When You Worry That it Won’t Work: Lessons from Responsive Tube Weaning (Guest Post 2)

This is the second part of our series around using Responsive Feeding Therapy when the stakes are the highest.  Our first guest post from Heidi Moreland from Thrive by Spectrum Pediatrics can be found here.

When You Worry That It Won’t Work

Elisabeth Kraus, MiT; Becky Keifer, MA-SLP, CCC; Lisa Grentz, RD

Growing Independent Eaters

I’ll never forget that phone call.


I was speaking with a mom who had spent the last years trying to be everything, and everyONE, that her little girl needed. A dietitian herself, she wept as she told me that she never imagined that her child would struggle to eat – struggle badly enough to require tube feeding in order to grow, in order to stay alive. And here they were, years into their journey, her daughter eating and drinking nothing by mouth, all while she tried to function as dietitian, nurse, doctor, feeding therapist, house cleaner, chauffeur, cook, and everything else that you can possibly imagine. Nothing, she told me, was helping her daughter learn how to eat, and she was exhausted – tired from the years of trying to do it all.  “I just want the chance to be a mom,” she said. “I’m don’t think I can keep doing it all.”

I’m not sure if she knew, but I sat on the other end of that phone call, crying myself as I recognized so deeply the pain she felt. She wanted her baby to be okay. She just wanted her baby to eat, not just because she had to, but because she experienced the wonder of family mealtimes and the food served at the family table.

As we spoke, I talked with her about her upcoming journey, the one she would take with her daughter, as they would both wean from the feeding tube that had kept her little girl alive. And I’ll be honest in admitting that this wonderful mom struggled, just a bit, to understand how our approach could work. We were going to help her learn to stop commenting on her daughter’s eating, to simply “let her be, and let her enjoy what you offer whether that enjoyment included eating or not.” Even though she believed in these principles, the thought that they could help a child who was completely orally averse learn to respond to her own body’s cues without prompting, bribing, forcing or distracting – well, it seemed too good to be true.

But it wasn’t.

Within weeks, her daughter was eating family foods at the family table, enjoying a wide variety of tastes and textures with joy! Because responsive, respectful mealtimes work – and here’s why:

  1. Children are hard-wired for autonomy.

Unlike peeing in the toilet or unloading the dishwasher, eating isn’t a behavior that should be extrinsically motivated with sticker charts and screen time. Children are not “good” for eating, and “naughty” for not, and when we, in essence, bribe our kids to “take one more bite” or to “just try it because you’ll like it,” we turn ourselves into human feeding tubes, medicalizing mealtimes, and conveying the notion that it’s okay to ignore the cues that their bodies are sending. Following the Division of Responsibility shows your child that you trust her to choose what she needs from that which you’ve offered. And trust is always empowering.

  1. A child-size portion is often less than we think it is.

In the US in particular, we have become accustomed to larger-than-life portion sizes, a notion which can cause parents to assume their child hasn’t eaten enough, which simply might not be the case. An easy rule of thumb when determining how much food to serve is to look at the size of your child’s hands.  The amount of protein should be able to fit into one palm, and the amount of whole grain should be able to fit into their other palm.  The amount of fruit should be the size of the fingers on one hand and this same rule applies for veggies on the other hand.  So, for toddlers, a couple of teaspoons or tablespoons of food from each food group can be more than sufficient to sustain healthy growth.

  1. Mealtimes are always about more than just eating.

They’re about joy! And trust! And togetherness! Relational sustenance goes hand-in-hand with nutritional sustenance. And in my opinion, we lose sight of our long-term goal when everything that we do at the dinner table is just about “getting our kids to eat.” Because ultimately, there is no “getting,” and healthy mealtimes are often about a shift in control: a shift from parent (putting food into the tube or the child’s mouth) to child (who now gets to decide what goes into his or her own mouth). That is a huge paradigm shift, and a difficult one! And it can start with being conscious about the words we use. Start thinking of your child as an eater. Start thinking of meals, not feeds. De-medicalize the feeding experience as much as possible. Use “life” vocabulary, not hospital vocabulary. Model it for your family and friends. Say it out loud for your own ears to hear. Think of offering food, eating alongside, or facilitating a meal. Hold your control lightly.

So, if your child is medically safe to explore foods, respectful and responsive mealtimes can empower her to do just that. But Rome wasn’t built in a day: while a bulldozer can knock down a building in a matter of minutes, re-building takes time – and the patience to trust the process. So for all of you who are constantly resisting the urge to push “one more bite,” I’m here to offer you some hope: you’ll get there – you’ll all get there together.

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