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Feeding development and difficulties

Sam

  • Transition from tube to oral feeding in a baby with transient developmental delays

    • Transient delays in development may occur for a variety of reasons including prolonged hospitalisation or prematurity.  Some children will require tube feeding to meet nutritional requirements.
    • Learning to drink and eat solid foods and reducing dependence on tube feeding will parallel development in other areas.   It is recommended to focus on the child’s stage of development rather than their age.
    • Babies whose development is disrupted during the transition from reflexive to voluntary sucking may have difficulties learning to feed from the breast or bottle. In line with development of oral motor skills they may transition directly from tube feeding using a cup for obtaining fluids.
    • Focusing on social interaction and enjoyment at mealtimes rather than on the amount of food eaten reduces mealtime stress and supports feeding development.
    • Regular follow- up is important for managing parent’s expectations and disappointments which interfere with their capacity to implement strategies or result in the advertent use of strategies that contribute to further difficulties. 

    Case scenario

    Sam aged 5 months has complex congenital heart disease.  He required surgery in the first week of life after which he was commenced on Nasogastric tube feeds.  He then had multiple complications with several admissions back to ICU. Growth during this time was slow. 

    He is now medically stable with weight tracking below the 5th percentile on WHO growth charts and is ready for discharge.  His parents are keen to establish breastfeeding and remove the Nasogastric tube.  They are also eager to starts solids. 

    An appointment for a review of feeding by the Dietitian and Speech pathologist is made for 3 weeks after discharge.  It is suggested solids not be introduced prior to the review and that parents should continue offering the breast or bottle and providing nasogastric top ups.

    Remember to consider your own response before viewing suggested answers.

    Question 1

    What reasons might have been given to Sam’s parents for not introducing solids before his outpatient review?

    Answer Question 1

    Solids are recommended at around 6 months when babies show signs of being developmentally ready. Possible reasons for not introducing solids during this time may have included:

    • Prolonged hospitalisation has led to transient delays in Sam's physical development.  He currently does not show signs that he is developmentally ready for solids.  Opportunities for him to discover and mouth his hands, explore toys and have tummy time developing his motor skills have been limited. The Physio and Occupational Therapists have provided Sam's parents with strategies to promote his physical development.  Links to come OT resources
    • Nasogastric feeding and hospital routines can make it difficult for babies to learn to recognise or give cues to indicate hunger and satiety.   Sam's parents may also have had limited opportunities to learn to read his cues.  
    • Sam is being offered the breast and or bottle prior to nasogastric feeds.  He is currently only taking small amounts.  Adding another feeding task at this stage may not be helpful.  

    A few weeks developing routines at home, getting to know each other and allowing time for progression in Sam's physical and oral motor development may be beneficial to his feeding development.

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