Feeding Help for Kids at School and DaycareAug 25, 2021
It’s that time of year again! Back-to-school…but this year is different and more overwhelming than usual. Our kids have been learning, socializing, and lunching at home for most of the past year. For many kids and families, working and learning from home has created changes in routine and new patterns (some good, some not so good). Many of the families I work with have told me that they are practicing more family meals (great news!) but they have found that working and learning from home has led to breakdowns in routines and schedules. Some kids are grazing more on snacks throughout the day, while parents are just trying to survive as they juggle work and a household of bored and hungry kids.
With back-to-school this year, kids will need time to adjust to returning to in-person school, including getting back to socializing with other kids while following school routines and expectations.
Many of the parents I speak with are worried: How will my child with feeding issues eat when returning to school or starting daycare? When kids don't eat well at school or childcare this can be very stressful for everyone - the parent, the school/daycare staff, and of course the child.
Here’s the good news!
Most of the children I see with feeding disorders benefit from attending school or childcare/daycare. Eating with other children and following a structured meal/snack routine helps their feeding development and can reduce picky eating. Often kids’ feeding skills begin to improve when they start school or daycare!
Childcare provides exposure to new foods on a repeated basis and follows the recommended schedule of 2.5 hours between feedings to promote appetite. Meal lengths are offered within a limited time of the recommended 20 minutes, which aligns with kids’ attention spans. Peer-modelling happens every day at every meal and snack. Kids are provided with multiple repeated opportunities to learn about how other kids eat new foods, feed themselves, and drink from an open cup.
Many parents express anxiety and fear about sending their child with feeding issues to school/childcare; however, I always reassure them that the school/daycare routine, peer-modelling, and daily food exposure will likely benefit their child. Some of the kids I see eat extremely well at childcare, but not well at home. This break in pattern from learned behaviours at home can really help kids with feeding issues.
Benefits of School/Daycare for Kids with Feeding Disorders:
- Peer modelling – kids eating a variety of foods that they may not see at home which may help reduce picky eating
- Self-feeding – staff typically encourage self-feeding as soon as possible
- Cup drinking – most childcares introduce cup drinking from an early age
- Regular Schedule – schools/daycares follow a schedule vs allowing grazing which helps with appetite development
- Shorter mealtimes – schools/daycares limit mealtimes to the recommended 20 minutes
- New feeders – a new face/person/feeder can create a change in kids’ feeding behaviours and break learned food refusal patterns
Feeding Tips for Back-to-School
Prepare Your Child in Advance:
For school-aged kids, take your child shopping and let them choose their own fun lunchbox. During the weeks leading up to school, engage your child in helping to pack their lunch with you. Do a couple of “school lunches” at home each week: Ask your child to go and get their lunch box, bring it to the table, and practice opening the containers inside. You can label a number “1” on foods that are for snack time and a number “2” on foods that are for lunchtime.
Always Offer Safe/Preferred Foods:
Most of your child’s school lunch should be foods that your child likes and can eat successfully, but always include 1 learning food in the lunchbox. You can label it “Learning Food”. Tell your child that you expect them to open all of the containers in their lunch (including the Learning Food) and look at what is inside. Do not pressure your child to eat or take a bite of the food, just encourage them to look at it, then eventually over time move the expectation to touching, smelling, licking/tasting the Learning Food. Try cutting foods into fun shapes with a cookie cutter and using small colourful containers to make the food more fun!
I also find for that for picky eaters it helps to prepare them in advance for what will be in their lunch to avoid any sensory surprises – “Today I have packed your bread slices and a cheese string in your lunch.” This reduces anxiety about what they will find when opening their lunchbox. Whenever possible, engage your child in packing their lunch so they feel involved, in control, and prepared for lunch in the school environment.
Feeding Tips for Starting Daycare
Brace Yourself for Bumps at the Beginning:
If your child demonstrates extreme picky eating there may be an initial period of time where your child does not eat well at childcare. I find that most of the kids with feeding issues that I work with take about 4-6 weeks to adjust to eating a childcare, so parents should brace themselves for a bit of a bumpy road at the beginning. Good news again! With repeated exposure and routine, many kids gradually begin to eat some of the foods offered at daycare.
Your Feeding Therapist Can Help:
In more severe cases, where the child is not eating at childcare over long periods of time, a Feeding Therapist can work/consult with the childcare staff to develop a feeding program to support the child’s feeding development and goals. This sometimes involves making exceptions (especially for children with special needs) where parents are permitted to send a familiar food from home to ensure that the child receives some nutrition during the day. This food is always presented along with foods that the other kids are eating for ongoing daily food exposure. As a Feeding Therapist, I work with the daycare staff to provide strategies to introduce new foods in a positive, responsive way. This involves giving the child “helping” jobs like serving foods or scraping their plate at the end of the mealtime. It also involves training childcare staff to engage the child in sensory-based food acceptance steps. A child may begin with just looking at new foods on their plate for the first few weeks, then progress to touching each food before clearing their plate, then learning to smell the foods, kiss/lick the foods, put bite marks on each food, bite and spit-out, and eventually take small tastes and swallow.
Feeding Tips for Childcare Providers and Teachers:
- Kids should follow a mealtime schedule with approximately 2.5 hours between feedings, so they come to the table with appetite.
- Mealtimes should be limited to 20 minutes and snacks to 10 minutes.
- Childcares should always provide a preferred or “safe” food that a child can eat successfully. This should be offered along with foods that the other kids are eating to provide repeated exposure.
- Kids should be able to choose which foods they want to eat. Some daycares that I have visited are practicing Family-Style Serving where foods are offered in bowls in the centre of the table and children can use tongs to choose which foods to eat.
- Kids should never be pressured, pushed, or forced to eat foods. Research has demonstrated that this leads to negative feeding patterns and increase food refusal. When kids become anxious, their cortisol level goes up, which immediately reduces their appetite. Mealtimes should be fun and positive!
- Food should not be rewarded with food (e.g., “You can have your fruit if you finish your chicken.” This sends a message that some foods are better than others, “You have to eat the bad food to get to the good food.”
- The adults’ job is to decide where, when, and what is being offered to eat and the child’s job is to decide how much to eat or whether to eat at all. This is called the Division of Responsibility (Ellyn Satter).
- Kids should control their eating and how much they eat. They should be able to eat as much or as little as they choose. Food amounts should not be restricted or controlled. Kids should not be expected to finish their food due to concerns about “wasting food.”
For extreme picky eaters with restricted diets due to motor/sensory difficulties and children with special needs like medical issues (e.g., tube feedings), parents may consider enlisting their child’s Feeding Therapist to work in collaboration with the daycare around foods and strategies to support feeding outside of the home. I encourage parents to speak with the daycare supervisor/staff or their child’s teacher to foster a team approach to promote their child’s feeding development. A feeding plan always works best when everyone is on the same page supporting a child with the same feeding approach.
Satter, Ellyn: The Division of Responsibility in Feeding: https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/
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