Children with medical challenges (e.g., prematurity, cardiac, respiratory, neurological, gastrointestinal, swallowing), and/or severe feeding aversion may require tube feedings to support their growth and nutrition. There are many reasons why children have difficulty with feeding. While some children will outgrow the need for a feeding tube, others will have a feeding tube for their lifetime. As a Feeding Therapist, I seek to support parents and caregivers of children that are tube-fed regardless of their unique experience. It is important to recognize that what may work for one child and family, may not work for another.
Tube feedings are intended to partially or fully replace calories from oral feedings and may be recommended to enhance weight gain or improve the nutritional status of a child who aspirates (food or liquid enters airway/lungs) or does not have the endurance to meet nutritional needs via oral feedings.
In my experience, feeding tubes are often viewed as the...
In Part 1, I discussed how children learn to accept new foods through a sensory hierarchy of looking, touching, smelling, kissing, licking, biting and spitting-out, and eventually chewing and swallowing. In order to help your child work through these steps, your job is to provide repeated exposure to new foods in order for your child to learn about them.
In Part 2, I shared information about the child vs caregivers’ role at mealtimes. I provided actionable 10-tips to help your child work toward food acceptance.
Hopefully, you now have a better understanding of the steps children go through when learning about new foods along with your role as caregiver to help your child be successful.
In last week’s blog (Part 1), I shared the sensory steps that kids often go through when learning to accept a new food. Your child may not be ready to chew and swallow a new food; however, he/she may be comfortable looking, squishing, smelling, or kissing the food. In time, he/she will work toward food acceptance, at his/her own pace.
Ellyn Satter is a renowned Registered Dietician who termed the “Division of Responsibility” or Golden Rule in feeding: Adults decide what food is served, when it is served, and where. The child decides how much to eat, and whether to eat at all. I highly recommend her website (link in references below) and resources. I often share Ellyn’s golden rule as a handout with the families I work with and I ask them to post-in on their fridge as a daily reminder:
Imagine you are visiting a new country. You are staying with a friendly group of people that enjoy fried grasshoppers as part of their culture and cuisine. They love fried grasshoppers. Watching these people crunch into the big, juicy grasshoppers with bits of legs and tentacles breaking off makes your stomach turn. Sometimes during mealtimes, you feel like gagging, as you are not familiar with this food. They keep telling you how delicious the grasshoppers are, and they constantly pressure you to just “try it”.
New foods are like fried grasshoppers to kids with feeding issues; they are scared of the food. The sight of a new food might make their stomach turn. They may gag or even vomit when pushed to “try” a new food. Foods that are familiar to you and me, like carrots, berries, and pasta might look like fried grasshoppers to a child with a feeding disorder. These kids do not...
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...
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.
Like many of you during this crazy-time, I have been adjusting to working from home and balancing full-time life with my hungry kids. The days can feel long, and sometimes the next meal is the most exciting event on the agenda. My teens seem to finish their last bite of food at dinner and ask, “What’s for dinner tomorrow night?”. Yikes...no pressure.
Historically, as a mom, I’ve never been a meal-planner…I’m not one of those organized people that plans a week of meals in advance. I’m more of a fly-by-the-seat-of-my-pants chef, typically deciding on dinner based on what’s left in the fridge. This has changed significantly for me during this pandemic. Here’s why:
Parents often ask me for advice about how to encourage their child to self-feed.
Common questions include:
• Should I force her to feed herself?
• Should I let him go hungry, so he starts self-feeding?
• Should I introduce utensils or let him use his hands?
• What if she doesn’t eat enough?
The answers are no, no, yes and worry-not.
Babies should be provided with opportunities to self-feed as early as possible. Babies and children that are allowed independence and control of their eating tend to be happier and more adventurous eaters. They are also better at regulating their hunger and satiety cues.
Self-feeding is a developmental process. It can start by simply allowing your baby to hold their own bottle or your breast. Some babies initiate this themselves; others need gentle encouragement. Children with developmental delays or a disability may need extra support to become involved in their feeding times. As soon as solid food is introduced, babies...
Growing-up, my family always ate meals together. Truth be told, mealtimes were pretty stressful in my house, as my parents were very strict about table manners. Nevertheless, it was a time where I remember coming together, sharing food, and communicating. Looking back, some of the things my parents did were not in-line with what I would recommend as a Feeding Therapist. We were expected to always finish our plates and we were forced to eat foods that we didn’t like. My parents were doing their best, but now, through research, we know better. Studies have demonstrated that kids eat and grow better when they decide how much to eat and follow their own hunger and satiety cues. We also know that forcing or bribing kids to eat foods they don’t like doesn’t work; it actually reduces their willingness to eat the food. As an adult, I avoid most of the foods that I was forced to eat as a child (e.g. kidney beans…ewwww!) Pushing kids to eat or...
A mealtime is meant to be a positive experience; a time to take a break, come together, share our culture, and communicate. Mealtimes and food are about giving and receiving love. We show our love through food. It is central to our lives. We celebrate with food and bring food when someone is grieving or in need. When a child has feeding issues, mealtimes can become a source of stress and frustration for parents. Often parents tell me that they dread mealtimes with their child. They describe dramatic and lengthy meals along with exhausting power struggles over food intake.
Ongoing mealtime power struggles can actually contribute to picky eating and food refusal. Pressuring kids to eat is often unintentional, but it can lead to reducing a child’s likelihood to eat. Successful mealtimes are built on trust. If a child feels stressed and anxious at mealtimes, they may want to feel like they have some control…and this often comes in the form of food refusal. Your child may...