Set Achievable Goals

Goal setting with the family and interdisciplinary team is essential to planning the enteral to oral transition approach. Defining success exclusively as ‘full oral feeding and tube removal’ can be counterproductive as this may not be achievable depending on the child’s underlying diagnosis and ongoing medical issues. Placing pressure on families and the child to increase oral volumes, sometimes at the expense of pleasurable mealtimes, can result in a sense of failure rather than focusing on each small success throughout the process.

Occasionally despite a thorough assessment, it is not possible to identify the underlying feeding difficulty or issue impacting oral intake until a child starts to reduce tube feeds and show interest in eating. Consider the following factors when setting goals with families and the interdisciplinary team to move from tube to oral feeding:

• safety of swallow and health status
• adequacy of weight and growth
• ability to consume food or fluid by mouth safely
• ability to tolerate bolus/intermittent feeds
• skill and texture acceptance
• volume of food and fluid taken by mouth
• accepted food range or variety
• pleasure and social participation

At each stage of the transition process, it is important to identify the current goal and work toward it rather than trying to work on all goals at one time. Support children and their families to facilitate autonomy, enabling the child to develop skills that will support oral intake.