Transition from Tube Feedings to Feedings by Mouth in Children: Preventing Eating Dysfunction

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Abstract

Tube feeding provides a temporary means of improving nutritional status and growth until a child can be nourished by mouth. Children in transition from tube to oral feeding typically display oral-motor, sensory, and developmental feeding problems and behaviors that make weaning difficult. A smooth transition benefits the child's health immediately by ameliorating eating difficulties and prevents dysfunction later in life. The weaning process from tube to oral feeding is best thought of in developmental terms. A four-step process is suggested to ensure a smooth transition: promote a positive feeding relationship between caregiver and child; determine feeding readiness; normalize feeding, including oral stimulation, eating-related behaviors, environment, and regulation; and initiate a behavioral feeding plan. The awareness and anticipatory guidance of nutrition professionals before this transition maximizes oral-feeding success for the formerly tube-fed child. J Am Diet Assoc. 1996; 96:277-281.

Section snippets

Promote a Positive Caregiver-Child Feeding Relationship

The first goal of any program to wean a child from tube or oral feeding is to maintain a positive feeding relationship between caregiver and child that supports optimal nutrition, growth, development, and well-being. The feeding relationship is the collection of interactions that take place between caregiver and child as they engage in food selection, ingestion, and eating regulation (3). A healthy child follows a general progression from a liquid diet of only breast milk or formula to a

Applications

Both intensive inpatient feeding programs that take weeks and outpatient programs that take months or years are effective for weaning a child from tube to oral feeding (7), (15), (16), (17). Inpatient treatment is rapid and involves minimal disruption to the family routine and maximal support from professionals, but it may not be covered by third-party insurance. Outpatient programs, which require much more commitment and time from parents or caregivers, may be the only option. A single health

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