Tube to Breast
Navigating the Transition from Enteral Feeding to Breastfeeding
In this 5.5-hour, self-paced continuing education course, OTs, SLPs and PTs will learn concrete skills to be confident to introduce and optimize breastfeeding with the goal of weaning enteral feedings.
Providing CEUs & L-CERPs for Healthcare Professionals
IBLCE Long-Term Provider
Treating infants who are tube-fed can be intimidating and challenging.
This course covers the reasons why infants may need enteral tube feedings, key differences between continuous and bolus tube feedings that have implications for weaning, as well as ways to promote a positive introduction to breastfeeding.
Focus is placed on factors that must be in place before weaning enteral feedings and red flags that warrant further evaluation.
Course Learning Objectives
Participants will be able to:
- List at least three reasons why infants may need enteral tube feedings
- Identify key differences between continuous and bolus tube feedings that have implications for weaning
- Describe three ways to promote a positive introduction to breastfeeding for infants who are tube fed
- Recognize three specific things that must be in place before weaning enteral feedings for breastfed infants
- Identify three red flags when working on weaning enteral feedings with an infant that would warrant further evaluation from a medical provider
- Recall unique considerations between weaning an infant who is tube fed and a child who is tube fed
Infants who are tube-fed are complex — so don’t rush as you complete this CEU course. This course is self-paced. You can pause, replay, and watch the videos as many times as you’d like — which is especially nice since you may not always have an infant on your caseload who is tube-fed.
- Learning objectives
Enteral Feeding Overview
1 hour 3 minutes
- Reason for tube feedings
- failure to thrive
- oral aversion
Considerations for Breastfeeding
- Strategies for facilitating safe oral experiences at breast
- Importance of breastmilk for health and well-being of high-risk infants
- Necessary components of parent education
- Sensory considerations for the use of various types of enteral feedings
- Review of current available literature comparing various methods
- Pediatric NGT to GT decision tree
- Establishing goals of feeding therapy
Breastfeeding & Tube-Feeding
- Common barrier and strategies for introducing breast to tube-fed and/or bottle fed infant
- Alternative feeding strategies (cup, paladai, spoon) with case video and images
- Use of nipple shields for transitioning to the breast
- Strategies for breast flow management
- Clinical assessment to measure ongoing progress
- Case Study A: Infant with NICU admission
Intervention Strategies & Considerations
- Supporting milk supply when infant has tube feedings
- Transitioning from continuous to bolus feedings to weaning
- Type of enteral feedings to transition to full oral feeding
- Tube weaning process: a stepwise approach
Team approach to the tube weaning process
Video: Breastfeeding Examples
Clinical use of breastfeeding scale for clinic vs. home
Research & Clinical Reasoning
Clinical reasoning for transitioning from tube feedings
Review of available research for weighted feedings and tube weaning outcomes
Case Study B: Premature 28 weeks infant with intraventricular hemorrhage
Red Flags & Complex Cases
Red flags when weaning from tube feedings
VFSS vs FEES
Breastfeeding the infant with dysphagia
Case Study C: Infant with Hypoxic-Ischemic Encephalopathy (HIE)
The Bigger Picture with Tube-Feeding
- Tube weaning for children
- Intensive tube weaning protocols
- Tube dependency
- Depression in parents of tube-fed children
- Inpatient tube weaning programs
- Home-based tube weaning programs
- Sensory approach to tube weaning
Psychological impact on parents when there is long-term tube feeding
Transitioning from tube-feeding to breastfeeding is possible for many infants with the right assessment, preparation, and interventions. This course will help you gain a deeper understanding of all the factors so you can make clinically sound, research-informed decisions.
Kelly Andrasik McLeod OTD, OTR/L, BCP, IBCLC, CNT
Kelly has been an occupational therapist for over 14 years, practicing in both adult and pediatric settings. She specializes in feeding and swallowing rehabilitation for medically fragile infants in the neonatal intensive care unit. She has received her advanced practice certification in “Swallowing Assessment, Evaluation, and Intervention” and was within the first group of therapists to become a Certified Neonatal Therapist (CNT). Additionally, she is trained and certified as an International Board-Certified Lactation Consultant (IBCLC).
Kelly received her doctorate degree in occupational therapy (OTD) in 2019 from Kansas University Medical Center, where her focus was occupational therapy’s role in maximizing breastfeeding support and improving breastfeeding outcomes for medically fragile infants. In addition to her clinical passions focused in the NICU, Kelly is a passionate instructor, serving as an adjunct faculty member at Kansas University Medical Center’s post-professional occupational therapy doctoral program.
The Lactation OT is an AOTA Approved Provider, ASHA CE Approved Provider, & IBLCE Long-Term Provider
Frequently Asked Questions
Who is this course intended for?
- Occupational Therapy Practitioners (OT & OTA)
- Speech Language Pathologist (SLP & SLP-A)
- Physical Therapy Practitioners (PT & PTA)
Are there prerequisites for this course?
There are no required prerequisites.
Can I count this course towards my 90 hours of lactation-specific education?
Absolutely! This course is approved for 5.5 L-CERPs. To receive credit for completion, each participant will need to complete a post-assessment with a passing score of at least 80% to ensure all learning objectives are met.
Information about AOTA CEUs
This course is approved for 0.55 AOTA CEUs for occupational therapy professionals
Participants will be required to:
- Complete the course in its entirety (100% of the course watched)
- Complete a multiple-choice post-assessment with a passing score of at least 80% (untimed test)
Information about ASHA CEUs
This course is available for 0.55 ASHA CEUs for speech language pathologists. To receive ASHA CEUs, participants will be required to:
- Ensure you are eligible to receive ASHA CEUs! Click here for more information
- Complete the course in its entirety (watch time is tracked by the learning management system)
- Complete the multiple-choice post-assessment with a passing score of at least 80% (untimed test, 3 retakes)
- There is no option for partial credit
Information for Physical Therapists
APTA does not approve individual companies and you will need to check with your individual state for online course requirements.
To best prepare you can save the following:
- The certificate of completion that will be provided
- List of references
- A copy of the assessment questions
How long will I have access to the course?
6 months from the purchase date.
What is your refund/cancellation policy?
Refunds must be requested within 14 days of purchase by emailing [email protected]. A full refund is available if no modules have been started. A partial refund is available once ANY portion of the course has been viewed. The amount refunded is at the sole discretion of The Lactation OT LLC. There is no refund available after 14 days of purchase OR if module one has been completed. Recipients will receive acknowledgment of refund requests within 3 business days. If the request is valid per the terms listed above, the refund will be processed within 7 business days. If for any reason the course is canceled by The Lactation OT before the course is started, a full refund will be provided.
How do I request special accommodation?
Please send us an email at [email protected] at least 14 days before starting the course with further details of your request.
You can support families of infants who are tube-fed and facilitate the positive introduction of breastfeeding in many instances. Having a deep understanding of enteral feeding and the red flags that may arise during weaning will help you provide the best outcomes for the infants on your caseload.
Bundle, Save, and Earn a Badge
Medically Fragile Infant (14 hours)
Breastfeeding Assessment and Intervention for the Medically Fragile Infant: Reframing the Clinical Approach
Failure to Thrive, Suboptimal Weight Gain, and the Lactation Savvy Therapist
Tube to Breast: Navigating the Transition from Enteral Feeding to Breastfeeding
The Lactation OT is proud to provide lactation-specific continuing education and resources to OT, SLP, PTs, IBCLCs, and healthcare professionals. Your clients depend on you, and we’re here to support you as you provide effective evidence-based care.
Thanks for joining us. Together we can continue to raise the level of care in lactation and infant feeding.