When you begin the process of choosing a team to support weaning your child from a feeding tube, we’d encourage beginning with the end in mind: Where do you want to be after the wean? How do you want your home to feel at mealtime? Understanding and articulating what that long-term goal is for your child’s relationship with food will help you pick a team that’s a good match. For us at GIE, that goal is simple: we help families sit down together to enjoy mealtimes that are happy, relationship nurturing, and health-sustaining for everyone involved.
Regardless of where you are in the process of thinking about weaning, and what your personal family goals are, we thought it might be helpful to look at some of the questions that we think should be asked of every weaning program -- and share our answers.
Q: Do you separate children from parents?
A: NO. We view eating as a family activity and a time for being together. You are your child’s best “therapist,” and family mealtimes provide the best opportunity for your child to explore this new world of eating with the people he/she loves most in all the world. Being separated from parents in a medical setting can be scary, and children can’t hear their tummies when they are scared.
Q: Do you track "refusal" behaviors such as gagging, crying, vomiting?
A: Only to make sure that we are avoiding anything that causes distress, whether physical or emotional. Since stress around eating always leads to less eating, we encourage noticing your child’s mealtime comfort, and letting us know if something is off so that we can help make it better.
Q: How do you manage a child's distress?
A: We respond to it empathically, with love and reassurance, and come up with ways to minimize or eliminate it. Eating should not be distressing, ever. Moreover, we guide parents in avoiding feeding styles that rely on coercion, bribes, or other adult attempts to control, which often cause understandable emotional upset, and to instead keep mealtimes happy and responsive. Eating happens in calmness!
Q: How do you see the role of appetite in eating?
A: Appetite is a necessary, central part of the weaning process. But we also recognize it is not the only part: successful weaning also prioritizes trust, joy, autonomy, and respect. Internal appetite and a positive emotional setting only work if they are a team.
Q: Do you use appetite as a driver for creating food interest?
A: Yes! But appetite does not mean “ravenous hunger,” so we are careful to structure a wean to let a child’s appetite to bloom enough to be noticed but not so much as to be overwhelming. Feeling super hungry is also stressful, and… eating doesn’t happen in stress.
Q: Do children have the right to refuse food?
A: Of course! Children have the right to look at their plates and decide that they don’t want to eat the brussel sprouts or the ice cream – just like the rest of us. Respectful eating means that we respect a child’s right to say “yes!” to some foods and “no!” to others.
Q: Are parents told to give prompts, such as "take your bite"?
A: No. Eating should internally motivated, and caregivers should have the tools to recognize and respect “no” or “I’m full” cues. As parents, we are companions and assistants, not “feeders.”
Q: Who chooses the foods?
A: You do! From your family’s mealtime culture and foods. Our goal is to help primary caregivers (mom, dad, grandparent, nanny, etc.) choose and adapt foods to the child’s *current* eating skill level. We support you in choosing foods that you are comfortable with. Whether your family food culture is vegetarian, kosher, low sugar, InstantPot-based, we want you to feed what you would want your child to have. After you have served skill-matched family foods, it is the child’s prerogative to choose what to eat from the foods that have been offered.
Q: Do you insist on specific foods and specific order of foods?
A: No. As the parent, you get to decide what to feed your child – and children get to decide in what order they eat them. Does that mean offer dessert alongside soup? Up to you! We definitely advise on textures that are matched to your child, so that they can be efficient and successful with them, and our dietitian Lisa is available to offer advice on foods for children with allergies or specific dietary needs, or how to adjust liquid calories based on age. (But if a program answered yes, it would be important to understand why and how it relates to your weaning goal.)
Q: Do you use rewards (toys, videos, or a bite of a "preferred" food) in order to get children to eat?
A: No. We do not want to create a “distraction tube” to replace the medical tube. Distractions hinder your child’s ability to hear the “hungry” and “full” cues that his body is sending, and rewards will always lose their shine. We look at eating as something children do for themselves, not for us or for a reward, when they feel appetite, they are with caring people who love them, and the foods they see are matched to their skill.
Q: Do you have timed high-chair sessions during which the child is not allowed to leave the feeding situation?
A: No. We encourage parents to listen to their child – to keep forming that companionship around mealtimes – and to understand a child’s frequent short patience. If a child is done, let them be done. We also encourage you to follow your family eating culture: if everyone stays together at the table, we would help you make that non-stressful for your weaning child. But we look at children the way we look at adults: If you wouldn’t make your friend or a family elder be required to stay in a chair past the point of interest or comfort, we wouldn’t do that to a child either. Again, avoiding stress!
Q: Are you familiar with the Division of Responsibility in Feeding or the Get Permission feeding approach?
A: Yes! Division of Responsibility is a core component of GIE programs.
Q: Do you help families wean to their desired family eating culture, or do caregivers have to continue a "protocol" at home? (Prompts, timed sessions, foods consumed in a given order, rewards)?
A: A family's food and eating culture are exactly what we want to help a family wean to: mealtimes that are familiar and enjoyable for all.
Olga Owens, JD, Parent Coach