How to support baby's oral feeding skills while using a feeding tube

Some babies who are born prematurely or have a medical condition need help getting the nutrients they need to grow and develop. When they are unable to meet their nutritional needs with oral feeding on their own, a feeding tube may be necessary. A feeding tube is a small tube placed in a baby’s stomach that allows food and medications to enter.

Although it is common for babies who are born prematurely and have medical conditions to need a feeding tube, it can be very stressful and make parents feel like they’re “failing” if their baby needs more time to reach full oral feeds. It may be helpful to reframe and view the tube as a way to keep all oral feeding experiences feeling safe, comfortable, and positive so babies can get the vital nutrition they need while they work on becoming ready to be a full oral feeder.

A feeding tube provides an important safety net for parents to take the pressure off of them feeling like they need to get their baby to eat when they are not yet ready to do so. In order to build a solid oral feeding foundation and to meet oral feeding goals, babies first need to feel safe and comfortable when they are eating orally. 

If a baby is not able to do this consistently, whether they don’t have enough energy yet or they are not yet physically ready or comfortable, the feeding tube ensures that all oral feeding experiences can feel positive. And when they are not, the tube allows the baby to get the nutrition they need.

IN THIS ARTICLE: 

How do feeding tubes help babies? 

that allows babies to get the nutrients they need to grow and develop. It also protects the baby's relationship with the bottle and/or breast so that when they are physiologically ready to have full oral feeds they can do so comfortably and easily. This is key for long-term eating success. 

Babies who are born prematurely and/or have medical complexities usually have unavoidable aversive experiences in the hospital because of the medical care they require — like NG tube placement and replacement, suctioning, frequent oral care, nasal cannula, CPAP placement, etc. This can make babies feel more stressed or uncomfortable with being touched in and around their mouths before they even start eating. Additionally, these babies are more prone to have more fatigue and gastrointestinal discomfort related to their prematurity or medical conditions, which often negatively impacts their ability to safely and comfortably eat by mouth. This can lead to babies associating their stress or discomfort with the bottle, taste of breastmilk/formula, or even the oral feeding situation. 

This can condition babies to feel stressed or uncomfortable with eating by mouth, possibly leading to long-term tube dependence and impaired oral-feeding skills. In order to protect the relationship between the breast and bottle in the short- and long-term, tube feeding is used for safer, more comfortable feeding. 

4 tips for supporting baby's oral feeding skills 

While tube feeding, there are a variety of positive ways for babies to build and maintain oral -motor skills and a positive relationship with eating orally. 

1. Engage in skin-to-skin contact

Skin-to-skin contact can provide bonding and comfort to babies during tube feeding and minimize negative stimulation. In general, this form of contact can [] calm and relax both a baby and their caregiver, regulate the baby's heart rate and breathing, reduce cortisol levels, and also stimulate digestion and interest in feeding. 

2. Implement cue-based feeding 

Cue-based feeding is a practice that prioritizes feeding babies orally when they’re showing hunger cues, instead of their feedings being by the clock at the same times every day — usually every 3 hours. The cue-based approach to feeding prioritizes quality of feeds over quantity. This can help babies find eating by mouth more enjoyable as well as something they want to continue to do. 

Some early hunger cues include stirring, mouth opening, rooting, etc. A little one who shows any of these cues would then be offered an oral feeding, even if it's been 2 hours since their last feed. 

This method also involves following an infant’s stop cues. If the baby seems stressed, disinterested, or tired during the feed, it should then end the session. If necessary, the rest of the feed would be given through the feeding tube. Also, note that babies would be given an entire feed via their feeding tube if they are not awake, alert, and/or cueing within a certain timeframe specified by providers managing their feeding plan.

Using the feeding tube in this way ensures babies aren’t being pushed beyond what they can safely and comfortably handle when it comes to being fed by mouth. This will allow them to thrive and continue to make progress in oral feeding. An easy way to keep track of baby's oral and tube feeding sessions is through the that allows you to track feeds and make notes about them.

3. Let baby explore with their mouth

Babies learn by exploring with their mouths! Positive touch and experiences in their mouth help them feel comfortable with eating and meeting their feeding milestones in both the short and long term. There are lots of ways to encourage this oral desensitization, typically starting with non-nutritive sucking (on a pacifier or nipple) or tasting breast milk or formula on a finger. Then these opportunities increase around the 3 - 4 month adjusted range when babies typically start showing interest in grabbing objects, putting their fingers in their mouth, etc.

At that age, you can naturally make this desensitization work part of your baby’s normal daily routine. Here are some activities: 

• Try offering teething toys at tummy time. 

• Toothbrushing is another great activity that helps babies get used to being touched inside their mouths. You can start this even before they get their first tooth by brushing their gums with their finger or a small silicone toothbrush. 

• Let them chew and chomp on their own hands if they’re showing interest in this. You can even offer your finger! 

If the baby gags or grimaces during any of these activities, that’s OK. Remain calm and positive, take a break and try again later to keep this type of play and exploration positive. 

4. Include your baby in family meals

Including your baby in positive eating environments can help them learn and grow, even when they’re not actively eating too. Involving your little one in family mealtimes increases their exposure to food and gives them opportunities to observe eating skills that can help them set a positive foundation for their own eating. 

The role of healthcare professionals

It’s important to seek guidance from healthcare professionals as your little one works on their oral feeding skills and makes progress towards full oral feeds. Your care team will likely include doctors and nurses, as well as speech-language therapists, certified lactation consultants or counselors, occupational therapists, and feeding psychologists. Feeding Matters [] is a great resource for families looking for information, services, and support in their area.  

Note that these tips are general suggestions for tube-fed babies but should not replace the care they receive from medical professionals who are familiar with their specific medical history and needs. 

Takeaway

• A feeding tube is a tool used to help babies meet their nutritional needs so they can grow and develop. It also helps ensure that oral feeds can be positive, comfortable experiences for babies who are learning to eat orally.  

• There are a variety of ways that caregivers can help build and preserve their tube-fed baby’s oral feeding skills. They include skin-to-skin contact, cue-based feedings, encouraging their baby to explore with their mouth, and incorporating baby in family mealtimes. 

• Babies are more likely to continue making progress towards oral eating when they have positive feeding experiences. Cue-based feeding means following a baby’s lead when deciding when to start and stop oral feeds and prioritizes quality over quantity.