Abby and her speech therapist were making major gains. She had mastered feeding herself, clapping and grinning, clearly proud of her accomplishments. Problem is, it all fell apart when Abby left her therapy center. Her parents tried bribes, rewards and begging, but Abby would simply refuse to eat unless she was nestled in Mom’s lap and spoon-fed.
Six-year-old Abby had been medically fragile, overcoming heart surgery and oral motor concerns. Mom had done a great job supporting and feeding her daughter over the years, but now at age six, the feeding practices that served them well were holding Abby back.
What can you do if you suspect you are stuck with feeding?
- • Utilize the team, bring in the latest information you are working from. Perhaps the advice from two months ago is no longer appropriate.
- • Find out if your child has adequate nutritional reserves to handle changes in feeding.
- • When appropriate, optimize feeding on a schedule, work on family meals. This will be the framework that will help Abby’s parents feel secure moving forward.
- • Explore your fears. Is it hard to let go of your notion of your child as medically fragile or incapable of feeding herself? Are you worried about a feeding tube? Voice your fears to the team. Believe them if they reassure you. (This assumes you have a good working relationship.)
- • Do you believe that if you pressure or push your child to eat more that they will grow better? Has this worked? Ask your feeding team to explain why pressure with feeding often backfires. (Studies show that overall, children who are pressured to eat do less well with eating and grow more slowly.)
- • Make sure that all care-givers involved are on the same page with any upcoming feeding changes. If Dad refuses to feed Abby, but Mom caves in, things won’t change.
- • Find a behaviorist or feeding specialist to work with. Get specific about how you are feeding. Are you eating with your child? Are you minimizing distractions? What kind of chair are you using? Is there a footrest, or soft belts to help center and focus your child? Bring in your utensils and plates. Sometimes having the right fork can make a huge difference.
- • What are you getting from feeding? Perhaps Abby and her mom get special cuddle time during meals? Explore, find other ways to connect, maybe keep the rituals if there is no harm, but be honest about your motivation. (My own daughter was not cuddly, so I held on to that last nighttime bottle longer than I “should” have, but there was no harm to her eating or health, and I needed that cuddle time! Eventually it became clear that it was time to give up the bottle and we did.)
- • Use your discipline techniques that work to enforce and teach behavior at the table. Be calm. Discipline behavior and not what or how much the child is eating. Ask the team or other parents for some ideas on this.
- • Center yourself before a meal. Food, nourishment, the “threat” of a “failure to thrive diagnosis,” and behavior challenges can all combine to make mealtime a high-stress, high-anxiety experience. Your child will pick up on this. Sit down, take a few deep breaths. Try to be pleasant and calm.
- • Have a game plan for making changes. Some thoughts for Abby who has the understanding and skills to work on change:
- • Start with breakfast (you know more snacks and meals are coming.) Be calm but firm with expectations. Do not feed Abby.
- • Be very reliable about offering balanced foods, with a mix of finger foods and spoon foods every 3-4 hours.
- • Get support. Check in with your team. If intake truly is a concern and she eats well for others in the care team, consider sharing duties during the transition.
- • Watch for small victories, but celebrate them in your head. Some kids view any praise or reward as pressure and will back off. Tailor your approach to what works with your child.
- • If positive reward works well, go for it. For Abby, all the offers of stickers and cheering may have slowed things down. Having the calm expectation of mastery might help.
- • Don’t focus on who is eating what. Talk to Dad or Big Sis. Abby might just pick up that spoon when no one is looking.
- • Give the new plan at least three days and longer if Abby has the nutritional reserve! Many parents lose their nerve about twenty minutes into a meal…
- • Understand normal growth and development (See chapter 2 of Child of Mine online at www.ellynsatter.com) so that you know it’s normal to eat small amounts some meals, and larger amounts at others. Allow children the time and space to learn to tune in to hungry and full if they are able. (Children with pain, or other underlying medical issues may have a harder time with this.)
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