Many of the children that I have worked with over the past 20+ years as feeding therapist require distractions in order to eat. Period. In many cases, these kids will not eat at all unless they are watching a device or playing with toys/books during feedings. These kids typically need distractions because they are anxious eaters or have sensory processing issues that make mealtimes a very unpleasant and difficult task. Parents often express guilt, remorse, and concern about their child’s need for distractions. Parents resort to distractions in order to “get the food in”, as they are in a place of genuine concern, because if they remove the distraction their child may not get enough calories to grow and thrive.
When children have severe feeding aversion paired with weight loss/poor growth, parents’ sometimes resort to force-feeding. I have seen force-feeding in many forms and as much as it’s awful for the child, it’s equally painful for the parent. No parent wants to force-feed their child; they do so out of sheer desperation and over time it becomes their new normal.
As I’ve shared in previous blogs, the more we force children to eat, the worse their feeding aversion becomes. As such, one of the first goals in feeding therapy is to find a way to stop force-feeding patterns while ensuring that the child is still eating and growing. This can be very challenging when a child has no internal motivation to eat. This would be a situation where I would introduce a distraction in place of force-feeding. If an iPad is introduced and the child can sit calmly without being forced and open their mouth when food is presented, in my opinion, this is a worthwhile trade-off. The distraction provides an opportunity to eliminate force-feeding and take the first step toward more positive mealtimes.
Sometimes when children are distracted, they are more likely to accept a new food or slight change to an existing food. I have used distractions therapeutically in feeding therapy with children that are highly resistant to changes in their food preparation. For example, I worked with a 6-year-old boy with severe Autism that only ate 1 food: dry, bow-tie, white pasta at every single meal. When his parents and I used food chaining and tried to introduce new shapes of pasta or a tiny drops of butter on his pasta, he would inspect his plate before the meal and completely refuse to eat if he identified even the slightest change to his foods. Using an iPad intermittently as a distraction allowed us to make gradual changes to this child’s diet and nutrition without creating anxiety and complete meal refusal. He was able to tolerate very small additions of new foods to his existing foods, because he was calm and happy while watching his favourite children’s show. He did not spend as much time inspecting the food for changes. I would talk to him and draw him away from the screen throughout the mealtime so he was intermittently engaged in his food and communication. Through distractions, his parents and I were able to gradually add butter/oil, hummus, pureed cauliflower, cheese sauce, and grated chicken to his very limited diet. He was aware of the changes; however, he was able to tolerate them as his anxiety was reduced and he didn’t feel like he was on sensory overload.
Sometimes being distracted helps us to tolerate something that is difficult. For example, my dentist plays Disney movies during dental repairs. My doctor has posters on the ceiling of his patient rooms to help take my mind off the examination or procedure. I sure appreciate watching those funny little Minions to distract myself from the task at hand. Tolerating new foods can be very stressful for some children, so providing them with a distraction can sometimes reduce their anxiety enough to allow them to tolerate a slight change in the taste or texture of their food.
Yes, of course it’s important to minimize distractions and work toward eliminating them. In a perfect mealtime scenario, children would not have distractions during meals. Ideally the mealtime should be a distraction in itself. During family meals, everyone comes together, talks, laughs, and shares food.
If children are placed in front of a screen during meals or offered toys on their tray this minimizes their awareness and they miss valuable learning and exposure to food. They miss the opportunity to become engaged in the food experience. Learning to eat is a developmental process that involves all of our senses. Children learn about foods by looking, touching, squishing, and smelling. This exploration leads to acceptance of new foods and promotes self-feeding. When children are starring at a screen or playing with a toy, they often do not notice the food in front of them.
Sometimes I see kids open their mouth for the spoon, but then hold the food in their mouth without swallowing because they are so engrossed in their program. Children that are distracted are frequently not eating mindfully and do not learn to follow their own hunger and satiety cues. Often when watching a screen or playing with a toy the child opens his/her mouth mindlessly while watching their program or playing and the parent “gets the food in”, thus determining how much the child should eat. Have you ever made yourself a ginormous bowl of popcorn when sitting down to watch a movie? Have you ever been surprised when you look down and the bowl is suddenly empty? You think, “Did I really eat all that?” Mindless eating can happen when we are too distracted by something. In order for children to develop healthy eating patterns, it’s important that they learn to listen to their bodies and become active participants in their mealtime experience.
As I have said in previous blogs, I rarely practice an all-or-nothing approach with feeding interventions. Distractions do not need to be removed using a cold-turkey method. Removing distractions can can be a gradual weaning process. This helps both parents and children feel less anxiety and more confidence at mealtimes.
Sometimes parents are ready to take a cold-turkey approach and they want to say a firm goodbye to technology at the table. This works for kids that could take-or-leave it as far as distractions. This approach may work if you are comfortable with accepting some behaviours and refusal for a period of time before your child adjusts to the new normal. Again, a first/then approach may help: “First we are going to eat. Then we can watch the iPad.” You can give clear, neutral instructions, “There are no screens at the table.”
In summary, don’t be too hard on yourself or your child if distractions have become a part of your mealtimes. Desperate times often call for desperate measures. Always work toward reducing the use of distractions so your child can explore foods and following his/her hunger cues and learn to listen to his/her body. Distractions may be necessary for a while for kids that have severe feeding aversion, especially if parents find themselves in a position where they are force-feeding their child. If used appropriately, distractions can sometimes help to reduce anxiety at meals and open the door to new foods and textures. Gradually, over time, distractions can be reduced to help your child become engaged in exploring food, actively participating in family meals, and enjoying family time. If you find yourself stuck with the need for distractions in order to “get the food in”, professional assessment and support may be needed. I encourage you to get help…things can get better.