All of us have sat through medical appointments where we are asked how well our child is “tolerating their tube feeds,” but for so many of us, “toleration” is the low bar that our kids can never seem to hit as our lives fill with unending retching, gagging, vomiting, constipation, and overall discomfort. To some people, toleration issues are a disappointing, but expected, part of tube-fed life, but they shouldn’t be.
Most full-term infants are born with innate reflexes to survive outside of the womb. The three most important reflexes for early feeding are the rooting reflex to locate the source of nourishment, the suck-swallow reflex to transfer breastmilk or formula, and the gag reflex to protect their airway. Although these automatic, reflexive patterns support the infant’s survival early on in life, they begin to integrate into volitional motor patterns around 3 months old.
Whether using commercial enteral formula or a homemade food blend, bolusing is an efficient method for administering enteral feeds. Bolus feeding requires the use of a syringe to deliver formula or food blends through the feeding tube. The rate of infusion is controlled by how fast the plunger is pushed or by removing the plunger and holding the syringe up, letting gravity take control and allowing formula to flow down through the tube.
