Why is it OK for kids to eat fluctuating volumes after tube feeds were so consistent?
Elisabeth Kraus, MA
Aubrey Phelps, MS RDN PPCES IFNCP CLC
In this series, we are tackling common post-wean worries, both from a medical perspective and from a parenting one. And the first question we’re going to tackle in this series is a good one! It’s one that almost all parents have after being stuck in a tube-fed regiment for months and years, and it sounds something like this: “Why is it safe for my child to eat such inconsistent volumes? Tube feed volumes were so predictable – and they only ever increased! But my child’s eating feels really unpredictable! How can that be safe?”
If you are a practitioner supporting a newly-weaned family, bear in mind that tube-feeds are externally regulated, giving parents the impression that needs and intake are (and should be!) consistent from day-to-day and meal-to-meal. But the reality is that almost no one eats exactly the same amount each day or for each meal. In fact, people’s eating varies based on a wide range of factors – mood, appetite, activity, schedules, illness, and more.
And for kids? You should add “distractions” to that list, too! Alongside learning new skills (like walking, crawling, vocabulary, etc.), a change in routine (starting school or daycare, dropping a nap, etc.), new people (visiting family, going on vacation or eating at a restaurant), illness, teething – and more!
These changes are good and challenging for all children, not just formerly tube-fed ones. And they all impact the volume and frequency with which children eat because, in those moments, eating isn’t (and shouldn’t) be the top priority: walking is! socializing is! skill development is! Etc. So the best way that medical providers can support newly weaned families is to expect of them the same things you expect from kids who never had tube support. Do this by safely spacing out weight checks, by encouraging families to pay attention to outputs (pees, poops, energy, milestones, etc.), and by spotting the kind of growth that isn’t just connected to weight (learning new skills, increasing vocabulary, etc.)
If you are a parent, those kinds of medical reassurances might not mean much when you’re stuck in the day-to-day grunt of it all. Sometimes, watching your child eat next to nothing for breakfast can send you into a straight panic! And when it does, it’s important to differentiate between what is actually happening and what you’re afraid is happening.
While you might be afraid that all the hard work of weaning is going down the toilet – and that is a valid fear after all you’ve endured! But what’s actually happening is that your child is listening to their bodies and learning to regulate. Just like you are more likely to eat a big dinner after a day that included a super light lunch, your child is likely to regulate when their hunger gets big enough! And while fluctuations feel really scary, especially when your child is newly oral, fluctuating intake is actually a great sign of typical eating: they are feeling their hunger and satiety cues and responding to them appropriately! Just as they should! Stick to what you know:
Pressure-free offers,
In age appropriate routines (5-6 offers per day),
With 2-3 hour gaps in between to avoid grazing.
The things that helped your child to wean successfully are the same things that will help them to stay safely weaned.