Amanda Kyle, MA, CCC-SLP
When a child is fully supported nutritionally by their feeding tube, we have no expectation that they will be eating orally. All of their nutritional needs are being met, so there is no expected hunger drive. And no hunger drive, means no eating. But, even in the absence of oral eating, there are some great things we can do to support the journey towards eating, without the actual act of chewing and swallowing.
1) Establish a mealtime routine.
If your child’s tube feeding schedule allows, pair the tube feed with an eating experience. This means washing hands, getting into their chair, having their tube feed, being offered food (again, no eating expected), and having other family members eating with them. Sometimes this aligns just to dinner, and if that’s the case, consider it a great opportunity for your tubie to smell foods, watch other people eat them and get into a mealtime routine. This will also help to begin to give the association between the tummy feeling full and oral input with food and mealtimes.
If your child is not used to being involved in mealtimes in this way, it can be a lot for them at first, and they may not be able to last the whole meal time. That’s ok! Start small and work up. Also having a small toy handy may help to keep them interested at the table. This should be a toy that they enjoy, but not an absolute favorite and bonus points if it is easily washed as I highly encourage keeping the food around as well. Feeding the toy is always a fun game!
2) Involve your kids in food related activities. Helping to cook, stir, chop (with kid safe knives), etc. as is age appropriate. This gets kids used to touching and manipulating foods, offering some great exploration without the perception of pressure to eat (because it is not a mealtime). All of these sensory experiences are so important to learning to eat.
3) Use foods as a teether (with direct supervision only). This allows them to get some taste into their mouths and feel the texture, without having to manage any pieces or worry about swallowing anything. Some great things to try are beef jerky, jicama sticks, carrots, celery, dried fruits, stale licorice; these should all be firm enough that your child cannot get a piece off of them. Monitor as they get soft, cut that piece off and re-offer). This will also help to ‘wake up’ the tongue and help it begin to move around the mouth in preparation of food, as it will be in charge of getting food to the molars for chewing later on.
4) Most important? Eat WITH your kids! This provides a model for what to do with foods, how to eat them, and if they can feel safe to eat them. Every food is a new food to weaning kids. They must learn what it smells like, tastes like, what happens when you bite it, how much to chew, etc with every offered food. You eating provides this model, as well as shows them that you are enjoying eating it. And when they are ready, you will too.
Additionally, with all of these things that we can be doing pre-wean, the biggest thing NOT to do is put on pressure to eat – or even to try! – any food. In fact, the number one rule with all eating is this: You only get to put food into your own mouth (unless your child has a disability that does not allow this, then I change it to ‘food does not go into your little one’s mouth without a clear ‘yes’ cue’). This means no ‘sneaking’ a taste into their mouth because you know they will love it, no pushing if they turn away, no distracting from the mealtime in order to “get more into them,” etc. Our kids have had a lot of reasons to not enjoy eating, so in this stage, we are starting from scratch with letting them enjoy foods, feel safe with them and try them when they are ready.
There are so many aspects that go into a mealtime beyond just the act of chewing and swallowing. By fostering these habits early on, creating safe, happy and enjoyable mealtimes, and emphasizing exploration over eating, your little one will begin to lay the foundation for happy oral eating, even before becoming an oral eater.
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