[Going from the tube feeding to the oral feeding in infants]. / Passage de la nutrition entérale a l'oralité chez l'enfant.

Tube feeding has greatly improved the vital prognosis in neonatology. However, after a varying time of tube feeding, the return to oral feeding can present quite a challenge for some infants. Moreover, going back home with tube feeding can cause succession of ordeals for the parents. Our purpose is to work out a successful return to home by having prepared the infant for future oral feeding at the very beginning of the hospitalization. Going from minor to serious pathologies, we describe a method aimed at helping the infant's sucking and an alternative method of cup feeding; both intended to avoid a very harmful forced feeding. We have to organize tube feeding, while inuring the mouth to tasty stimulations, and establishing a frequency comparable to the normal feeding rhythm. The intolerance to a bolus of food or rapid flow rate occur when the oral cavity and the oesophagus are bypassed by the tube. The digestive physiology requires observing the digestive chain reaction going from the mouth to the small intestine.

Weaning children from tube to oral feeding.

Most of the children seen by specialists in neonatalogy, neuropaediatrics or neurosurgery do not have any problems in starting with oral feeding after a period of tube feeding lasting between 15 and 20 days. Children who have been tube fed for a longer period, however, can find it very difficult or even impossible to re-establish oral feeding when they have sufficiently recovered from their underlying problem. To cope with this situation we propose a procedure based on the afferentation or re-afferentation of the oropharyngeal cavity by sensory stimulations and by re-establishment of the biological clock (circadian rhythm) by applying these stimulations during tube feeding at regular hours. In 19 children who showed difficulties oral feeding became possible a short time after such a procedure had been applied. If the principles of swallowing neurophysiology and the biological rhythm are respected, this procedure, which also involves a contribution from the family, leads to quicker oral feeding and shorter stay in hospital.