Is My Baby Ready To Tube Wean?

For many families, the question isn’t whether they want to tube wean — it’s when it is safe to begin. Tube weaning is not determined by age, nor by how long a baby has been tube fed. It depends on whether a baby has the physiological capacity to tolerate the changes that occur during the weaning process and whether the foundations for oral feeding can be developed safely.

Some babies are ready to proceed directly to tube weaning. Others require a period of preparation first. Both are appropriate pathways, and both can lead to successful outcomes when the baby’s needs are properly assessed.

Why some babies remain tube fed

Many babies remain tube fed long after the original medical reason for tube feeding has resolved. In most cases, this is not because the baby is incapable of eating, but because feeding has not been learned in a way that is comfortable, efficient, or reliable.

Tube feeding bypasses the normal process through which babies learn to eat. When nutrition is delivered directly into the stomach, a baby has limited opportunity to experience hunger, practise oral feeding, or learn that eating relieves hunger. Over time, feeding skills may remain underdeveloped and reliance on the tube can increase, even when the body is physiologically capable of oral intake.

Feeding difficulties may also be reinforced by early discomfort, repeated failed feeding attempts, or pressure to eat. These experiences can lead a baby to avoid feeding, independent of the original medical condition, and often need to be addressed before tube weaning can safely begin.

Why babies do not “grow out of” tube feeding

Tube feeding meets a baby’s nutritional needs, but it does not teach the skills required for oral feeding.

Eating is a learned process. It relies on the development of coordinated sucking, swallowing and breathing, oral strength and endurance, hunger awareness, and repeated positive feeding experiences. Clinical feeding research and long-standing clinical practice consistently show that babies who have not had opportunities to feed orally do not reliably develop these skills with time alone.

Many tube-fed babies have never learned how to eat because early medical instability, prolonged tube dependence, or stressful feeding experiences limited their opportunity to practise. This is not a matter of willingness or capability, but of learning history.

Increasing hunger without addressing feeding skills or experiences does not reliably result in progress. In practice, hunger alone is more likely to increase distress and resistance, and in some cases contributes to the development of feeding aversion rather than improved intake.

Progress toward oral feeding is most commonly seen when feeding skills are actively supported and pressure is removed, allowing babies to learn to eat gradually and safely.

What does readiness mean?

Being ready for tube weaning does not mean that a baby is already feeding well orally. Many babies who are successfully tube weaned begin with little or no oral intake.

Readiness refers to whether a baby can safely learn to feed while tolerating the inevitable fluctuations in intake that occur as tube feeds are reduced.

In general, tube weaning may be appropriate when a baby:

• Has demonstrated some ability to orally feed or has been medically cleared to swallow safely

• Can coordinate sucking, swallowing and breathing, even if these skills are immature

• Has no unresolved anatomical or physical barriers to oral feeding

• Is medically stable

• Is at a safe weight to tolerate the physiological demands of weaning

Each of these factors matters far more than age, volume consumed, or how long the tube has been in place.

Why weight matters in tube weaning

Weight is not about meeting an arbitrary number. It is about physiological safety.

During tube weaning, tube feeds are gradually reduced. As intake decreases, hunger increases — and hunger is what drives a baby to learn new feeding skills. This is an essential part of the process.

However, hunger also places stress on the body.

If a baby does not have adequate nutritional reserves, their body may respond to reduced intake by conserving energy rather than investing it in learning. This can affect:

• Muscle strength and endurance needed for sucking and swallowing

• Coordination of breathing during feeds

• Temperature regulation

• Blood glucose stability

• Overall resilience to stress

In an underweight baby, even small reductions in intake can lead to fatigue, reduced alertness, and poorer feeding performance — the opposite of what we want during tube weaning.

For this reason, babies need to be at a safe and stable weight before tube feeds are reduced. In our program, we typically look for a BMI of 15 or above, although this is never assessed in isolation. Growth patterns, medical history, and individual circumstances are always taken into account.

If a baby is significantly underweight, tube weaning may still be possible — but timing matters. In these cases, a period of preparation is usually required before tube feeds are reduced. Preparation tube weaning focuses on adjusting feeding management to support safe weight gain, minimise overfeeding and vomiting, and address bottle-feeding behaviours that interfere with intake. This period allows the baby time to build energy reserves in a controlled, low-stress way so that, when tube weaning begins, their body is better able to tolerate reduced intake and respond to hunger appropriately.

What if my baby has never orally fed?

This does not automatically mean your baby cannot be tube weaned. Oral feeding is a learned skill. Many tube-fed babies have never had the opportunity to develop it due to early medical challenges, not because they are incapable.

While the sucking reflex fades in the early months, babies can still be taught to bottle-feed after this reflex has disappeared. Feeding at this stage relies on learning and coordination rather than reflexive sucking. With appropriate support, babies can develop the skills required to suck, swallow, and breathe effectively, even if oral feeding was delayed or absent in infancy.

Provided there are no physical barriers to feeding and your baby has been medically cleared to swallow safely, oral feeding skills can be introduced later.

In these situations, a preparation tube-weaning phase is usually recommended. This phase focuses on:

• Building comfort and familiarity with oral feeding

• Reducing fear if a feeding aversion is present (see feeding aversion)

• Developing early sucking and swallowing skills

• Creating positive, pressure-free feeding experiences

Once these foundations are in place, tube weaning can proceed more safely and with a higher chance of success.

What if my baby has medical or developmental issues?

Medical complexity does not automatically exclude a baby from tube weaning. Some conditions simply require a more cautious approach, additional preparation, or closer monitoring with your baby's medical team. What matters most is that issues affecting swallowing, breathing, or digestion have been appropriately assessed and managed before tube feeds are reduced.

When medical causes for feeding difficulty have been addressed, the remaining challenges are often developmental or behavioural, both of which can be supported through the tube-weaning process.

Hunger and motivation are learned

Hunger is not just a physical sensation. It is a signal that must be experienced, recognised, and linked with the act of feeding. For babies who have been tube fed for a prolonged period, this learning process may be delayed or disrupted.

When feeds are delivered via a tube, hunger is often prevented rather than experienced. As a result, some babies do not learn to associate hunger with eating, or to tolerate the sensation long enough to respond to it with feeding. Others may experience hunger as distressing rather than motivating, particularly if early oral feeding attempts were uncomfortable or stressful.

Preparation tube weaning focuses on safely reintroducing hunger in a controlled way, while supporting feeding skills and emotional regulation. This allows hunger to become a useful signal for learning, rather than a source of exhaustion or distress.

When is a preparation tube weaning consultation recommended?

Preparation is typically advised when a baby:

• Has not orally fed for a month or more
• Has a complex medical history
• Is significantly underweight
• Shows strong feeding aversion or distress
• Scores lower on tube-weaning readiness measures

Preparation is not a delay. It is a protective phase that allows your baby’s body and nervous system to be supported before tube weaning begins. During preparation, feeds are adjusted to reduce overfeeding, vomiting, and fatigue, while oral feeding skills and feeding tolerance are gently built. This period gives babies time to develop stamina, regulate hunger more comfortably, and experience feeding without pressure or distress.

So, is my baby ready?

Readiness is not about perfection. It is about whether the conditions are right for your baby to tolerate hunger, learn new skills, and remain physiologically stable throughout the process. And if those conditions are not yet in place, the next step is not to wait — it is to prepare.

With the right assessment and support, most babies can move toward tube weaning safely and successfully. Below is a general checklist to determine if your baby is ready.

Tube weaning readiness checklist

This checklist helps clarify whether your baby may be ready to begin tube weaning now, or whether preparation is needed first.

Medical and Physical Safety

☐ My baby has been medically cleared to swallow safely
☐ There are no untreated anatomical or physical barriers to oral feeding
☐ Any conditions affecting breathing, swallowing, or digestion have been assessed
☐ My baby is medically well

Weight and Physiological Readiness

☐ My baby’s BMI is at least 15, or has been assessed as safe for tube weaning by a clinician
☐ Recent weight trends are steady rather than rapidly declining
☐ My baby has enough energy to remain alert during feeds
☐ My baby can tolerate hunger without becoming exhausted or too distressed to feed

Feeding Skills

☐ My baby can coordinate sucking, swallowing, and breathing, even if skills are immature
☐ My baby has shown some tolerance of oral feeding experiences
☐ Feeding does not consistently trigger severe distress or panic

Feeding History

☐ My baby has had opportunities to practise oral feeding skills
☐ My baby has fed orally in the past (even a little)
☐ Any feeding aversion has been recognised and addressed
☐ Feeding interactions are mostly pressure-free

If Several Boxes Are Unticked

This does not mean tube weaning is not possible. It usually indicates that preparation is required first to support weight, reduce feeding stress, and build oral feeding skills before tube feeds are reduced. If you are unsure, feel free to contact us.

Final note...

Successful tube weaning depends on timing, not urgency. When a baby’s body and feeding skills are ready, the process is safer and more sustainable. If you are uncertain whether your baby is ready to begin, a structured assessment can help clarify the safest path forward. The safest approach to tube weaning depends on individual medical history and should be guided by an experienced clinician.

How Baby Care Advice can help

At Baby Care Advice, our Tube Weaning Program is based on Rowena Bennett’s internationally recognised approach to feeding aversion and tube dependence. We focus on helping babies feel safe with feeding again, rebuild oral feeding skills, and develop internal motivation to eat — rather than relying on pressure, force, or rushed withdrawal of tube feeds.

Our approach is gentle, structured, and responsive to each baby’s individual needs. We closely monitor progress and adjust the plan as needed, ensuring the process supports both your baby’s physical safety and their emotional relationship with feeding.

Families complete the program at home, where babies feel most secure and feeding patterns are most natural. Over the years, we have supported thousands of babies worldwide through tube weaning, with a consistently high success rate. Our goal is not just tube removal, but a lasting, positive feeding relationship that supports healthy growth and long-term wellbeing.

By Rowena Bennett

References and further reading

• World Health Organization (2006). WHO Child Growth Standards: Body mass index-for-age.
  

• Browne, J. V., & Ross, E. S. (2011). Eating as a neurodevelopmental process for high-risk newborns. Clinics in Perinatology, 38(4), 731–743.

• Silverman, A. H. (2010). Interdisciplinary care for feeding problems in children. Nutrition in Clinical Practice, 25(2), 160–165.
  Supports the role of structured, staged preparation and behavioural approaches in tube weaning.

• Wilken, M., Cremer, V., Berry, J., & Atkinson, M. (2013). Behavioral tube weaning in children with feeding disorders. Journal of Pediatric Gastroenterology and Nutrition, 57(5), 650–655.

About Rowena

Rowena Bennett (RN, RM, CHN, MHN, IBCLC) is a leading infant-feeding and sleep specialist and author of several books on infant feeding and behaviour, including the widely acclaimed “Your Baby’s Bottle-Feeding Aversion: Reasons & Solutions.” With over three decades of clinical experience across child health, midwifery, mental health, and lactation, she has helped thousands of families worldwide understand and resolve complex feeding challenges through her evidence-based, baby-led approaches.

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