In this interview we'll look at how parents of children with special needs can take steps to reduce stress eating and other unwanted habit behaviors with guest expert, Cookie Rosenblum. Cookie has an incredible podcast, Weight Loss Made Real (link below) with over 2.6 million downloads on iTunes. Cookie has a Masters Degree in clinical psychology with a specialization in addictive behaviors, as well as two additional coaching certifications. She’s been working with individuals and groups on weight loss and emotional eating issues for over 35 years using a blend of brain science, psychology, life coaching and life experience.
Links mentioned in the video:
Cookie Rosenblum's website: https://realweightlossrealwomen.com/gift
Weight Loss Made Real Podcast: https://podcasts.apple.com/gb/podcast/weight-loss-made-real/id1070598794
Episode 1: The Difference Between Emotional Eating, Binge Eating and Compulsive Overeating https://podcasts.apple.com/gb/podcast/episode-1-difference-between-emotional-eating-binge/id1070598794?i=1000389833430
Episode 6: Troubleshooting When to Start and When to Stop Eating https://podcasts.apple.com/gb/podcast/episode-6-troubleshooting-when-to-start-when-to-stop/id1070598794?i=1000362490826
Episode 7: Managing Your Mind to Manage Your Emotional Eating https://podcasts.apple.com/gb/podcast/episode-7-managing-your-mind-to-manage-your-emotional/id1070598794?i=1000363022071
In this video, we will talk with award-winning estate planning attorney, Paula Peaden, about estate planning for children with special needs and special needs trusts.
Links mentioned in this video:
Paula Peaden https://www.parkerpollard.com/attorneys/paula-l-peaden/
Special Needs Alliance https://www.specialneedsalliance.org/find-an-attorney/
Able Now accounts: https://www.able-now.com/
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In this video we'll walk through all things related to venting children with a feeding tube (or g tube), including basic steps, troubleshooting, positioning and more.
This series is going to cover the how-to and some top tips for gravity feeding, syringe feeding and venting for children with feeding tubes. We are not specifically covering feeding for infants less than a year old or children who use feeding pumps, but venting applies to any child with a feeding tube, regardless of how the feedings are administered.
And before we get started, if you like these topics and want to hear more, please hit like and subscribe in YouTube!
In the first video we talked about comfort and making sure the tube feeding is going well and developing a Plan B when the feeding isn’t going well. And now we’ll get started on the second topic in this series, which is venting. Venting is one of those topics that I think is very underrated in terms of its usefulness.
Venting can be an incredible tool, not only to keep your child comfortable during a feeding but also to understand how your child is processing food and whether the food needs are changing.
What is venting?
Venting is a quick procedure where excess air (and even food) is allowed to flow out of the stomach by using a syringe. Venting is so important to tube feeding because not only does it release excess air in the digestive track that can be problematic BUT IT ALSO gives you a lot of information about how the feeding is going and even more generally, about what your child’s feeding needs may be as they change over time.
So first, how does air get in the stomach?
There are multiple ways:
In our first clip we go over the basics of how to vent.
You can see that here we’re following the basic steps:
How often do you vent?
For our child, we typically vent prior to a feeding, about every 20%-25% or so throughout the feeding and then we vent about 10 minutes after the feeding. We also vent periodically between meals or as free water is given. Venting takes about 30-60 seconds. Our son has both a feeding tube and a nissen, which can trap air more frequently in the stomach, so that is something we take into consideration. Once you experiment with venting and, as we’ll talk about later, once you make sure that your child is actually in the right position to vent effectively, you can figure out your own venting protocol. Whatever you decide, make sure that is communicated to everyone who is feeding your child to make sure that your child is consistently comfortable during feedings.
So once you vent, a couple of things to keep in mind:
Are you getting a LOT of excess air? If so, you may want to examine what the child ate to see if there could be a food intolerance, particularly if you are introducing new foods (like a blenderized diet). If this is a new issue and food is not the culprit, you may want to consult your GI to see if there could be another issue going on like bacterial overgrowth. If your child is constantly building up excess air (like from swallowing air for example) you may want to talk to your doctor about using a Farrell bag which funnels air out of the stomach continuously.
Here are a few additional clips of venting, what it looks and sounds like.
Here’s one other concept for venting that I think is very, very important and may be overlooked. I am going to demonstrate on a bottle in the video. Pretend the bottle is a stomach, and the feeding tube is the black dot on the bottle. When the bottle is upright, its like a child sitting in an upright position. Where is the air? Its at the top? Where is the feeding tube? It’s in the middle. Is the air near the feeding tube? No? If you vent this child, will you really be getting the excess air out of the stomach? Only maybe. If I turn the bottle, this is similar to a child laying flatter. Is the air near the feeding tube? Yes. My point is this: you may be going through the motions of venting and you may be getting some air and some stomach contents, but I think it is VITAL that you experiment with different positions to vent and you may find you are much more successful in a more reclined position, simply because of the physics of air in the stomach relative to the feeding tube placement, even if your child tolerates eating while sitting upright.
Now what else does venting tell us? Venting can show us how much food is coming back out into the syringe. If you’re in the beginning of the meal, and stomach motility is optimal, you likely won’t see a whole lot of food coming back out. If you’re closer to the end of the meal, it would be more expected to see more food coming out into the syringe, but a LOT of excess food (like more than ~1 oz or 35 mL) may indicate a few things:
I’ll give you two specific examples:
We find with our son that sometimes we need to increase his calories if he’s going through a growth spurt. Once he is done with that spurt, sometimes we find he becomes overly full and isn’t accepting the same volume and calories as before- when he starts consistently backing up food into the syringe for several meals in a row when we vent him during feedings, we know that we need to pull down the calories and volume somewhat.
Another example is that when we were first experimenting with foods for a blenderized diet, we tried avocado. When we fed him the blend with avocado, he would back up a lot of food in the syringe during venting. We learned that the combination of fat and fiber in this particular food was not a good fit and slowed down the rate at which his stomach processed food.
On the other hand, if you’re bolus feeding (i.e., not using a feeding pump and/or doing continuous feeds) and getting minimal stomach contents toward the middle or end of a feed (or nothing) two things could be going on:
1) you may want to look into whether your child is getting enough food at a given feed and/or enough hydration. OR
2) and this is critical, when you vent toward the mid or endpoint of the feeding, and you do not get much of any stomach contents, this can also indicate that something is blocking the feeding tube and preventing air and food from passing. By the end of the feeding, there should be some nice flow of stomach contents coming out into the syringe. If there’s nothing, you should be a suspicious.
This gets to our number one troubleshooting technique for venting. Actually, you can use this trick for venting or feeding. We call it the “reverse vent” because instead of removing the plunger and allowing the stomach contents or air to naturally flow into the syringe, you are going to leave the syringe plunger in the syringe and actively pull out some of the stomach contents. Sometimes you will find that fiber from the food or even mucus in the stomach can be blocking the flow of air or stomach contents from coming out of the feeding tube. If you are going through the motions of venting but nothing is coming out, the child can actually be building excess air or be getting overly full, uncomfortable and even nauseated, and you might not know it because the flow of stomach contents out of the tube is blocked.
If you reverse vent and you pull back “gunk” into the syringe (a few mL’s) we discard that and then try flushing and venting again to make sure we’re getting air and food back into the syringe. We include a clip of what this looks like.
So those are the basics on venting. As you can see, venting can be an incredible tool, not only to keep your child comfortable during a feeding but also to understand how your child is processing food and whether the food needs are changing.
If you liked this video and blog post, please Like and hit subscribe on YouTube if you’d like to hear more on these types of topics and please leave a comment or drop me a line through the contact page on this site.
Additional links: More on stomach air and venting:
This video is the first in a three-part series on feeding and venting children with feeding tubes. This video gives a fundamental overview of maintaining comfort and connection during a tube feedings and developing a clear Plan B when there's an indication that your child is not tolerating a tube feeding, which can be followed consistently by everyone feeding the child. Included are some tips for what to look for (in a non-verbal child) and considerations for how to optimize the success of a feeding.
We are not specifically covering feeding for infants less than a year old or children who use feeding pumps, but there are similar concepts and ideas so even if you are feeding an infant or using a feeding pump I encourage you to watch anyway.
Being aware of a child’s comfort and connection during feeding is so important because it sets the tone for your child’s experience and happiness during the feeding process and putting some thought in this area can really optimize a tube feeding experience.
Whenever someone feeds a child through a feeding tube, making sure the child is comfortable and that it is a positive experience (or at least not a negative experience) is very important. Sometimes a tube feeding can be stressful for the parent and child, particularly if the child has a history of vomiting or gagging and retching. When your child is verbal (speaks), it is much easier to understand whether they are comfortable or if they are starting to feel pain or nausea because they can communicate that to you. Many feeding therapists will advise that it is often counterproductive to continue feeding when a child feels uncomfortable or sick, yet parents can feel enormous pressure to keep going because they want their child’s basic nutrition and hydration needs to be met or they may be wanting to closely follow the instructions of their doctor or therapist. This can cause a negative feedback loop with a child that can make feeding issues worse. I would urge you to consult your feeding therapist to find ways to make your child more comfortable. Maybe you need to explore what you are feeding your child with a dietitian to see if something in the food could be causing discomfort. For example, my son doesn’t tolerate certain foods and they cause intestinal distress which causes gas and bloating, which is uncomfortable. Sometimes children have less issues with blenderized food than commercial formula so that could be something to explore. Sometimes positioning during feeding is the issue, sometimes the feeding speed, or amount of food, or excess air can be the issue. Sometimes the parent is so agitated that the child picks up on that stress and becomes stressed themselves. All of these issues should be examined if your child is uncomfortable. If you suspect something more serious is going on, of course, involve your child’s medical team. For example in cases of chronic reflux, where food and stomach acid come up into the esophagus, there are medications, positioning techniques, and even surgery that can mitigate that condition.
The bottom line is that there are a lot of things a parent can explore to make feeding a positive and comfortable experience for the child.
Suzanne Evans Morris (who I interviewed in my video on considerations for a blended formula) gives some wonderful advice and guidance on this in her book Homemade Blended Formula Handbook in Chapters 12 and 13.
If your child is non-verbal, it can take a little more observation to know whether your child is doing ok with a feeding. You will have to be aware of non-verbal cues, such as body movements, facial expressions or other changes that equate to pain or discomfort.
To give you an example, when we feed our son, we are conscious of his normal baseline state. He is typically happy and engaged, he often smiles and laughs, he rarely cries or winces. We understand his normal body movements and facial expressions when everything is ok.
Some signs that he is NOT doing ok with a feeding are:
Take a minute to think about the last time you felt sick during or after eating or right before you vomited. We’re you salivating? Did the corners of your mouth turn down? Did you start breathing a little heavier because you were so uncomfortable?
What can you do if this happens?
Every parent should have a Plan B for feeding in place. This may be something you create with your GI or feeding therapist or you may develop it on your own over time. Plan B’s are very individualized because children are different. If anyone else is feeding your child, like a nurse or caregiver or family member, they should know about the Plan B as well. It is very important that the Plan B is communicated and applied consistently to everyone feeding your child.
To give you an example, this is our Plan B:
A. Be aware of the signs that the feeding is not going well (we’ll talk about this in another video, but continuous observation is one of the key elements of tube feeding)
B. If ANY of the signs are observed, Immediately stop feeding- hoping that things will get better and continuing to feed is typically not a good idea, for us anyway. It will almost always lead to vomiting. Also, don’t wait for multiple signs. One sign is enough to take a break.
C. Immediately vent the stomach, which we will talk about in more detail in another video in this series. By venting the stomach you will do two things:
1) release any excess air which could be taking up room in the stomach and leading to feeding overly full, which can cause nausea or pain; and/or
2) allowing any excess food to come back out of the stomach to relieve some of the pressure.
If a lot of food comes back out into the syringe, you may want to throw some of that away and allow the stomach time to digest with the smaller amount of food. You may need to quickly reposition the child to vent effectively. For example, the child may do well eating while sitting up but may vent more effectively by being reclined. Quickly taking these steps can not only relieve discomfort, but you may be able to prevent vomiting and losing the meal. The key is being observant and have a Plan B that you can quickly fall back on.
D. Restarting the feeding. You’ll want to allow some time to pass. You’ll want to also take into consideration where you were in the feeding. If you’re close to the end of the feeding, you may want to stop the meal altogether. It is normal for all children, tube fed or not, to require more or less food on different days or at different times. Sometimes when our son is in a growth spurt, we notice his stomach motility is increased, his stomach may growl more often, and when we vent him we see very little stomach contents (i.e., food) remaining in his stomach. Other times, we can see that he has more stomach contents (i.e., food) left than usual and fills up faster, which means he’s not requiring as much food at a certain meal.
If you were in the beginning or middle, you may want to keep going with caution after a break. In our case, if we decide to continue the feeding, we typically allow 15-20 minutes before restarting a feeding to allow time to digest, particularly if a lot of food came out of the stomach when we vented (which tells us that the motility may be a little slow and/or we fed too much too fast). Then we will go at least twice as slowly as we did in the beginning, venting frequently and continuing to watch for signs of discomfort.
E. Investigate. Whether or not you decide to restart the feeding, if you have had to engage in Plan B, it is also a good idea to do a little investigating. If your child does not normally become uncomfortable or nauseated during mealtimes, what was different about this one? Was there something different about the food? Was there more food or was the food fed at a faster pace? Was this meal closer to other meals or free water than usual? Have any medications changed? Could your child be constipated? Was your child in a different position than usual? For example, our son has cerebral palsy and has very low tone through his midsection. If we feed him while he is upright or seated, he slouches and it decreases his stomach volume which can lead to being uncomfortable or nauseated when we feed him. We have learned that he does best being fed laying down on a wedge. Some children need to be more upright, like being reclined in a wheelchair, due to reflux. So being aware of a child’s optimal position is important. Again, we’ll talk about this in the venting section, but some children don’t release air as well in certain positions and that air buildup can make children nauseated, so thinking about positioning not only for feeding but for venting is important. And be aware that sometimes those positions are different.
Lastly, it is important to take into consideration the environment where the feeding is taking place. Basically, you want to feed a child in an environment where they can be happy and relaxed; feeling stress while eating can be counterproductive to any child’s eating habits.
Think about the elements type of environment in which you like to eat and in which you
don’t like to eat. Noisy or quiet? Messy or clean? Rushed or relaxed? With people who are happy or people who are stressed? With people ignoring you, or interacting with you and noticing how you feel? Children often have the same preferences.
If child feels like their signs of discomfort are routinely ignored, it may be hard to them to relax. Consider whether it possible to feed the child with the family at times? Or at least with a family member or caregiver who can positively interact with them during the feeding, and observe any signs of difficulty. Even if a child is non-verbal, assuring them that you are noticing how they are feeling during the feeding can be comforting. Maybe the child likes listening to music or singing? Or with young children, maybe they can be held while tube feeding? If your child can safely take some food by mouth, offering bites of food they can play with or taste while tube feeding can make the meal more enjoyable.
I hope this has given you some ideas to think about as you tube feed your child. The other videos coming up in this Feeding and Venting Series will focus on the specific techniques for feeding and venting.
If you liked this video please hit like and if you want to hear more about these topics, please subscribe. Please leave a comment or send us an email at email@example.com.
Thanks for visiting!
Mentioned in this video: Homemade Blended Formula Handbook Chapters 12 and 13
Being a caregiver to a child with significant special needs for over a decade, Laura McGrath wants to provide support and information to the special needs community.
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