Responsive Feeding Therapy with Severe Feeding Challenges: Lessons from Responsive Tube Weaning (Guest Post 1)

From parents and even professionals at workshops, we are often asked, “Well, Responsive Feeding Therapy sounds good, but does it work for children with severe challenges, or who can’t’ feel hunger due to medical issues or feeding tubes?”  In this first guest post of two, we explore responsive therapies where relationship, autonomy and trust are guiding principals. The lessons learned from these challenging cases can apply to every family struggling with a child who is an anxious or reluctant eater.


                            Heidi Moreland graciously shares some of her thoughts around tube weaning.


Heidi Liefer Moreland, MS, CCC-SLP, BCS-S, CLC

Kids who are on feeding tubes have often missed the early period of learning to eat. For some of them, the medical difficulties that led to the placement of the feeding tube may continue to impact their development.  On top of that, the feeding tube itself will impact hunger, making learning to eat seem like unnecessary work. Children who are fearful, who learn more slowly, or have more difficulty with physical coordination are at even greater risk of getting “stuck” in a pattern of fear, feeding refusal and family frustration.

Unfortunately, that often leads to the belief that they can’t or won’t learn to eat in the way that other children do. Parents and other professionals feel that if they want to help children become oral eaters they have no alternative to direct instruction, bribing, or forceful feeding tactics.  The problem is that we know those strategies are harmful to a healthy relationship with food and result in the most fragile eaters being subjected to the most harmful feeding techniques. The negative approaches seem justified when children seem like they can’t or won’t progress with less invasive strategies, but the truth is that they need responsive adult feeders even more than typically developing eaters!

Responsive feeding relies on parents and caregivers to read the child’s cues and give the right amount of support to build small successes. This approach works especially well when weaning children from a feeding tube because it is the perfect opportunity for a new start in building a healthy relationship with food.   In order to develop a firm foundation for that relationship, the first focus can’t be on delivering calories. Forceful feeding and counting calories may feel productive, but it only replaces the tube with a person. We should instead foster the development of competent eaters who won’t be dependent upon us to feed them. Tube dependency, learning difficulties or physical challenges may mean there is a need for more strategic support or longer learning times, but the truths about responsive feeding for all children are still true for them.

  1. Responsive feeding works.
    There is a significant amount of evidence that shows that responsive feeding helps children become lifelong independent, healthy eaters. This should be a goal for all children, even those with difficult beginnings.


2. Responsive feeding is good for family relationships.
The first step is learning to read children’s cues of fear, interest, hesitation, anticipation and enjoyment at mealtimes.  Those are also skills that parents learn when they bring home a new baby. In both cases, there is an interactive learning curve, but the foundation has lifelong importance and will continue as children grow and develop.

3. Responsive feeding develops self-regulation skills.
Self-regulation means learning to control your body, your emotions and your attention.  Most children begin to develop this skill first during feeding and mealtime interactions. For children who have had less opportunity to learn control of themselves and their environment, this is a crucial part of development that shouldn’t be overlooked.

All children benefit from love, support, acceptance and appropriate guidance. All early eaters will benefit from parents and caregivers who are responsive to their needs and help them progress, regardless of when this happens or how long it takes.  Responsive feeding does work for all kids and should be a foundational part of any feeding treatment or tube-weaning process.


Heidi is a treating therapist and clinical coordinator at Thrive by Spectrum Pediatrics.  She has been working with children and families in a variety of settings for 30 years.  She enjoys interacting with the families she works with, but takes particular enjoyment in the pride children show when they realize for the first time that they are an eater.


Photos posted with permission from Thrive by Spectrum Pediatrics


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