How fast should tube weaning really be? Is there a right speed? At Thrive, we hear from parents starting their journey, in the middle of weaning, or during follow up wondering about how fast to push their kid or how slow to go. Tube weaning often gets broken down into two simplified categories: Rapid weaning and the “wait and see” method. At Thrive, we are typically put into the rapid weaning category, but in this week’s episode, Jennifer and Heidi discuss how our therapists make clinical decisions while weaning. At Thrive, there is not one “fast” or “slow” lane, as it is extremely important to respond to the child and every child is different throughout their weaning journey. This episode reviews why it is so important to acknowledge that children develop at different rates, learn skills at different times, and for some children weaning can happen fast, while others need to slow down. Jennifer and Heidi review why sometimes a child may need to slow down or take a break while weaning, and while other times it is important to move faster. At Thrive, our philosophy is unique and we respond to each child individually by learning their cues and encouraging parents to do the same. It is important to consider how children learn to self-regulate, respond to hunger, and build trust, acceptance, and a relationship with food.
Why don’t we “wait and see”?
We often have parents report that they have been told by therapists, members of their medical team, or well-meaning friends and family to just “wait it out” and their child “will eventually eat”. The problem with waiting is that the longer you wait, it is more likely that you are missing critical windows of development. There are certain developmental windows, specifically in feeding, that we have discussed in a past podcast episode where children’s brains are ready to learn to eat. These windows are generally around 4-6 months learning to eat purees and 8-12 months for learning to eat solid foods. When we look at typical feeding development, most pediatricians recommend children to transition from bottle to table foods by 12 months of age. If that is the norm, then by waiting to wean from the tube we are missing critical windows of development that help this transition happen. Waiting can also impact your child’s ability to learn how to self-regulate and respond to what their body needs. The longer a child is on the feeding tube when they no longer medically need it, the longer their body does not have the ability to get their needs met independently.
If we don’t wait and see…what do we do?
Thrive at Spectrum Pediatrics is often thrown into the “rapid weaning” approach because we are much faster than other programs out there. We typically resist that term because it makes it sound like everything we do is at one, constant speed. At Thrive, our program does not have a fast or slow lane that we stay in the entire time. We adjust to what the child is showing us and those adjustments may cause us to slow down, or speed up the process. There SHOULD be variability while learning to eat. Childhood is variable, children develop at different rates, and learn skills at different times. By responding to the child and making changes based on what they are showing us, we are helping the child learn to self-regulate, respond to hunger in an appropriate way, and build trust. For some children, this may look like a straight line, but often it is full of ups and downs while learning. This philosophy requires a lot of patience, but at Thrive, our therapists are there with you to walk you through decisions and encourage parents to be independent with their decision making.
Time to slow down…
What would make a therapist recommend to slow down during this process? For some children who learn motor movements at a slower pace and need more time, they may need a push in the beginning, then slow down as they build the motor skills. We often see children who are interested in food and initiating, but they do not yet have the skills to bite, chew, or eat the food they want! We do not want a child who is showing interest and doing an awesome job to feel constantly frustrated when they are trying their best. It is important to look at what a child is doing, both with interest and with skills, then base your supplementation decisions on what you are observing. This is important to help build the connection between eating and learning new skills, and feeling good! We have had parents report that this constant decision making with supplementation can feel like a dance of trying to find the “sweet spot” for where the child needs to be to initiate, understand hunger, and learn new skills. Every child has a different limit and responds differently to hunger and decreased or increased supplementation, therefore it is important during weaning to make decisions based on the child’s cues and wellness.
Time to speed up…
There are also times throughout the weaning process where it is time to go fast and push the child a little further. Sometimes after a period of going slow, a child may get “stuck” there and needs a further decrease or change in supplementation to respond to hunger. Sometimes by moving slow, we are rescuing the child right before they are about to rescue themselves. What does this mean? As a child is learning self-regulation, they are learning to respond to what their body needs. By giving them support when they might no longer need it, we are getting in the way of allowing them to be independent.
“Is it okay to let them eat throughout the day then supplement the rest at night?” This is a common question we get from parents who have been using that approach, but not seeing progress. When it comes to self-regulation, in this situation the child is feeling the same no matter how much effort they put in independently. This process does not allow for a child to feel different if they eat a large amount or choose to eat nothing at all. If this is working for your family now, then keep it up! Stability is important while learning, but that doesn’t mean that your child is unable to learn to eat in a bigger way. With this approach, the internal motivation to eat more or learn new skills is not there. At Thrive, the variability and approach allows for children to feel these differences and respond to hunger in an appropriate way.
Is it okay to go slow AND fast?
YES. Adjustments are necessary, and important during this period. You may reach a level where your child is motivated, responding to hunger, and slowly learning skills. When you’re here, it is okay to want to stay there and allow your child to feel GOOD for a longer period. During our follow up period, parents often ask “Well how will they continue to progress?” and the answer is, we want them to be motivated by MORE than just hunger. As discussed in past episodes, hunger is NOT the magic bullet. We also need a child to enjoy mealtimes, socialize with their family, build endurance, and learn to attend to the food. These are all important skills that a child can focus on once they feel stable.
You may see a plateau at a certain time, and that is okay. Once your team notices this is happening, a plan is made to make any changes that your child might need. After a sudden change, it is crucial for children to feel comfortable, establish a routine with eating, and feel good after all their efforts. We have found that it is important to focus on QUALITY before QUANTITY. You need to get the quality to get the quantity. For your child to increase volume, they need to feel comfortable around mealtimes and confident while eating. This can be hard for families who have relied on the numbers from the feeding tube for a long time, but your feeding team is there to help you decrease your focus on the numbers, and learn what other factors to look at. You got this!