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.
Parent Question: How can I help my child with Autism with his feeding issues?
Throughout my career as a Speech-Language Pathologist I have worked with children with Autism Spectrum Disorder (ASD) and feeding challenges. Children on the Autism Spectrum have a significantly higher incidence of feeding issues than typically developing children. These are some of the feeding differences I have encountered when working with children with ASD:
“Just offer your child what the rest of the family is eating. If he gets hungry enough, he will eat”
This logic does not apply to all kids, especially to children with ARFID (Avoidant Restrictive Food Intake Disorder) or those with severe selective eating/sensory-based feeding issues. I have seen this myth in practice. Children with severe feeding issues will often go without eating, rather than eat foods that they feel they “cannot” eat. I say “cannot” because these kids view the food as something that they are unable to eat. It’s not a matter of not wanting to eat it, they feel that the food cannot be eaten. Instead offer your child foods they can eat successfully along with foods you would like to introduce. I ask parents to use the 75-25 rule. This means that 75% of the plate should be familiar foods the child can eat, and 25% should be new foods for exposure and learning.
“My doctor says not to worry, my child...
Feeding issues are extremely distressing for parents. It’s normal for parents to want to know why their child is having feeding issues, when they are often surrounded by other kids that are eating well. Seeing other kids eat well is frustrating and painful for parents and they often tell me that they wish their child would eat like their friends’ kids. I find it’s helpful for parents to understand the “Why” of their child’s feeding challenges. In my 20-years of experience as a feeding therapist, these are the 7 main reasons children have feeding issues. Many kids have more than one contributing factor, which can make feeding even more challenging for little ones and their families: