This week’s episode of the Tube To Table Podcast focuses on the specific progression from feeding tube dependency to eating orally. Your hosts, Heidi and Jennifer, will walk you through the five crucial steps that the Thrive by Spectrum Pediatrics Tube Weaning Program focuses on when working with families who are ready to start their journey to being tube-free.

You can download this episode from Itunes, Stitcher, Spotify, Google Play, or listen to it below:

FIRST, DO NO HARM 

This is a time where you should start to minimize or eliminate anything that may be causing your child to have a negative association with food or mealtimes. 

• Look at any medical issues that could be causing feedings to be uncomfortable or scary for your child. Talk with your medical team about what can happen from a medical standpoint to make feedings more positive for your child.
• There should be no EXTERNAL pressure to eat. This is the time to take a step back from any mealtime situations or therapy that is focusing on the child may perceive as pressure. Talk to your caregivers or therapist about how you can change some of the strategies or therapy that is causing the child to pull away. 
• Unfortunately, it is very common in feeding therapy to focus on external motivations such as distractions or rewards. We recently wrote a blog post about the dangers of behavioral feeding therapy. When a child is eating for an external reason, it sends the message that food is “work” and that they “need” a reward or a prize to eat. This message that food is something they need to “work to overcome” is dangerous and the wrong message for a child to hear during mealtimes. 

BUILD TRUST 

Once you have eliminated any medical complications, pressure during mealtimes, and any harmful therapy strategies, it is crucial that the focus turns to building trust around food and mealtimes.

• Child-directed food play is extremely helpful in overcoming aversions and learning about food. This is not meant to be a time to “work” on food or pressure your child to do certain things with the food. This is meant to allow your child to engage in food exploration. 
• Take a break. Giving your child a break from what they are expected to do and allow them to be independent with their exploration. This is one of the HARDEST phases because parents often feel as though they are doing nothing, yet this is one of the most VALUABLE parts of your journey. 
• Allow your child to refuse. When children are allowed to refuse, it feels safe. It is important to accept the refusal and not override it.  

CREATE RESPONSIVE FAMILY MEALTIMES 

This phase helps to set the stage for life-long, healthy eating. The focus of a mealtime should be togetherness and enjoyment, rather than the bites your child takes or a breakdown of what they are eating. If a child learns that mealtimes are relaxed and fun, even if they are not yet eating, they are able to feel safe and learn that mealtimes are a positive experience rather than scary.

• The research shows that families who eat together and have happy mealtimes have longer term health benefits. This does not have to be every night, but making a regular time together however that makes sense for your family. 
• Mealtime discussions should not be focused on food or trying to “sell” food to your child. Think about your experience out to dinner, it is likely that the conversation is rarely focused solely on the food and how much or what you are eating. 
• There are resources out there to help families with conversation starters and topics to discuss at mealtimes for children of all different ages.

DISCOVER INTERNAL DRIVES TO EAT 

Children need to learn to listen to their body and be given the opportunity to self-regulate. When children can listen to what their body needs around food, it develops a life-long positive and healthy relationship with food.

• Internal drives for eating include hunger, taste, comfort, curiosity, and togetherness. It is crucial to allow all of these to emerge while your child is becoming an oral eater.  
• The Thrive Tube Weaning Program allows for your child to experience hunger within the medical parameters set with your medical team. To learn more about why learning to eat in the context of hunger is so important, listen to our Week 3 Episode.

SUPPORT SKILL DEVELOPMENT 

When children are born, they have a natural drive to learn how to eat. There are initial reflexes as an infant, then as hunger comes into the process, the child has repeated successful and comfortable experiences with eating, which help a child continue to learn and develop skills. These skills become automatic with repeated experiences.

• In many therapies, the focus is to improve oral skills BEFORE they are hungry. Therefore, the skills are not learned in a meaningful environment. If it is only meaningful for the adult and not the child, the skill development will be extremely limited.  
• Eating skills can often fall behind developmental skills for a child who is tube fed. If a child is in a certain developmental level with gross and fine motor skills, with the internal motivation and repeated experiences, their feeding skills can typically develop to the same level.
• If you are having a difficult time with these skills progressing, it is important to make sure that while learning these skills, therapy is still child-directed and takes a responsive feeding approach.

THRIVE 

This is the last, and our favorite, phase of the tube-weaning journey. This is a time where your child can thrive, grow, and gain when they feel safe and eating is meaningful and positive. Family mealtimes become more manageable and focus on togetherness, while a child is able to participate in mealtimes and enjoy food! 

We have an exciting topic next week, so stay tuned!