Aubrey Phelps, MS RDN PPCES IFNCP CLC
When families embark on a wean, it often feels like a pretty clear and linear process, at least in theory. The steps are precisely outlined, and the obvious end goal is an oral eater. Simple enough, right?
While some kids do move through the weaning steps in a linear fashion, so many more find themselves taking a few steps forward only to need to take a temporary step back. For this reason, it’s so important for parents and caregivers to enter the weaning experience with an open hand, remembering that weaning is a bit of a dance: parents and children moving back and forth, learning each other’s cues, and adjusting to each other’s rhythm as changes open up, slowly and progressively, over time.
Often, families will begin moving through the weaning process but will need to do a temporary reset: returning to full tube feeds for a time, re-envisioning the weaning process, and then re-starting the wean. These resets happen for a variety of reasons, which we will explore in a bit, but when faced with the reality that you need to reset your wean, it’s important to know that resets are not failures. They are not the end of the road, and in no way do they indicate that your child is unable to wean.
Here, in no particular order, are some of the reasons that we might suggest re-setting a wean, and every one of them relates to ensuring the wean is eventually successful.
1) Weight Loss:
Temporary weight loss is a safe and expected part of weaning, and that loss is capped at 10% of starting weight. If your child is coming up to that 10% loss or has been weaning for a long time such that their weight has just stayed the same for months, we might recommend a reset to ensure your child can continue weaning without fearing prolonged periods of time without growth.
In most cases, this reset time is used to help get your child back to their pre-wean weight before diving into the wean again. Occasionally, we may reset until they gain a little extra. In any case, when you wean with GIE, your support time doesn’t expire and we’re still here to support you during that transition, especially if full tube feeds make your child uncomfortable and you want to try a more intuitive tube feeding approach.
2) Division of Responsibility (DOR) is Shaky or Non-existent.
Division of Responsibility or DOR is the crux of what cultivates a healthy, happy, long-term eater. It is not just a psychological approach to helping mealtimes feel safe and happy (though it is that as well). It is the approach that helps mealtimes feel peaceful so that your child can begin to hear and regulate their hunger system. For this reason, DOR is not a specific weaning tool; rather, it’s a mealtime approach used to establish and maintain calm, happy, intuitive eating.
If a wean is not progressing as expected, or if a family returns to us because mealtimes have fallen apart, the first “check” on the list has to do with DOR: if families are not following the Division of Responsibility, we do not expect a child to be able to regulate and respond to their hunger cues. So, if DOR is faltering or is clearly not well established, a wean reset allows your child to safely get needed nutrition while their caregivers can improve this aspect of the eating experience.
3) Distracted Eating:
This is closely related to disintegrating DOR.
As the wean goes on, we often find families getting more and more anxious about their child’s intake (or lack thereof), and rightfully so! It’s scary to be cutting tube feeds more and more, only to feel like your child is barely licking a Goldfish cracker! And then, one day, you discover that if you let them watch a silly show, bring out your phone or tablet, invite toys to the table, read books, and dance all around – they eat! And so, slowly but surely, every meal turns into a literal song and dance, and caregivers find that they have exchanged a medical feeding tube for a human one.
While distractions may “work” in the short term, they won’t for the long haul. The novelty always wears off. So, when families ask if it’s ok if they “do XYZ to get their child to eat,” my response is usually, “Do you want to be doing this 2 years from now?” If the answer is no, then you shouldn’t do it now either!
Distractions prevent kids from hearing and connecting with their bodies. When that happens, they aren’t able to hear their own hunger and satiety cues. Long-term, that’s a recipe for increased and adamant food refusal! So, if families have introduced or become dependent on distracted eating, a reset is often necessary in order to mitigate those refusals without risking a full lack of nutrition.
4) Illness:
Depending on how a wean has progressed, we may encourage a temporary reset if your child comes down with an illness. Kids who are sick most often refuse to eat – as we all understandably do! So, if illness sprouts early in the weaning process, we may encourage families to back up, utilize full tube feeds, let their child fully recover, and then begin again!
5) Consistent Mealtime Stress:
Weaning is stressful – it is an exercise in losing control! And it’s not easy to trust your child to eat when your child has literally never eaten before. If this stress goes unmanaged for too long, it can leak into every area of life. So, if your weaning team notices that the stress seems to be overwhelming, if it’s impacting children to the point that they cry at the sight of the bottle or hate coming to the table, particularly if we’ve been at this weaning thing for a few weeks, this can often be a good time to reset and make sure everything is in place for calm, peaceful, non-pressured offerings. And it’s WAY easier to do that when you don’t feel the added pressure and concern of knowing your child isn’t getting adequate calories or nutrition.
At the end of the day, most families face the chance to reset during their wean, and while that can be frustrating and disappointing, it’s so important to remember that resets aren’t failures. They’re just an opportunity to regroup, take a deep breath, and try again. It is ok if your child needs a few tries when they are learning something as important as how to fuel their own bodies!
Any skills that your child started to develop while weaning initially are almost always retained so we often see kids move through a subsequent wean attempt much quicker and with greater ease. And ultimately, the goal of a reset is to support everyone as they establish a lasting relationship with food. So, if you or your team feels a reset might be a good idea, think of it more as a “second chance,” a bend in the road, or a bonus opportunity to really nail these foundational pieces for long-term success and happy family meals.