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The topic of feeding is vulnerable to pressures to perform. A quick online search reveals nearly ten thousand books, telling parents how to feed their children, and some days it may seem as though every passing stranger has an opinion on how to get your child to eat.
As the parent of a child with a feeding tube, you have, undoubtably, already experienced an intense rollercoaster of emotions, and now you are at the point where you should be celebrating. The medical team have stated that the feeding tube is no longer necessary, and yet your child shows no interest in eating, may even be gagging or getting distressed at the sight of food.
The thoughts that run through your mind are multiple. Perhaps, you think, your child just needs a little taste to realise the food is nice; if you just put one spoonful in his mouth, he will want more. Or maybe with an older child, you start to worry that the problem isn’t eating, but discipline, and perhaps the threat of punishment will motivate your child to finally eat.
As professionals, who deal with tube weaning in a wide variety of conditions, we understand the feelings that arise when you are confronted with a child who will not eat, especially when it feels like every other child is happily munching away on anything that is placed in front of them. We see and hear the attempts made by loving, caring parents to get their child to eat.
This article is about the processes parents try to get their child to eat and why we want you to avoid them, and help you free your child from the feeding tube without using any methods involving force or persuasion. Tube weaning will never work when using force feeding as an intervention, because, having the experience of being tube fed, in itself ia highly intrusive intervention, it places the child in the role of “the victim”. All the more, during tube weaning every aspect of force must be avoided, be this in actions or thinking since the transition from externally regulated and controlled feeding routines to a self-determined and child led oral intake can only work if the child him- or herself is given full responsibility and autonomy over its nutritional intake.
To start with, what do we mean by forcing your child to eat? Eating should be a simple process of recognising hunger, responding to that drive by eating, and then stopping when satisfied. By forcing we mean any behaviour that distracts or detracts from that simple action. From gentle coaxing to physically restraining your child or to physically shoving food in the child’s mouth, we discourage any of this.
There are also some clear cues and behaviors, which an infant or young child is able to express his or hernon-approval of: If an infant is turning its head away or crying when faced with a bottle or breast then you need to stop and offer it again later. This can be frustrating when you are making up formula and have to discard it, and when you are worried about having an infant, who is not gaining weight and hasn’t fed for a while. Most tube-fed babies of this age have little to no experience of feeding orally or of being hungry. They also have often been through oral traumas, and forcing a bottle upon them may worsen this avoidance, rather than treat it.
The current standard recommendations for healthy infants is to begin transitioning to solid food at the age of six months. This is sometimes the point, when one typically finds oneself struggling with interactions between caregiver and child.
The first thing to remember is that six months is a guideline. Some children will be ready earlier, and some later. When weaning from the tube, some weight loss is to be expected, and initially, contact with food should be about exposure to new flavours and textures, without worrying too much about volume.
Some parents are lucky enough to have children, who sit like a baby bird, mouth open, and readily accept any food given to them. However, many other children are not so easy, especially if they have been fed through a feeding tube.
If you are spoon-feeding your child, you may be tempted to try a little subterfuge here, make the child laugh and sneak in a mouthful, distract them with a toy and do the same. This process, while it gets food into them, is a short-term solution, which, in the long-term, the child will learn to work around. Imagine as an adult, you would be unlikely to enjoy food that was shoved into your mouth unexpectedly when you were not hungry.
Instead we recommend allowing the child to feed him- or herself, if possible. There are lots of finger foods that can be safely enjoyed by a six-month-old. Just place it in front of them for them to see and touch,Making sure food is available frequently to fit in with when the child is likely to be hungry, rather than at adult pre-determined mealtimes.
If your child is a little older, you may be tempted to coax them into eating; offering a reward for trying some food or a promise of pudding, if they eat some vegetables. We want children to eat in response to hunger, rather than a desire to please their parents or get a reward. If you have tried, this you may have noticed that it rarely works. The child’s desire to avoid eating is stronger than their desire for reward and you both can end up just getting frustrated.
Puddings at mealtimes can be a hazardous topic, and you may feel judged by other parents, regarding what type of food is best for your child. At this point, do not worry about whether food is ‘healthy’ or not. First of all, your child is likely to have a small appetite, so foods that are high in calories but small in volume are ideal. Secondly, the important thing is for your child to eat anything. A lot of children who struggle to eat are more sensitive to certain flavours and textures; This often eases as they get older, but only offering them food, which is unpleasant to them, will not encourage them to want to eat.
As a caregiver you can easily fall into the trap of believing that refusal to eat is a matter of discipline. You can find yourself threatening to withhold treats, unless a meal is eaten, or refusing to let the meal end, until a certain amount of food is ingested. It can often seem like the more effort you put into a meal, the more likely it is to be refused!
This is where, hard though it is, you need to step back. A child with aversion to food is not refusing it to spite you. You are not a bad parent, if you let your child turn down a meal. A child who has to force down a cold, congealed meal, while crying and gagging, is not likely to look forward to the next offering.
Another temptation is to distract an older child with television or games and spoon-feeding them while distracted. Although this doesn’t usually distress the child, and we understand the need to have an easy meal every now and then, we don’t encourage doing this very often.
When we work with parents during the tube-weaning process, some of the most significant stress for them comes from perceived and real outside judgement; i.e. the feeling that society judges parents based on what their children eat, as well as pressure from well-meaning friends and relatives.