To tube feed or not to tube feed?

My daughter has had ongoing eating issues. She grew wonderfully for the first 6 months of her life, but violently resisted the introduction of solid foods, and gradually drank less and less milk as the months wore on. However, there was no obvious cause--if she had reflux at the time, it was not major, and all the specialists we've seen believe it's behavioral. At one point (around 9 months) we could entertain her with toys to keep her drinking, but she grew tired of that and now we just feed her when she wants, how much she wants. Usually, it's very little and occasionally she goes on fasts with very little drinking.

We worked with therapists, a pediatric food "psychologist", and so on, who basically said we were doing what we should. Miraculously, she began eating at about the 13 month mark--suddenly she decided she did want food, and would even try different things and let us feed her. It was a major shift, and as we were on the wait list for the g-tube, we were hoping this would let us avoid it.

Since then, she's been picky and inconsistent. Her food intake for a day rarely adds up to more than a few tablespoons, although she does have the occasionally unexpectedly big meal. She drinks fortified formula or fortified breastmilk, with extra fat and formula powder (about 350-400 ml/day). We add unsalted butter to anything she seems willing to eat. She wakes up several times a night, partly to feed, but doesn't have much.

Anyway, the last three weeks have passed with no weight gain and her g-tube appointment is in a week. Her primary pediatrician thinks she should go ahead and take the plunge and that it may help her get on track. But we're finding the decision difficult, because she does eat, even if it's inconsistent and insufficient. Right now, she is about 3rd percentile in weight--14 months old and 8.4 kg. At 6 months she was in the 75th percentile. If we put off the appointment, it will be at least a couple of months before we can get another one. In the meantime, we aren't really worried about dehydration (which so far hasn't happened) but we don't expect her to suddenly increase her intake and grow faster.

Anyone have words of wisdom as we think this over?

IMO
i think she would be ok with out it. My DD was born in th 90th%ile.. she is now 9.5kg at 25 months... we have had alot of issues.. mostly hers are absortion issues she will eat and eat..

our pead suggested polyjoule as well as high fat(cream and butter on everything)
how is she if she feeds herself? (no spoons) does she like to play with food?

the breast milk will be doing Alot of keeping her nurished(is she breastfed aswell as EBM?)

i hope it gets sorted soon.. at about your DDs age was when my DD started to "improve"

I would put it off for another month or so before you go down tube feeding path, my dd was born off the top of the charts and at the 13.5months is the same weight as your dd, she has been hovering around 8 to 8.5 since 11.5 months.

Some kids don't eat heaps and are happy without it all.

My neice who is 6 and will be 7 in november is only 14-15 kilos now. And she was a picky eater as a bub and is healthy she is just a little girl.

Are you tall/large build, because if you are a small build and dh then myabe dd will be to.

hold off.
if its making you feel uncomfortable and she does eat just small amounts and does drink daily then thats not to bad
my DD who is 24 months only weigh 10.2kilo and was always in the 50th percentile she is now just in the 3rd
she eats some days its alot others not much, she has only this week eaten breaky every morning and eaten half her dinner we dont serve her big meals, but she will graze all day on fruit and cheese.

maybe try getting her to feed herself make it a game teach her to count using carrots say eat 2 carrots then count 1, 2 or something so she doesnt think she is eating but is if that makes sense.

A couple of clarifications. She was not jsut born at 75th percentile, she was there or above for the first seven months of her life. It was at that point when she fell off rapidly. Games & such for eating aren't really a solution because she has shown clear food aversion. For months she didn't want anything in her mouth, especially food. At seven months, if any food got in she would leave her mouth dangling open until it dribbled out. At ten months, the highlight of her eating would be sucking an animal cracker--but as soon as it turned soft or started to break up, she would put it down rather than risk swallowing something. She would go through spells where she would clearly be hungry (rumbling stomach, for example), and would drink half an ounce and then stop abruptly. So it's not really an issue of her just being a small baby or going at her own pace (which, obviously, would be fine). But it's also not an issue of her having an underlying physical abnormality.

Putting a g-tube in before, when she didn't eat even a crumb, would have been an easier decision. The problem for us is that she's shown progress, just not enough to meet her caloric needs. If there's anyone who's been in a similar situation--considering putting a g-tube in a toddler or a baby with food aversion, we'd love to hear how it worked for you. In the meantime, thanks for all your replies so far!

Just stumbled across this post now but probably too late - what did you decide? My feeling (as a speech therapist) is to hold off on tube if she has started eating. It may take a while but it is wonderful that she is making progress as it sounds like she has a significant aversion to oral intake. My experience is the sooner you can get her to take food orally the better you will go in the long run. If she doesn't need the food (because she has the tube) you could find it harder to get her to want to eat orally (as she will feel full). It's such a difficult decision though as she certainly needs the nutrition. I presume you are seeing a speechy to assist with oral intake suggestions? She is still very young so I'm sure whatever you decide she will make gains either way. Best of luck and my thoughts are with you.