In this two part blog from our Dietitian Lisa Grentz, we talk about hunger and satiety regulation during a wean. Read Part Two here!
Hunger and satiety regulation play a pivotal role in successfully weaning off tube feeds. At Growing Independent Eaters, we often divide a child’s weaning plan into four phases to establish hunger and satiety regulation.
The first phase focuses on establishing hunger cycles, stabilizing weight gain and growth. Here, the family establishes positive mealtime routines, building acceptance and reducing anxiety towards new foods.
The second phase focuses on gradual increase in hunger. The third phase is very similar to the second phase as our goal is to continue to increase hunger through the reduction in tube feeds.
The fourth phase is to stabilize growth and hunger, allowing for balanced energy distribution over the course of the day. Here, we aim for functional sleep, and promote GI tolerance all while meeting 100% of the child’s unique energy needs by mouth.
When children are tube fed, they get a consistent volume or bolus of formula or breast milk at consistent intervals throughout the day. During a tube wean, as oral intake of foods and beverages increases, portions will start to vary and this is ok. We expect some inconsistency of portion intake as this indicates self-regulation.
Evaluating children’s feeding behaviors can tell us a lot about their hunger and satiety regulation. Does your child express hunger or hunger cues? Are there any challenging behaviors prior to meals or does your child readily come to the table to eat? Does your child come to the table hungry at mealtimes? Does your child sit to eat? Does your child focus during mealtimes? Does your child eat at a reasonable pace? How long does it take for food to be eaten and is the quantity of food consumed reasonable for this time frame? Does your child eat a combination of foods and if so, how are these foods selected? Does your child consume and tolerate enough foods to feel satisfied? How is satiety indicated? How frequently is your child asking for food? Can your child tolerate going 2-3 hrs between each meal and snack?
Communication during mealtimes is also very important. Does your child have a way to express hunger or satiety? If not, we want to teach children a functional way to communicate during mealtimes so that they can clearly express if they are all done or if they want more to eat. We also want to look at how your child communicates during the meal, both verbally and nonverbally. Does your child ask for food for nourishment, or are they asking because they know this captures your attention resulting in praise for taking a bite? If the latter, it might be time to adjust communication styles so that eating becomes intrinsically motivated: a result of listening to bodily cues, not as a means of getting rewards or praise.
Another consideration in establishing hunger and satiety is to look at the distribution of calories from solids and fluids at meal and snack times. Children coming off a predominately liquid diet in the form of tube feeds or oral supplement drinks will have the majority of their caloric intake from fluids. As the quantity of solids increases in the diet, we want to shift beverages to a combination of calorie containing and non-calorie containing drinks. This helps with regulation of hunger and thirst. Children that are hungry may ask for a supplement drink or a tube feeding. Over time, we want to reduce the calories from their beverages so children learn satiety from eating not drinking and associate quenching thirst with drinking.
Children with rigid mealtime behaviors or who have a very limited number of accepted foods can be challenging. We want to make sure there isn’t any gastrointestinal discomfort from reflux, food sensitivities, constipation, or other underlying medical issue that could be contributing to these behaviors. We want to make sure your child is offered a combination of foods, with at least one familiar food presented, at each mealtime to reduce some of the anxiety around meals.
Lisa Grentz, MS, RD, CD, Dietitian