How Can My Baby Be Tube Weaned?

Our baby has a feeding tube, which was placed as a temporary measure. But it now looks like staying for the long term, because although he is ready to feed orally, he refuses to. Understanding why this happens is the first step in helping your baby move from tube feeding to oral feeding.

Feeding tubes are lifelines for babies who cannot safely feed orally, who are too weak to ingest enough calories, or who are unable to keep down sufficient nutrients to sustain healthy growth. Some babies only need tube support for a short period, while others require it for much longer. Sadly, many babies remain tube fed far longer than medically necessary because avoidable barriers to oral feeding have not been addressed.

Key points

• A timely, structured tube weaning plan is essential when tube feeding is intended to be temporary.
• Many babies remain tube fed longer than needed because behavioural barriers are overlooked, not because they are incapable of oral feeding.
• Common barriers include lack of feeding experience, lack of motivation to eat, difficulty understanding hunger, desensitised hunger cues, feeding or oral aversion, and tube dependency.
• Addressing both medical and behavioural factors provides the best chance of a successful and safe transition to oral feeding.

Why a tube weaning plan is necessary

Feeding tubes are vital for babies who cannot safely or effectively feed orally. They protect growth, support medical recovery and buy time while a baby matures or heals.

Some babies need tube feeding only until they are strong enough or coordinated enough to feed by mouth. Others require tube support for longer because of underlying medical conditions. However, many babies who were expected to feed orally eventually become tube fed for far longer than planned, not because they are unable, but because no effective weaning plan was created.

A tube weaning plan needs to be both timely and comprehensive. The longer a child is tube fed, the more entrenched feeding patterns and behaviours can become, and the more difficult the transition to oral feeding may be.

Barriers to tube weaning

Most tube fed babies are expected to move toward oral feeding once medical and developmental conditions allow. This transition does not always occur smoothly. Some babies continue to rely on tube feeding, even when their doctors consider them ready for oral intake.

Common barriers include:

• Lack of opportunity to develop feeding skills
• Lack of motivation to feed orally
• Lack of understanding of how to respond to hunger
• Desensitised hunger cues
• Feeding or oral aversion
• Tube dependency

Identifying which of these apply to your baby is essential for a realistic and successful weaning plan.

1. Lack of opportunity to develop feeding skills

A tube fed baby may be physically capable of safe oral feeding but lack the experience needed to coordinate sucking, swallowing and breathing. There are sensitive periods during which feeding skills are most easily learned.

33 weeks gestation to 3 to 4 months of age (corrected)
During this time, infant reflexes, such as the sucking reflex, support babies to learn oral feeding. The sucking reflex is triggered by pressure on the roof of the mouth. Over time, reflexive sucking helps babies acquire the skills required to suck voluntarily once the reflex fades, usually around 3 to 4 months of age.

4 to 6 months
This is a sensitive period for learning to eat solid foods. Many babies show interest in watching others eat and in exploring new tastes. Introducing solids during this window can help support acceptance of a range of foods later on.

4 to 10 months
This is an important period for accepting new tastes and textures. After this time, babies and toddlers often become more cautious and may be less willing to try unfamiliar foods. Late introduction of solid textures can contribute to food refusal in later childhood.

Babies who rely heavily on tube feeding during one or more of these sensitive periods may simply have had fewer opportunities to practise oral skills. They can still learn, but progress may be slower and require more support.

2. Lack of motivation to feed orally

Hunger is the main motivator that drives babies to eat. When all nutritional needs are met via the tube, the natural drive to feed orally can fade.

Offering an oral feed before a tube feed does not guarantee that the baby will be hungry enough to try. Appetite is influenced by many factors, including feeding pattern, total volume, and timing of feeds.

Reasons a baby may lack motivation to feed orally include:

• An inappropriate feeding pattern. If feeding times do not align with your baby’s natural rhythms, he may not feel hungry when oral feeds are offered.
• Overfeeding via tube. Providing more calories than your baby needs for growth and energy at his current stage suppresses appetite for longer periods.
• Night feeds continued beyond need. Frequent night feeds reduce appetite during the day and may leave little hunger for daytime oral practice.

Babies’ nutritional needs change constantly as they grow. A tube feeding regime that was appropriate weeks ago may later be too generous, unintentionally reducing appetite and opportunities for oral intake.

3. Lack of understanding of what to do about hunger

Some tube fed babies do feel hunger but do not understand what to do about it. They may have had tube support for so long that they have not learned the link between feeling hungry and feeding orally.

When allowed to experience hunger for the first time, these babies may become irritable, cry or seem distressed. Yet when a bottle, breast or spoon is offered, they may cry harder or turn away. The sensation is uncomfortable and unfamiliar, and they have not yet associated oral feeding with relief and satisfaction.

4. Desensitised hunger cues

Some parents report that even after many hours without food, their tube fed baby does not fuss or seem upset. This can be frightening and confusing. It may appear that the baby is unaware of hunger.

Tube feeding can blunt hunger cues over time. When nutrition arrives regardless of how the baby feels, there is no need to act on hunger. A baby may be fed at specific times whether he is hungry or not, and his cues can be overlooked, especially if the focus is on meeting target volumes.

The difference between a baby who cries with hunger but does not know how to respond, and one who seems oblivious to hunger, may be related to temperament and past experience. The encouraging news is that neurologically normal babies can regain sensitivity to hunger once feeding patterns are adjusted and they are given opportunities to experience and respond to hunger in a supported way.

5. Feeding or oral aversion

A baby can have the skills to feed orally, be given time to feel hungry, and still strongly resist feeding because of a feeding or oral aversion.

Feeding aversion is specific to feeding. The baby is distressed by attempts to feed but may be happy to mouth toys or hands.

Oral aversion is broader. The baby finds anything near the mouth or face distressing, including feeding equipment, toys and other objects.

Signs of aversion can include intense crying at the sight of feeding equipment, turning away, back arching to create distance, refusal to sit in a feeding position, gagging, retching, or vomiting in response to food being placed into the mouth.

Reasons aversion may develop include:

• Repeated pressure to feed against the baby’s will
• Painful feeding related to reflux, allergy or medical conditions
• Unpleasant or bitter tastes, for example some formulas or medications added to milk
• Distressing medical procedures involving the mouth, nose or throat
• Past choking or frightening feeding events

A feeding tube may resolve growth concerns but not the underlying aversive behaviour. If the cause of the aversion is not identified and addressed, the baby may continue to resist oral feeds even when medically ready.

6. Tube dependency

Tube dependency describes a situation where a child actively refuses to eat and drink, or shows no will to transition to oral feeding, even after repeated opportunities and despite being medically cleared to feed by mouth.

Tube dependency is a recognised complication of long term tube feeding. It usually reflects one or more of the behavioural barriers already described, such as lack of skills, low appetite, desensitised hunger cues or feeding aversion.

Once tube dependency is established, the situation can be challenging to reverse. Prevention is always easier than treatment. The sooner a child can safely begin a carefully planned transition to oral feeding, the better.

How Baby Care Advice can help with a tube weaning program at home

Our health professionals have helped thousands of parents of tube fed babies develop effective tube weaning plans. Many of these babies were already under the care of a paediatrician, dietitian, speech pathologist and or occupational therapist. In many cases, the medical team had done excellent work treating the underlying condition, but behavioural factors that prevented oral feeding had not been fully addressed.

It is not possible or appropriate for us to accept every tube weaning case. Much depends on the reason the baby continues to require tube feeding and whether tube feeds are still medically needed. We are very specific about the cases we accept. In general, we consider tube weaning support when:

• Your child is less than 2 years of age.
• Your child has been medically cleared to feed or eat orally.
• Your child has demonstrated that he can feed, drink or eat safely, even if only a little, either recently or in the past.

Written by Rowena Bennett.

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