We’re back for Season 2! Thank you so much for listening to Season 1 of the Tube To Table Podcast, we are so excited for you to hear our upcoming season! Your hosts, Jennifer and Heidi, are back and ready for a great season! This week, Jennifer and Heidi are discussing the tools and tricks of the trade. What does that mean exactly? They are answering all your common questions including, “What cup should I use?”, “When should I introduce spoons?”, and “Is there a magic food?!” When starting treatment or preparing for an intensive tube wean, parents often ask these questions in order to feel prepared for getting started. While these are all great questions, it is hard to pick just one tool or utensil, so this week your hosts will discuss the spoons, cups, forks, and other utensils that might be helpful for your little one! There are three specific factors to consider when choosing these tools: Familiarity, Novelty, and Control. Since the tool you choose will depend on your child specifically, this week’s podcast will discuss guidelines for where to look and how to choose. 

You can download this episode from Itunes, Stitcher, Spotify, Google Play, or listen to it below:

When starting to feed a child by mouth, it is important that when you are introducing new tools or utensils you are taking into consideration that what you are choosing does not remind them of any negative or traumatic experiences in the past. This doesn’t always mean that a child won’t go back to something they were using, but that is not generally where we recommend to start. 

Familiarity: 

Many children will want to use what their parents are using or what they have seen grownups use in the past. Although every child is different and we always see a different response, it is almost always consistent that a child will reach for or show interest in what their parents are using. This is helpful to keep in mind while choosing an initial cup. Why the interest? 

• There is no pressure associated with something you have been using 

• The cup is familiar because they have seen you drink from it or use it at all  their meals  
• Parents most likely have not offered their child their coffee cup or their wine glass! 

Novelty: 

Although children benefit from something familiar, trying something brand new is also helpful! This is the opposite end of the spectrum, but choosing something that they have never seen before has no association with it. Choosing a large open cup that they haven’t seen in their house before is exciting. Babies and toddlers typically all like novelty with their toy and choosing a tool for feeding is no different.  

Control: 

Tube feeding is typically all adult-directed, therefore your child has not had a lot of experience with being in control at mealtimes. This is an important factor to consider when choosing a utensil or tool to start with during your tube weaning journey. It is crucial for a child to feel comfortable and trusting of the tool you are choosing. Here are a few ways to help your child feel in control at mealtimes: 

• The food gets set on the table or tray rather than handing it to them. This allows your child to choose what they want to do with it 
• Wait for them to initiate. Even if your child cannot pick up the food, there are other ways to show you they are ready, including: Looking at you, looking at the food, relaxed shoulders, relaxed hands 
• Take turns. This allows your child to be in control, while still allowing you to help feed them. Taking turns allows the parent to feel that they are not “taking over” the mealtime 
• Be attentive on how you are handing the food to your child, they may want you to just simply load the utensil and place it down, OR they want you to give them the utensil directly. 

If you’re not sure where your child is on the spectrum of needing more or less control, the most frequent advice we give to parents is to ALWAYS start further away. This will allow you to slowly assist as your child shows you they want you to help.  

Now, what tools? 

Spoons: 

When it comes to using utensils, the more normal and less “kid like” it looks, we typically find the more likely the child is to use it. Every child is a bit clumsy when first learning how to use utensils, and this goes for children who are tube fed as well! This is important to remember that utensil development takes time, and it is not always easy right away. Here are a few tips to help with this transition: 

• Choose a small spoon that might look like a regular spoon (small teaspoon, espresso spoon) rather than one with bright colors on it so it looks just like what mom or dad uses! 

• Longer handles and deep spoons are tricky and can be hard for a child to be independent with 
• Try a shorter spoon, with a flat spoon to allow your child to be more successful when first learning how to spoon feed. 
• If a child is successful in the beginning, they may be more willing to continue! 

Cups: 

“What about the sippy cup?” – This is a question we get from almost every parent. In our program, we rarely see a child go right to a sippy cup unless they’ve seen a sibling use it or they have shown a preference for it in the past. Although we allow children to navigate towards the cup of their choice, we would typically recommend starting with an open cup or straw cup. 

• An adult open cup is typically one of the first cups, which is not neat and easy, it is messy and hard! It is helpful because they are able to see what is going in their mouth and able to choose if they want to drink it.  
• When there is no trust there because they do not have experience, being able to see it gives the child more control and feels much safer.  
• Open cups also are easy to modify, you can fill it up to the top so that it is easy to get a small taste with their tongue, prior to pouring it into their mouth.  
• Straws can be more difficult, but it is also something they see their siblings or parents using very frequently. 

• The straw valves are extremely helpful because they allow consistency when a child is learning how to coordinate a straw.  This keeps the liquid at the top of the straw with the one-way valve. Once a child has figured out how to take the smallest sip, they can build on their control and coordination. 

Forks: 

Typically, forks are not seen in the beginning of the process since these are typically last in development with typical utensil progression. With older children who are eating a little at first, there are a few forks or tools we do recommend to help introduce the idea of a fork. 

• Small bento forks are helpful because they are very small and allow for a child small child to control. **Be mindful to give these only to children who are old enough to know the function of a fork. Always keep an eye on your child when introducing these since they are small 
• Toothpicks: Again, it is very important to keep a close eye on this, but this can help children learn the stabbing motion of the fork, with taking the coordination out of it at first.  

There is no one magic utensil (we wish!). It is important to look at each child independently and consider the above factors that are discussed during this week’s episode. It is okay to adjust what you are choosing accordingly in an appropriate manner that doesn’t overwhelm your child. If you have further questions about this email us at thrive@spectrumpediatrics.com, or share these concerns with your child’s team! 

See you next week!