to support them while they adjust to oral feedings," Phelps says.
But just because you step back doesn't mean your child has regressed. "The skills they learn in one step—like bringing food to the mouth or moving it around—don't go away," Phelps says. "That progression is still there."
In fact, when your child is ready to try that next step again, there's a good chance the process will move faster.
It's also important to remember that children are, well, children. They can be finicky eaters regardless of whether or not they've had a feeding tube, and sometimes there's no rhyme or reason behind how they eat one day versus the next.
Still, that unpredictability can be frustrating and stressful for a parent. That's why Phelps also suggests working with a mental health expert, ideally a psychologist or psychiatrist familiar with feeding issues.
"Parental anxiety can actually disrupt the child from successfully weaning," she explains. It's another form of feeling pressured that can result in a refusal to eat.
Talking to a mental health expert can help you work through your anxieties, and they can provide suggestions on how to successfully navigate those emotions in a way that helps, rather than hinders, your child's progress.
This story has been medically reviewed by Stan Cohen, M.D., a pediatric gastroenterologist at the Children's Center for Digestive Health Care in Atlanta and the director of Nutrtion4Kids Medical Advisory Board.
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