Weight is a primary focus from the minute your infant is born and is one of the first questions you ask after birth. And this is a good thing because weight measurements are a part of standard well child care to ensure proper growth and development. Yet, when little ones have feeding difficulties, their weight and other anthropometric data (height, weight, BMI, head circumference, etc.) is gathered more frequently. These frequent weight checks can lead to parental anxiety, and can set parents up to become fixated on the scale because those numbers are often what led to the placement of the feeding tube in the first place. After a feeding tube is placed, sufficient energy intake to promote age appropriate or catch-up rates of growth can still be a struggle because of volume sensitivities, GI discomfort, negative behaviors associated with feeding, etc. and this further perpetuates parental anxiety and stress.
Once an infant or child has had time to improve his feeding skills and has established an acceptable growth pattern with the assistance of tube feeds, an enteral wean can be implemented. Starting a feeding tube wean can be scary for parents because the idea of cutting calories to establish hunger regulation often leads to some initial weight loss. And setting your child up to lose weight is counterintuitive to everything we have been focused on since birth!
When starting a wean, tube feeds are usually reduced by a calculated percentage so that children can start to understand hunger and satiety. We don’t expect children who are primarily dependent on tube feeds to immediately start eating age-appropriate volumes of solids and liquids. It takes time to build feeding interest and volume, which is why weight loss is often seen in the first few weeks following the initiation of a weaning protocol. Weight loss of up to ten percent of the child’s body weight is considered acceptable by industry standards.
And here is where our question comes in: when should we weigh a weaning child? And why is that timeframe important?
Weighing the child too soon after starting the wean can compound parental anxiety and stress, so we often ask for our first weight check to be 3-4 week after starting the wean. We know that weight loss will likely occur during that time, but it is generally not a long enough interval where we would typically reach our maximum level of acceptable weight loss. Instead of focusing on the decrease in tube calories and weight, we want you to shift focus towards creating positive and relaxed mealtimes where the child is offered a variety of delicious family foods. And we encourage you to begin watching your child, rather than the scale, for signs of health: peeing sufficiently? Stooling normally? As energetic as is usual? Etc.
The data obtained at that first weight check will determine how frequently weight is monitored moving forward. Children that only loose 2-4% of their total body weight may not be asked to be weighed again for another 4 weeks; whereas children that loose 6-8% of their total body weight may need to be weighed again in 1-2 weeks.
But of course, a child nearing a 10% loss of his or her body weight does not necessarily indicate a failed wean. Rather, we readjust the weaning schedule to reduce energy intake at a slower rate. So instead of cutting calories by 30%, for example, perhaps we would adjust the plan so that energy is reduced by 15-20%.
Of course, weight is a consideration as we make incremental reductions in energy from tube feeds, but as the wean progresses, our goal is to gradually shift focus off weight and onto mealtime behaviors, quality of oral feeds, and positive feeding experiences. As your child gets more confident with eating and drinking, his or her volumes will naturally pick-up, which promotes growth and development.
Lisa Grentz, MS, RD, CD, Dietitian