General Mealtime Strategies To Support Your Child Going From Tube Feeding To Oral Feeding

Setting feeding goals for your child

Try to set small achievable goals for eating. These may be the same as the goals in the Readiness Tool ('Evaluation of readiness for transition from tube feeding to oral feeding'). Set simple goals - for example, sitting at the table with your whānau (family) or tasting one new food per week.

How to establish a meal schedule for your child

Regular mealtimes

Try to have regular mealtimes - 3 meals and 2 to 3 snack times, around 2 hours apart (or 2 hours from the last tube feed).

Structure at mealtimes

Try to have structure at mealtimes. For example, sitting at a table, using a similar bib and placemat each time and avoiding distractions.

Sitting for tube feeds

Have your child sitting for tube feeds (not while playing with toys etc). Tube feeds can take place during whānau mealtimes as well.

Avoiding snacks through the day

Try not to allow your child to snack through the day. Allow only water between meals. Other meals might affect your child's hunger.

Thinking about the meal and hunger together

Help your child think about the meal and hunger together. For example, "it’s been a while since breakfast, is your tummy hungry?"

Relaxation activity

Try to do a relaxation activity before the mealtime. For example, washing hands with lots of bubbles or having a regular song or music to begin the meal with.

Keeping it positive

Try to keep the eating area positive. For example, if your child resists medicine, do not give it in the same room where you have meals.

How long to make your child's meal

A general eating period is 20 to 30 min for main meals, and 10 to 20 min for snacks (for example, morning tea or afternoon tea).

If your child does not sit down for this long, start with short periods. For example, 5 minutes (use a timer), then 10 minutes. This should help your child learn that meals end at set times, and on a positive note, not because of refusal.

How to encourage positive interactions during meals

Consistent instructions

Provide consistent instructions at each meal. For example, what your child is expected to eat, staying in their seat.

Provide choices

Provide opportunities for your child to make choices. For example, the type of cup, utensils or foods. Choices between options are best. For example "You can choose strawberry or vanilla yoghurt", not "What kind of foods would you like today?"

Involve your child

Involve your child in mealtime preparation. For example, cutting foods into shapes, setting the table, and choosing foods at the supermarket.

Give praise

Provide positive attention (praise) for appropriate mealtime behaviours. For example, touch, smiling, and encouraging. Provide praise as soon as you notice these behaviours, and for any approach to food.

Give a short break

For some tamariki (children), it is helpful to give a short break to do a preferred activity as well as praise. For example, blowing bubbles.

Limit attention for challenging behaviours

Try to limit the attention you give your child when they show challenging behaviours (spitting food or complaining). Limiting attention could be looking away, not mentioning the behaviour, staying calm, and keep what you say focused on the expectation. For example, "Our meal goes for another 5 minutes".

Try eating similar foods

Try to eat similar foods at meals to model a positive example and talk positively about food. For example, "My yoghurt is sweet, what does yours taste like?" Have siblings do the same where possible.

Incentive charts and rewards

Depending on your child's understanding, incentive charts or reward systems can also be helpful. You and your child can decide on a reward, and what they need to do to earn it.

How to introduce new foods to your child

Starting with familiar foods

It is best to start with foods that your child is familiar with. For example, they have accepted or approached it before.

New foods in small steps

Introduce new foods in small steps. For example, tiny pieces, or a pea-size amount on a spoon, or at a familiar texture.

A separate 'learning plate'

You can introduce new foods in regular whānau meals but place them on a separate plate. For example, a 'learning plate' or offer them before the rest of the foods.

New foods outside of regular mealtimes

You can give new foods outside of regular mealtimes - for example, if intake during meals is of concern. These might be short 'practice sessions'. For example, you can ask your child to try a few bites of a new food. As your child progresses, you can introduce the food to regular meals.

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Tube Feeding