Hunger is Not a Medical Emergency
By Amanda Kyle, MA, CCC-SLP
Hunger is not a medical emergency. Not for you or me. Not for your little one who is ready to wean is actively weaning, or who is already an oral eater. And this mantra is something that we need to let sink in while we are weaning our little ones – but gosh! It’s a hard concept to grasp because at one point in your child’s life, it was. There was a time when they were not able to eat enough to survive, and you had a front row seat to this struggle. To add to the stress, you know that your job as a parent your job is to love them, feed them, and keep them safe, and when one of these is not going well, you feel like you are failing your baby. And this anxiety is a form of medical trauma. It is real and present throughout your child’s early life, and weaning can be triggering of this past trauma, causing it to resurface during and following the wean period. The main reason being that we often see the very things that caused the need for the tube early on, weight loss and not eating during the active wean stages – and this can feel very scary.
Our brains do not always differentiate the safe, controlled weight loss that occurs during a wean plan from the scary, uncontrollable weight loss that your child experienced in a medical emergency. Even if you can reasonably understand that weaning weight loss is safe, our parent brain can go into fight or flight. Which means that we need to learn to take a deep breath, recenter, and remind ourselves that they are safe and we are safe – remind ourselves of the difference between what we are afraid is happening and what is actually happening.
Additionally, the pre-tube focus so often gets shifted to “intake at all costs” when a child is failing to eat and grow, and it is hard to get out of that survival mindset. But, when we are growing oral eaters, we want them to be able to listen to their own bodies and learn to modulate: “if I am super hungry, I am going to eat more, and if I am less hungry I eat a smaller portion.” This is a hard job – to let go of and allow our children to fulfill on their own calibration because it requires a different mindset than pre-tube and tube feeding. That mindset relies on remembering that the way we respond in a medical emergency is – and should be! – different than how we respond when we are not in a medical emergency.
And if your child is medically stable enough to pursue tube weaning, then it’s time to embrace that they are not in medical crisis and they are ready for a new approach to eating.
Even within the Division of Responsibility, parents rightly care so much about what they are eating and how much, but embracing a weaning mindset means embracing that these are no longer our jobs they way they were on tube feeds: when a child is tube fed, all of these jobs fall on you as a parent, but when kids are becoming oral eaters, it’s time for the jobs to be divided. Your job as the parent is to set your child up to be successful by establishing when to eat, what to offer, and where to sit. The other jobs are up to your child!
Kids are in charge of what to eat of what is offered and how much. At this point, if everyone is doing their jobs, if your child is not eating, it is their decision – and it’s safe for them to make that decision. And, if they do not eat enough, the natural consequence is they will be hungrier and they will have another chance to fill their belly in a couple of hours. This can be inconvenient, and we can sometimes see crabbiness – but hunger is not an emergency. They will not lose weight or begin to fail in the amount of time between one small meal and the next offer. The more we can remind ourselves of this, the more their eating volumes will become less of big deal because kids are inconsistent in their intake, so seeing this inconsistency is actually a good step in the right direction of learning to fill their belly.
In all, learning that hunger is not a medical emergency – even when it feels like one! – takes time. And patience. Help and support. Taking deep breaths and reminding yourself of the stability your child has achieved can help! As can your weaning team – so lean in! This is a whole new world!