I have spent endless hours in my clients’ homes talking to parents about their children’s feeding issues. Naturally, I talk about about cups, self-feeding, textures, and mealtime strategies to encourage the development of healthy eating patterns. Yet in equal measure, I have spent hours at kitchen tables, on couches, and living room floors counselling parents about the incredibly emotional and painful side of having a child with a feeding disorder: the mental health part. The part that doesn’t get talked about much. The part that frequently brings exhausted parents to heaving sobs during our meetings.
I wear many hats in this profession: Feeding Therapist, Counsellor, Advocate, and hopefully Friend. When I was a teenager working as an office telephone receptionist, each morning the manager would walk by my desk and say, “Good morning, Nicola: Friend of the Friendless.” As a clinician and a good human I continue to strive for this: to be a friend of the friendless. To listen and empathize. To understand people that feel misunderstood or unheard. Isn’t that what we all need from a friend: a person to hear us, without judgement? A friend that “gets us”; a person to recognize and acknowledge things that no-one else “gets”. When it comes to feeding issues, grandparents often don’t “get it”, other parents in the playgroup don’t “get it”, the doctor doesn’t “get it”, and sometimes even a spouse doesn’t “get it”. Feeding disorders can be a long, tiresome, and lonely journey that impacts the entire family unit. When I move away from talking to parents about cups and food textures and address the elephant in the room by naming their feelings and acknowledging the difficult journey they are on, it’s cathartic. Someone finally “gets it”.
When I was being trained as an S-LP (Speech-Language Pathologist), I completed 3-years of full-time, intensive Master’s level courses: Anatomy, Neuroscience, Statistics, Speech and Hearing Science, etc. None were so valuable or relevant as the course called “Counselling”. I truly wish more of my graduate training had been dedicated to this area of our profession, as I had no idea how much I would need it. I rarely get through a work day without counselling a crying parent as we discuss the emotional pain associated with their child’s feeding issues. I remember in grad school learning about professional boundaries, like not hugging clients or sharing details of my personal life. I wholeheartedly disagree. Throughout my career I have become a better person and clinician by sharing my own experiences as a mother of a sick child (with feeding issues), hugging my clients when they are hurting, crying with them, and hopefully being a “friend of the friendless”.
So let’s name the pain.
Many parents dread the next meal with their child. They are exhausted. Tired of the power struggle. Burned-out. Overwhelmed. Mealtimes with a child with a feeding disorder can be fraught with stress, tears, gagging, and food refusal. Children with feeding disorders tend to be kept in their chair for longer than typically developing children or “good eaters”, which further contributes to both the child and parents’ stress and exhaustion.
Parents often tell me that they finish one meal and it’s almost time to start the next one. These same parents have frequently been told by a doctor that their child is not growing adequately. These are the most terrifying words for a parent and they will do almost anything to get the food in, which translates into force-feeding, tricking, using distractions, lengthy feedings and mealtime power-struggles.
Parents often blame themselves for their child’s feeding issues. In truth, parents are rarely to blame. There is almost always a physiological reason that kids have a feeding issue (e.g., gastroesophageal reflux, sensory processing issues, oral-motor delays, complex medical history, etc.). The feeding issue is secondary to an underlying or overt physiological issue impacting the child’s ability to successfully eat. I try to address this during my first visit with parents. I take them off the hook as quickly as possible and explain that it’s not their fault; then I watch their shoulders come down and the tears flow.
As parents we all fear doing something wrong that will mess up our kids. I know I do. My son was born with a rare, life-threatening autoimmune disease. I spent hours wondering what I might have fed him or done to him to cause his illness. Although the logical and educated side of me knows otherwise, I’m honestly not sure if I’ve ever let myself completely off-the-guilt-hook. When things don’t go as imagined for a child, we often reach toward self-blame.
Parenting a child with feeding issues is completely and utterly exhausting. Parents may feel hopeless; that nothing will ever get better. Progress with feeding development tends to be very slow…incremental. Parents are consumed in their child’s feeding issues…every day…every meal…every snack. They are reminded of their child’s challenges and delays every time they see another child eating “normally”. Every visit to the mall, a play date, or a friend’s house is a reminder that their child is not able to eat like a typically developing child. This is excruciating for parents. “If only my child could eat like my nephew. I’d give anything.” Parents question why their child can't eat like other children.
To add insult to injury, family members and friends make comparisons and often give bad advice by telling parents that they should just force the child to eat or let the child go hungry and they will eventually learn to eat. Alternatively they say, “You should just leave him at my house for a week. I will teach him to eat.” This suggests that the parents are doing something wrong and undermines their parental abilities, creating further frustration and feelings of inadequacy and failure. It also compromises the advice they are receiving from professionals, which makes parents question the treatment path. I often spend sessions reassuring parents about the evidence that supports the approach we are using and assuring them that they are doing the right thing regardless of the advice and judgement from friends and family members.
The parenting books and magazines present images of healthy thriving babies drinking from breasts/bottles and digging into their food with vigour. The images show parents laughing, smiling, and cuddling their baby while bonding and enjoying the mealtime. This is what parents envision. There are no images of prematurity, gagging, neonatal intensive care units, surgeries, feeding tubes, vomiting, force-feeding, poor growth, and feeding aversion. This was not in the manual. There is often a disconnect between what parents imagined feeding times would be like and what their reality looks like. Parents often express exasperation stating, “I didn’t know it would be like this.” followed by overwhelming feelings of guilt for feeling that way. Feeding issues affect the bond between parent and child. The lovely, warm, cuddly feeding visions are shattered when a child can’t latch, vomits with feedings, and pushes food away. Parents express a great sense of loss over what they had envisioned and what could have been. They worry that things will never get better.
Society is making great strides toward addressing and talking about mental health. As clinicians treating feeding disorders, we can’t compartmentalize our role. Yes, we need to provide evidence-based practice and strategies and interventions to support children’s feeding development, but we can’t ignore our role as counsellors and client advocates.
Dear Parents: You are doing a fantastic job. You know your child better than anyone. Your parenting instincts are good. Please seek help if you are scared, sad, overwhelmed, and feel unheard. Talk to your feeding therapist. Talk to your doctor. Ask to be connected with mental health support. Things will get better.
Dear Clinicians: Please reach out to parents in your sessions. Talk about the hard stuff, the emotional side, the part that brings floods of tears and difficult conversations. Help take these parents off-the-hook. Listen, acknowledge, empathize, and provide hope. If parents express that they are feeling overwhelmed, depressed, and hopeless, become their advocate and help them to access mental health resources to support them on their journey.