(Reprinted with permission Exceptional Parent Magazine Vol. 36 Issue 02)

Tube feedings are used to nourish children who are otherwise unable to take in enough calories to grow. When tubes are first placed, many families describe feeling overwhelMEd. There is a whole new language and new equipment, none of which parents really wanted to learn. And then there is the responsibility of feeding their child through the tube. In the worry about “getting it right,” the tube feeding can easily turn into another procedure to follow, like taking a temperature or giving MEdicine. Instead of being a meal, the tube feeding becomes a dose!

Let’s look at helpful hints for putting the “mealtime” back into tube feedings.

Think about mealtimes
Consider “mealtimes” for orally fed children. They eat with different people, in different places, and have different amounts and kinds of foods. They have conversations and use mealtimes to socialize and interact and learn. These mealtimes are times of nourishment but not JUST calorie nourishment. Let’s look beyond the calorie focus of tube feeding to include some of the other nourishing qualities of mealtimes.

Celebrate the snuggle time
Find a position for tube feeding babies that turns the procedure into that snuggle closeness celebrated in breast and bottle feeding. Be able to look into your baby’s eyes during the feeding. Perhaps the feeding will be in parent’s arms or face to face with an infant seat.

Listen to the child
Tube fed children tell us with their body language how they are feeling about mealtimes. Listen to them and adjust the feedings for comfort. If the recommended feeding volume seems like too much for the baby, work with the team to adjust the amount. Baby comfort is very important in the overall enjoyment of the meal and in developing good feelings about eating.

Teach others to use the tube
Children eat with many people. Expand who can offer the tube feeding to increase experiences. This also reduces the stress that can develop when the tube feeding responsibility falls on one set of shoulders.

Mealtime modeling
Include the older tube fed child in the family meals. Bring them to the table. Children learn a great deal about eating from watching others. Tube fed children can become comfortable with the smells, tastes, textures and routines of family mealtimes. Provide the child with his own utensils and plate of food to taste, touch and explore (with MEdical permission) so he sees himself as a member of a family that eats.

Vary where meals are offered
Provide the tube feedings in different locations so the child learns that a full tummy can occur at family meals, at Grandma’s house, at a birthday party and at a picnic.

Have mealtime conversations
Have conversations at the mealtime that are appropriate for the child. Conversations with orally fed children are not dominated by commands to ”have another bite” and “swallow your food”. Try to focus the conversation on pleasant discussion that takes some of the attention OFF whether or not the child is actually orally eating at the meal. “Have another bite” conversations can be stressful for all involved. Some children will eventually learn to eat but need to do so in a pleasant and supportive environment without pressure. For other children, it may not even be safe to eat orally; however, they will need to learn to be part of mealtime conversations and interactions.

Invite participation in eating events
When all the siblings are going to get cheeseburgers at a fast food restaurant, invite the tube fed child along. He may be proud to participate in the social aspects of having his own cheeseburger, even if it is just to hold, lick, or taste it.

Mealtime preparation
Involve the child in activities surrounding the meal that do not require eating as an outcome. The older tube fed child can help prepare his own blended formula, make the family salad, spread butter on toast, or set the table. They do not HAVE to eat to be a participant.

Celebrate any mealtime participation
If a child has the potential to be an oral eater, the participation in meals will be important in familiarization with food and the mealtime process. Gradually the child can learn to trust and explore the nuances of mealtime. The journey towards oral eating will happen at the pace the child can handle.

Other children are not safe candidates for oral feeding, but they still live in a world where others eat. They need to find a way to be comfortable included and celebrated during mealtimes.

By turning tube feedings into mealtimes with all that a mealtime involves, a world of sensory, communication, interaction and imitation opportunities opens up for the child. Enjoy those mealtimes together!

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