The Thrive by Spectrum Pediatrics Tube Weaning Program focuses on the importance of establishing a strong foundation before expecting any progress in skill development, variety, or intake. The foundational pieces include Do No Harm, Build Trust, and Create Responsive Mealtimes. After building this foundation, you can then focus on Discovering the Internal Drives to Eat and watching your child Thrive! Find a PDF to our pyramid here that provides a visual for these foundational steps to building a relationship with food.

FIRST, DO NO HARM 

The first phase when starting your journey to becoming tube-free is to “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.  

• Make sure all of the medical complications are under control. 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. 

BUILD TRUST 

Once you have eliminated any medical complications, pressure during mealtimes, and any harmful therapy strategies, it is crucial that the focus starts to be on building trust around food and mealtimes. The more trust that a child has around food, the better chance they have of becoming a healthy and successful eater long-term. 

• 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 report it feels 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. 

DISCOVER INTERNAL DRIVES TO EAT 

Children need to learn to listen to their body and be given the opportunity to self-regulate. This means that they can get their needs met through self-directed activities. 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 does allow 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 Tube to Table podcast here.

SUPPORT SKILL DEVELOPMENT 

When children are born, they have an initial 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.  

• 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.  
• If you are having a difficult time with these skills progressing, a responsive feeding professional can help you. 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! 

Check out our podcast episode on this topic for more information!