Amanda Kyle, MA, CCC-SLP
Weaning a toddler can be so gratifying – especially as they begin to explore and enjoy foods that you truly wondered if they ever would! But it can also present some unique challenges, especially as toddlers develop new interests and opinions about the world around them! One of these challenges centers on how aware your toddler is of their tube feeds, and becomes especially tricky when your toddler begins to protest those feeds. When this happens, it’s important to have some tools to help you approach the situation with healthy boundaries and a lot of empathy.
When a child uses their words to express emotion, we first want to acknowledge what they said, and then (to the best of our ability) remain emotionally neutral by responding with neutral language as opposed to pressured language.
Saying something like, "When you start eating more, then we won't need these" puts pressure on oral eating, accidentally turning tube feeds into a “punishment” for not eating. In fact, these kinds of when/then statements imply that your child can avoid something they do not want to do if you see the preferred behavior (oral eating), and that adds pressure.
And so, during times when tube nutrition is necessary, it’s important to do little resets and to follow the Division of Responsibility. As the parent, the timing and amount of tube nutrition is your decision. However, you can give your child some choices around the other aspects of what those tube feeds look like, and this helps to build alignment and a healthy sense of mastery/control while still setting the structure a toddler needs.
Being respectful of your toddler’s body and feelings means avoiding anything that might feel like force or overpowering. So, within that structure, consider following a routine that looks something like this:
Let your child know about the transition. This might mean saying something like, “We're going to have some breakfast/snack/lunch/etc. with our tube" while letting them see the tube.
Because the tube is a part of your child’s mealtime process and nourishment, use language to show that it’s part of mealtimes (something they participate in), as opposed to a “feed” (something that happens to them).
Check-in with how you are feeling. Mealtimes – through a tube or not – are about connectedness, so look for that sense of safety within yourself first. Foster calm and neutral emotions because you set the emotional tone.
If your toddler says something about the tube, acknowledge them. For instance, if they say, "no" or "don't do that,” you can respond with, "I heard you say no" or "I see you feel upset/unsure/frustrated/etc". Reassure your child that you are there with them and that you see them. Allow your child to feel their emotions and just be present with them.
A calm and responsive demeanor on your part models emotion regulation and helps children work through and organize the emotions they are experiencing. Trying to talk a child out of the emotion, or a frustrated/fearful/anxiety emotion state on our part, tends to escalate the situation.
Keep in mind that, for a time, tube nutrition is not optional. However, you can involve your child in them, and let them make some choices between two options for the next step. Toddlers love to do things themselves, so only offer choices that are OK and work for you. For instance, you might ask, "Would you like to sit in my lap or on the chair?", "Do you want to hold the tube or guide my hand?", etc. Then, place the tube and go on to talk about other things and family mealtime.
Throughout this process, remain focused on relationships and spending time together, and not overly focused on food (either oral or through the tube). The goal is not to change how your child feels about their tube, but instead to offer a supportive and caring space where they can find calm and empathy with you, the person who knows and loves them best.