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. The Readiness Tool evaluates readiness for transition from tube feeding to oral feeding.

Set simple goals - for example, sitting at the table with your whānau (family) or tasting 1 new food each week.

How to establish a meal schedule for your child

Regular mealtimes

Try to have regular mealtimes. Aim for 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
• avoiding distractions

Sitting for tube feeds

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

Avoiding snacks throughout the day

Try not to let your child snack throughout the day. Offer only water between meals. Eating at other times can affect their hunger. Encourage siblings and other whānau to only eat at regular mealtimes too.

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.

If your child struggles with even the sight of food, start by sitting at the table for short periods without food. Focus on interaction or an activity instead.

How to encourage positive interactions during meals

Consistent instructions

Provide consistent instructions at each meal. For example, let your child know what they are expected to eat. Let them know they need to stay 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
• choosing foods at the supermarket

Give praise

Provide positive attention (praise) for participating in the mealtime. For example, touch, smiling, and encouragement. 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, listening to a song or stacking blocks.

Limit attention for challenging behaviours

Try to limit the attention you give your child when they show challenging behaviours. For example, when spitting food or complaining. You can limit your attention by:

• looking away and focusing on your own food
• not mentioning the behaviour
• staying calm

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 be helpful. You and your child can decide on a reward, and what they need to do to earn it.

Star Charts For Children

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. Choose foods they have accepted or approached before.

New foods in small steps

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

A separate 'learning plate'

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

New foods outside of regular mealtimes

You can give new foods outside of regular mealtimes - especially 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.

More information

You can print a PDF version of the content  on this page and take it with you to your appointment.

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Readiness Tool | Starship

The readiness tool evaluates readiness for transition from tube feeding to oral feeding. You can view or download it from the starship website.

Check out the readiness tool (PDF, 344 KB)

Tube Feeding