It’s no secret that nutrition fuels our baby’s physical growth and mental development. Well-child visits, weight checks, growth charts, milestone conversations – all come back to the notion of how “well-fed” our babies are. And so, rightly, we parents put a lot of pressure on ourselves to make sure that, from the very beginning, our babies are getting enough of the right nutrients.
This worry becomes particularly prevalent for parents whose children needed a feeding tube placed in response to these very concerns! And when it comes time to consider whether or not weaning is safe for your child, naturally, you may have concerns about the way that a wean – particularly one that features the safe introduction of appetite by gradually reducing the number of calories put through a tube – would impact your child’s brain development. So, in an effort to answer these concerns, let’s take some time to understand two important principles.
1) The first principle to keep in mind is that there is a difference between “hunger” and “appetite.”
Weans that focus on “hunger” often cut tube feeds according to a “one size fits all” schedule, or they cut tube feeds altogether – all with the hope that, if your child becomes hungry enough, she will eat. But this is an approach that we caution against for a few reasons. First, we recognize that every child is different and unique, and that reductions should be made based on how your child is responding to the wean (and not according to a pre-determined schedule). Second, we recognize that children who have been tube-fed for all or most of their lives do not yet correlate the feeling of hunger with the relief of eating so, this approach of rapidly eliminating feeds often leads to confused, cranky kiddos who are at risk of unnecessary weight loss because they don’t know what to do with the feelings in their bodies.
The opposite of this is a wean that acknowledges “appetite.” We believe that appetite is a blooming process, and not a light switch. As such, weans that are appetite-based will focus on a gradual reduction of tubed calories, looking for your child to respond to one cut before moving to the next. This allows for appetite to awaken in a healthy manner, eliminating the risk of dehydration or ravenous hunger, and allowing your child to safely begin to correlate feelings of hunger with the satisfaction of eating.
2) The next principle has to do with how the body prioritizes the nutrition that it gets. And this is a principle that, we hope, will put your mind at ease when it comes to considering an appetite-based wean for your child.
The most important facet of this principle is this: the human body is smart! It knows that the brain requires good nutrition most, so when fed, the brain takes what it needs before sending nutrients to the rest of the body. This means that the body will alert us to a problem long before brain development is impeded. In other words, should the body begin to lack sufficient sustenance, nourishment to the brain is prioritized and the rest of the body will start showing early warning signs that could include weight loss, muscle weakness, dizziness, or fatigue. If poor nutrition persists long-term, you will see a deceleration in linear growth. It is only in a state of severe malnutrition that there is a deceleration in head circumference. .
Now, a wean that focuses on “hunger” might see these signs and require a pause in the wean, but an appetite-based wean rarely does because calorie reductions are never so steep that the child is put at risk. Nonetheless, parents should feel some reassurance, knowing that your child’s body will give strong and clear “danger!” warnings long before her brain development is in jeopardy.
These two principles, we hope, are helpful in explaining why an appetite-based wean will not put your child’s brain development in jeopardy. In addition, there is another important safeguard in place: your team. A competent weaning team will help you to interpret what your child’s body is telling you, and empower you to respond to those messages.
So our best tip for finding success in your wean is this: lean on your team. We are there to help!
by Elisabeth Kraus, MiT, and Lisa Grenz, RD