Some children with feeding challenges may require a feeding tube. This may be due to the child having inadequate skills to eat or manage their food safely. It could also be due to severe picky eating; if a child eats very little or refuses to eat altogether, it can result in significant nutritional deficiencies.
What is a feeding tube?
Feeding tubes are medical devices used when someone has difficulty eating or drinking. They may need a feeding tube due to difficulties with swallowing, but also due to eating and feeding disorders. Feeding tubes ensure that the individual can still get needed nutrients, fluids, and medication. The need for the tube might be temporary or permanent due to a chronic condition and the kind of tube will depend on the condition and how long it is needed.
How can a feeding tube help a child?
Common uses for feeding tubes include but are not limited to:
Providing nutrition: Liquid foods can be fed through a feeding tube to help provide carbohydrates, proteins, and fats to the individual. This may be their primary source of nutrition, or can help supplement oral intake.
Providing fluids: We all need to stay hydrated! Water can be fed through a feeding tube to ensure the individual is hydrated.
Providing medication: Many children with feeding challenges who require a feeding tube have difficulty swallowing pills and tablets. Any necessary medications can be made into a powder or can be blended with water and fed through the feeding tube.
Types of feeding tubes
There are four main feeding tubes. If the need is temporary, the individual may receive a nasogastric tube (NG tube) or orogastric tube (OG tube), which are placed in the nose or through the mouth, respectively, then feed into their stomach. Formula, breast milk, and even very thin liquid foods can be fed through the tube.
If the individual needs a permanent tube, then they may receive a gastrostomy tube (G tube), which enters through the stomach, or a jejunostomy (J tube), which enters through the small intestine. Although this is considered to be a more permanent option, either can be surgically removed when the person no longer needs it.
Learning to eat with a feeding tube
There is a sense of relief and peace of mind that comes with tube feedings. Your child that has had difficulty eating can now receive proper nutrition and you no longer need to worry about refusal or safety. We know parents commonly want their child to resume or to learn to eat as other children do. It is a valuable skill that can enrich a child’s life in many ways, including socially (think about how often you share memories with your family or friends over a meal).
Parents can start preparing for weaning as soon as the tube is in place, as this will make for a smoother transition to oral feeding (this is also something a speech language pathologist who is a feeding therapist can help with!). We recommend working with your doctor, feeding specialist, and other professional team members to work out a plan that is best for your child and to ensure they can swallow safely; there are always individual circumstances that can change the plan of care. Even if your child isn’t able to begin eating, there are activities you can begin that will help them get ready to eat once it is deemed safe to do so.
Read more about team members that may be needed in your journey to tube weaning.
Activities to help with learning to eat & transitioning to oral feeding
Oral play
Many children with feeding tubes develop strong oral aversions because they are not used to having anything in their mouth, which can cause the whole mouth area to become sensitive. Some children who are tube fed are also afraid of choking, tastes, or textures, and therefore may refuse to have anything near their mouth. Toothbrushes, teethers, and safe toys are a great place to start! This is a new experience for them, so it is important to start slowly and gradually increase the time and extent of the play. You can practice at various times throughout the day until they are more comfortable accepting these items in their mouth.
Texture Play
Sensitivity to texture is a common type of oral aversion. If you notice your child gagging at the sight, smell, and/or touch of a food or any other texture, they likely are very sensitive to texture. Heightened sensitivity can make it more difficult to eat any food. Interacting and playing with a variety of textures including water play, sand play, play dough, and sensory bins can help children become more tolerant of different textures. Frequent exposure can also result in children eventually being more comfortable with different textures in their mouths.
Tasting
If you have been advised that it is safe to start oral feedings, you can start feeding your child small tastes of food. Small tastes provided within positive experiences can help increase their interest in eating. Just don’t forget, this is a process, and it takes time! Yogurt, baby food, apple sauce, pudding, or homemade pureed foods are a great place to start. These initial foods should be smooth and therefore easier for many children.
Timing
Timing is so important to success because your child now has to learn to identify when they are hungry! Most children that have feeding tubes are not aware of when they are hungry because, up until now, food has automatically been deposited into their stomach. Matching up the timing of the oral and tube feeds is key to success as your child learns to identify and understand hunger cues. This should all be done under the guidance of a professional, especially if schedule changes are needed. As your child begins to eat more food orally, you can decrease the amount of food they get from their tube feeding. The goal is to increase the amount of nutrition through oral feedings while lessening the dependency on the feeding tube. This exchange will continue over time until the tube is no longer needed.
Eating and Drinking
At this point, working with a feeding therapist is an important option and resource. The feeding therapist will be able to assist in choosing the volume and variety of foods to best help your child. As your child accepts purees they will begin moving on to foods that need to be chewed. A feeding therapist can help a child strengthen their oral motor skills in order to help them safely chew and control their new foods.
Read more about Pediatric Feeding and Swallowing Disorders and Feeding and Swallowing Disorders in Children on the American Speech-Language Hearing Association’s Website.
This is an exciting journey for any parent! Although, we know that it can be nerve-racking too. Our team at Talk Time Speech Language Therapy is here to help. Our therapists have the experience and knowledge to help guide you through this process. Contact us with any questions you may have!