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

5.5 L-CERPs

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

Timed Agenda

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.

Course Information

9 minutes

  • Introduction
  • Disclosures
  • Learning objectives
  •  Course overview

Enteral Feeding Overview

1 hour 3 minutes

  • Reason for tube feedings
    • metabolic
    • failure to thrive
    • oral aversion
    • sensory
    • medical
    • dysphagia

Considerations for Breastfeeding

58 minutes

  • 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

41 minutes

  • 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

48 minutes

  • 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

30 minutes

  • 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

44 minutes

  • 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

30 minutes

  • 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


7 minutes

  • Psychological impact on parents when there is long-term tube feeding 

  •  Closing thoughts

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 since 2008, 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. 



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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

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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.

Looking for more information? Have a comment or complaint? Send an email to [email protected]. View complaint policy here.