Feeding your child is one of the first and most basic tasks of parenting a child. It is how we bond with a newborn, nurture our growing children, teach them manners and social skills, celebrate milestones and lay down a lifetime of memories. Feeding establishes the first relationship in a child’s life, a relationship ideally based on trust and mutual respect for both parent and child. Meals and mealtimes are the basis of many family, community and social interactions. When your child has difficulty eating or gaining weight, these important relationships, routine social interactions, and important life cycle events may be interrupted, and you may think you are not being a ‘good enough’ parent. Your identity as a parent may become disrupted and give rise to continuing distress, anxiety or guilt. A child’s feeding difficulty may develop into adult feeding disorders, emotional problems, learning and social skills problems, or wide spread family distress. Feeding therapy by an occupational therapist can help.
Occupational Therapy is the art and science of using activities to help people rehabilitate from injury, disease or developmental delay, so they are able to carry out meaningful productive tasks and activities to support participation in daily life. A child’s occupation is determined by how old they are chronologically and developmentally, and would include their ability to play, move through space, socialize, learn, and take care of themselves. Learning to eat is one of these developmental skills. A child’s ability to eat a variety of foods and become an independent eater develops in synchrony with his age and development. Remediation of concerns with feeding focuses on seeing the child as a whole person and carefully assessing a child’s history, skills, family and social situation and their individual preferences.
When evaluating and treating feeding problems, the first step is a thorough evaluation. The child’s medical and feeding history is carefully examined. Frequently, feeding problems begin early in life and can be traced to early health problems or the medical interventions that were done to cure them. Other causes may be from congenital, developmental, neurological, or physiological disorders and/or motor or sensory problems that affect either the whole child or only their oral areas. For example, gastro-esophageal reflux is a common ailment of early infancy that has been shown to predispose babies to feeding disorders. A child’s developmental, emotional, and sensory-motor skills are all important to the big feeding picture and need to be assessed and integrated into the treatment plan. Oral motor and sensory problems need to be addressed and remediated and are frequently the foundational basis of many feeding problems.
Eating is much more than just putting food into our mouths and swallowing. Feeding therapy likewise is more than a focus of just what and how much a child eats. Feeding therapy requires participation of the child and family as active members of the team. The family’s mealtime habits and attitudes about food, the family’s and child’s food preferences, and the extended family and community as they impact the child’s eating are all examined as possibilities for growth and change.
Our job as parents is to nurture our children to become successful, independent, happy adults. A Talmudic story compares a child to a quiver of arrows on a bow. To launch, a child must first be pulled toward us, but to soar they must be released. It is important for parents to find the balance between control and permissiveness, as our children are moving from dependence toward autonomy. Learning to eat should be seen as a journey, not a final product. Enjoy the adventure as your child discovers his personal eating style.
Before You Get Started with Feeding Therapy
- Communicate with your primary health care provider about your child’s basic health, weight and developmental issues, your concerns, and how feeding therapy will be funded. Find out what your insurance will pay for, if your child is eligible for Regional Center funding, or other possibilities for reimbursement, such as an HAS.
- Clarify your concerns so you can communicate them to potential therapists.
- Find a good fit- look for a therapist with clear communication and interpersonal skills that you can form a long lasting relationship with. Feeding therapy is not a fast fix. You want someone who can relate to your child, your self, your family and your needs, who share your goals for your child and understand your child’s issues. Do not hesitate to ask potential therapists their educational background, continuing educational experiences, and philosophy of treatment.
- Assemble your team. Involve your partner or co-parent, and any other important adults in your child’s life; whether it be your spouse, primary nanny, secondary baby sitter, parents or in-laws, extended family members; teachers, other therapists, or friends you see often. Anyone who is involved with your family and child in feeding or mealtime on a daily or weekly basis needs to know what you are doing, what your goals are, and what the program is. Conflict and disagreements among the adults in your child’s life will hamper change. Learn how to politely dismiss naysayers or those who will try to bobby trap your efforts.
- Prepare to expend time, energy and resources. You may feel you are wasting food when it just gets thrown on the floor. You may be faced with multitude of washing duties, of clothing that is dirty, dishes that get served but only overturned, food that gets purchased and prepared but is only rejected. Your patience will be tried, your energy drained by yet another tantrum.
- Understand that feeding develops in an irregular, crooked line. It is one or two very small baby steps forward, three giant steps back when your little one gets sick, the family goes on vacation, or for no apparent reason at all.
- Adjust your expectations. Look at the much bigger picture, as well as the bite size achievements from meal to meal. Appreciate the importance of small changes in behavior, manners, attitude, language, or just the ability to sit at the table with the family, rather than how much or what your child is eating.
- Recognize that feeding and eating is a multi-faceted, complex activity. Feeding is much more than just putting food into our mouths and swallowing. It is a vastly complex yet individual task, a process that involves our physiology and digestions, our sensory and motor systems, our expectations, attitudes and beliefs, and those around us.
- Prepare to learn. About yourself, your own feeding history and habits, and your beliefs about food and eating. You may be challenged by what you learn about yourself.
- Be prepared to make some changes. You may need to change your daily or weekly schedule, your expectations for yourself and your family, your eating or shopping habits, or your attitudes about food, eating and mealtimes.