Grazing is for Sheep…

When children who have been tube fed for a majority of their lives begin the process of weaning off of the tube, it becomes really easy to feed them all day long – because we’re so invested in them eating, and we don’t ever want to tell them that it’s not time to eat. But in order to utilize appetite as a motivator for eating, it’s important to foster a normal physiological GI cycle, giving the stomach the opportunity to fill all the way up (signaling the brain that the body is full), and then giving the stomach the chance to empty (signaling the brain that the body is hungry, and ready to eat!)

Snacking all day long (grazing) prohibits the brain from sending those signals because your body is never full or hungry. And if neither of those signals – fullness and hunger – is ever triggered, your appetite doesn’t have a chance to kick in and motivate eating. And in my practice, I have seen fully tube fed children wean successfully simply by eliminating grazing, and instead by providing structured meals and snacks with clear beginnings and ends. I have watched this establishment of routine aid in skill development because appetite is an intrinsic motivator for intentional eating – and intrinsic motivation! There’s nothing more powerful!

So to foster a good, healthy appetite, caregivers should consider having their child’s tube feeds resemble as normal an eating schedule as possible. Mirror your oral feeds to the same pattern, remembering that infants can eat anywhere from 6-8 times per day, toddlers eat 5-6 times per day, and school-aged children eat 4-6 times per day. Anything within that spectrum is normal. For example, when weaning an infant, we may encourage parents to eliminate continuous night feeds, letting the baby wake to eat because as tired as we may become, that is what babies do!

When it comes to toddlers and older children, however, our expectations change: we expect these kiddos to only eat during the day. But regardless of age, every mealtime should have a noticeable beginning and a noticeable ending. (Notice that I am not referencing “feeds,” but mealtimes – because it’s important to begin thinking of tube feeds as mealtimes.)

For all children – infants on up – we like mealtimes to last for about a half an hour. This includes bottle feeds or toddler meals: a half an hour maximum is a good goal. More so, we encourage parents to plan for there to be at least 1 hour before the beginning a meal where no food or drink is offered. This is so the body has time to signal the brain that it’s hungry. If meals and snacks are too close together or are small and consistent all day long, the brain doesn’t receive the necessary hunger cues from the body.

So if your child is stuck in a grazing pattern and stalled in their progress, consider changing your routine to establish clear meal and snack times. You may just find that appetite is just the ticket!

Becky Keifer, MA, CCC-SLP, Lead Feeding Therapist