Growth Expectations: When to Expect Weight Gain Post-Tube-Wean

Weight gain, or the lack thereof, is often the reason that children are put on feeding tubes. And though parents learn to accept a small bit of loss during the weaning process, often the question remains as to when they might see their child begin to gain again post-wean. So let’s see if we might understand what to expect by looking at how orally-eating children typically gain weight.

When orally-eating infants learn to walk, we often see their weight plateau for 3-4 months because their bodies are learning to regulate their food and beverage intake to meet the increased energy demands associated with being more mobile.  Since this growth pattern is typical of age, primary care team members are content to wait it out and reassess growth after a few months. What we need to keep in mind is that this same weight pattern occurs post-wean.  Once supplemental nutrition support via tube is discontinued, it’s important to remember that your child needs time to regulate her oral intake to meet her body’s energy needs in order to promote growth.  This process – regulation and weight gain – doesn’t happen overnight, but rather over a couple of months, which is why we often see weight plateau when the child achieves independent eating status.

It is perfectly ok – expected, even – for your child’s weight to hold steady for a couple of months post-wean. When you see this, you can manage your anxiety by reminding yourself that this will not lead to any cognitive deficits.  However, sometimes, because the primary care team has perseverated on weight and growth while the tube was in place, it can be uncomfortable for them (and parents) to let your child hover in a state of weight maintenance for a couple of months. But don’t panic! Please be reassured that this kind of stall is typical, and that after a few months, oral intake will become sufficient to promote weight gain.  The rate of gain may be a little suboptimal for age to start with, but should continue to progress until your child is meeting standard growth goals for age within 6 months of weaning.  That means that we don’t need to panic or intervene until we hit that 6-month-mark. Only then, if weight maintenance persists and we aren’t seeing the growth that we’d like, we can intervene to further enrich calories of foods and beverages to increase overall energy intake and to promote growth.

So if you are in that post-wean stage, worried about when you should expect to see gains and growth, rest assured. And give yourself, and your little one, time. In time, that growth should pick up and you’ll be well on your way!

Lisa Grentz, MS, RD, CD, Lead Dietitian