Why Do Kids Need to Eat 5-6 Times a Day?
By Amanda Kyle, MA, CCC-SLP
Tube fed children are often put on various schedules, with large boluses and big gaps of time between feeds. It is not uncommon to have a tube fed child on only a couple of feeds during the day, or even all feeds overnight. And, one of the first things that your team does when we are looking to start a wean from the tube is look at that schedule because ultimately, a tube schedule is very different than an oral child’s schedule. Tube feed schedules do not need to account for the natural rhythm of hunger and satiety, but oral eating does! And, the ability to fill and manner in which kids fill their nutrition and hydration needs via oral eating vs tube feeding is different as well.
When starting the wean process, change the way you think about your child from being a “tube-fed child with some oral eating,” towards considering them as an “oral child with a bit of tube support.” This shift allows us to create a sustainable schedule for an oral child, and oral children, beyond infancy, do not typically eat in the night time. The most common oral schedule used is offering eating times every 2-3 hours during waking hours, resulting in 5-6 eating times in the day. When this has not been your typical rhythm, this can feel overwhelming, but in reality, this is a typical oral child feeding schedule and there are some big reasons why we utilize it.
We want to establish a strong hunger and satiety rhythm.
In the weaning process (as well as when feeding little ones), we are capitalizing on the hunger and satiety cycle (which makes up appetite) to provide the main motivation for eating. This works the best when we let the stomach empty so that the body can secrete hunger hormones (ghrelin), prompting you to fill your stomach so that the body can secrete the satiety hormone (leptin) to tell you to stop eating. When you get a good cycle of “hungry” and “full,” your body secretes more hunger hormones and more satiety hormones to make these signals clearer. When we go too long between offers or when we prompt eating too soon, kids actually get fewer of these hormone signals. This is where we see kids learn to eat to turn off the signal, not eat to get full. We want the latter.
We need to provide enough opportunities in the day for kids to get what they need nutritionally.
Kids have small tummies, which means that they need frequent enough opportunities to fill them up in order to grow sufficiently. The ideal rhythm for this is offering eating times every 2-3 hours, no fewer than 5-6x per day. In our experience, when we see stretching out the time to 4 hours and only have 4 eating times in the day, we do not see a significant increase in volume of foods eaten at the meals because they have too few opportunities to get the nutrition that they need.
We want to make the most of caloric beverages.
The other way that we capitalize on this hunger and satiety pattern is that we only offer caloric beverages (i.e. juice, milk, smoothies, toddler formulas, etc.) at eating times – and not in between. By offering food first, then rounding out the meal with a caloric beverage, it helps kids to fill their bellies efficiently. Think of it as topping off the tank! This is especially helpful when kids are just beginning learning and building skills.
Water can be offered between meal times because it does not trigger those hunger and satiety cues in the same way. That said, be cautious to cut off water 30-45 minutes prior to the next eating time to ensure that they are not filling their bellies up before eating.
So, making the switch to an ‘oral kiddo’ schedule can feel really daunting at first, working in multiple eating times in a day. However, with time and adjustment, this will feel part of your normal routine – and the benefits to promote appetite are well worth the adjustment!