5 Tips to Transition from Tube to Mouth

Transitioning from tube feeding to oral feeding is a multifaceted process that requires careful planning, patience, and a tailored approach to meet each child's unique needs. This blog will discuss essential aspects and provide guidance for feeding therapists to support a smooth and effective transition.

1. Address Pre-Feeding Skills

Before beginning the transition to oral feeding, it's crucial to evaluate and develop the child’s pre-feeding skills. These include an interest in feeding, breath coordination, and suctioning needs.

• Interest in Feeding: A child must show curiosity about food and a willingness to explore oral activities. This might be indicated by reaching for food, watching others eat, or putting toys and fingers in their mouth. Encouraging this interest can be as simple as allowing the child to observe family meals or offering safe, flavored objects to explore.

• Breath Coordination: Efficient breathing patterns are vital for safe swallowing. Children transitioning from tube feeding may have underdeveloped breath coordination due to their reliance on tube feeding. Practice with non-nutritive sucking (such as on a pacifier) can help improve this skill by encouraging the synchronization of sucking, swallowing, and breathing for some children.

• Suctioning Needs: For some children, managing secretions or saliva is not somethign that they have the oral motor skills to navigate safely and they rely on sectiuoning. Goals centering around closed mouth posture, swallowing saliva, and participating in suctioning tasks may be helpful before they can safely begin oral feeding.

2. Enhancing Interoception by Structuring Tube Feedings

Interoception, or the body’s ability to recognize and respond to internal cues includes sensations such as hunger and fullness. This sense is often disrupted in children who have been tube-fed. They may not naturally associate the feeling of fullness with oral intake because they've primarily experienced feeding through a tube. To foster this connection:

• Pair Oral Stimulation with Tube Feeding: Providing oral motor input, such as sucking on a flavored pacifier or engaging in oral exercises, during tube feedings can help the child link the sensations of eating with the feeling of fullness. This pairing supports the development of interoceptive awareness, gradually helping the child to recognize and respond to their body’s hunger and fullness cues during oral feeding.

• Mimic Natural Routines: A critical aspect of transition is aligning the tube feeding schedule with natural eating patterns. Gradually modify the tube feeding schedule to coincide with regular meal times. For example, if the family eats breakfast at 8 AM, the tube feeding should be scheduled around this time. As the child begins to take in more oral feeds, tube feedings can be adjusted or reduced to encourage oral intake while still meeting nutritional needs. Where medically possible, moving away from continuous or overnight feeds is best for development in this area.

3. Start Small and Build Daily Practice

No matter how small the initial steps may be, daily practice is crucial for building the skills necessary for oral feeding.

• Value Daily Practice: Begin with whatever the child is capable of doing, whether it’s simply exploring a spoon with their mouth, tasting a small amount of puree, or working on oral motor exercises. Consistent, daily practice is essential for developing the strength, coordination, and endurance needed for successful oral feeding. These small, incremental steps are vital in building confidence and competence over time and are way more important that a large home program completed just one time per week.

4. Overcoming Low Tone in Oral Musculature

Children transitioning from tube feeding often have low muscle tone in their face and mouth due to the lack of regular use in eating. This can make the transition to oral feeding more challenging.

• Develop a Home Plan: A structured plan for oral motor exercises is essential to address low tone. These exercises might include lip rounding, tongue lateralization, and jaw stability activities, specifically designed to target the muscles used in feeding. Ideally, a home plan should include the child participating in positive touch or massage to their face and mouth, strengthening their lips, cheeks and tongue, and practicing functional oral motor movements.

• Food Interactions: Encourage interactions with food that match the child's current abilities, such as tasting purees, chewing on soft foods, or drinking from a cup. These interactions provide both the sensory experience and the physical workout needed to build muscle strength and coordination. The focus of food interactions at the beginning is not on how much the child is able to eat, but how flavors and tastes increase the child’s interest and willingness to participate in building strength and coordination in their mouth. Once the child begins to demonstrate improved skills, you can the component of measurable intake.

5. Supplement Oral Feeding with Tube Feeds, Not the Other Way Around

As the child is able to begin to eat a little by mouth, it's essential to make the focus on oral feeds instead of the tube.

• Offer Oral Feeds First: Start each feeding oppertunity by offering what the child can manage by mouth. This reinforces the practice of oral feeding and helps build the child’s skills and confidence. Once the oral feeding session is complete, supplement with tube feeding to ensure that the child’s nutritional and hydration needs are fully met. Over time, as the child’s oral intake increases, the reliance on tube feeding can be gradually reduced.

• Do Not Force Intake by Mouth: Offering foods consistently first should always be presented in a playful and meaningful way for the child. Do not push or force the child to just “take one more bite” if they are showing signs of disinterest and fatigue. Often signs of disinterest are meaningful and represent physical factors such as fatigue or poor coordination. If feeding cues are ignored, the child may actually become more resistive and less interested in eating.

Conclusion

Transitioning from tube feeding to oral feeding is a complex journey that involves addressing pre-feeding skills, enhancing interoception, structuring a supportive feeding schedule, and building strength and coordination through consistent practice. By considering these key areas, feeding therapists can guide children toward successful oral feeding, helping them develop the skills they need to enjoy meals and participate in family life. Each small step in this process is a victory, contributing to the child's overall progress and well-being.

Happy Eating!