Welcome back readers! At Headstart for Life, we believe in a holistic approach to paediatric intervention. In our previous posts, we’ve talked about play, executive functioning, social skills, speech, language, cognition and behaviours. In this blog post, let’s expand even further and dive into the world of food, FEEDING.
A wide variety of studies suggest that on average, 20% of children struggle with some type of feeding and/or growth issue during the first 5 years of life, dependent on whose perspective is viewed. Most of the time, children with issues on feeding are often described negatively by adults around them. When we start describing children as “lazy ” or “stubborn”, we are immediately jumping to conclusions that their issues are psychological.
Stop. Let’s take few steps back, and rethink…
When trying to understand and manage “problematic” behaviours during mealtimes, think sensory first!
Remember, behaviours of children, especially those who have issues in communication, are their way of expressing themselves. These behaviours are there for a purpose. Children behave differently in hundred other ways, and we as adults are responsible to be more observant and smart enough to interpret the meaning of these behaviours. It is not an easy task, but as you breakdown these behaviours, the communicative intent and function become more apparent.
Last year, I had the opportunity to attend a training workshop done by Dr. Kay A. Toomey, PhD and Dr. Erin S. Ross about assessment and treatment using the SOS (Sequential Oral Sensory) Approach to feeding. This approach rationalises the importance of the sensory system when treating feeding issues among children. When the sensory system is not functioning at its best, the child will likely spend more time and energy protecting himself than exploring the food presented to him. He will start to limit his food choices to a narrow group of familiar foods that he has previously experienced.
According to K.A. Toomey and E.R. Ross, children behave with 3 purposes:
1. To escape from an aversive stimulus.
When children show maladaptive behaviours, this is because he/she cannot deal with the situation and the body’s immediate reaction is to flee from the item/action/event. When you start chasing your child around the house with a spoonful of food, clearly, he/she does not want to be in that situation.
2. To get a desired object/interaction.
You notice that your child starts throwing food from his plate during mealtimes and you keep picking it up over and over again. Perhaps he finds it fascinating to have that interaction with you. This could also be the case when your child starts screaming during mealtimes, but immediately stops when you give him his favourite ice cream.
3. Because the behaviour itself feels good.
When your child starts rocking, swinging, turning or singing the moment you put the food down in front of her, this may mean that she is trying to calm herself down. And doing those inappropriate behaviours are making him feel good in an otherwise stressful situation.
Finding out the reason why our children show unexpected behaviours, especially during feeding can be challenging. It takes an observant eye to notice indistinct signs and reactions. Sometimes, it helps if mealtimes are video recorded to observe the subtle cues that the child is making, which you might have missed during the process. Note down these observations and be specific what happened before, during and after the “problematic” behaviour occurred. This includes how you reacted to the behaviour.
We all react differently to things and events depending on how well our sensory system is functioning at that time. Thus, do not assume that when the child can do things yesterday, he can do it again today! Certain situations may challenge the sensory system, thus making it function less optimally. This may happen when a) the child is physically sick or unwell; b) the child is exposed to high levels of stress; and c) there has been too many changes in his/her daily life, routine and/or environment.
A better understanding of your child’s behaviour will lead to a better planning and implementation of an effective mealtime program. Children’s reactions will differ under various circumstances. Below are few considerations you might want to take into account when planning a meal with your child.
We often hear from our therapists and teachers about the importance of structure in our children’s lives. Don’t we all need a certain structure one way or another? The same is true for our children. Children need to be in an organised sensory state to start with, in order to successfully engage in difficult tasks (K.A. Toomey and E.R. Ross, 2017). This means providing sensory techniques for calming before and during mealtimes. Proprioceptive exercises and activities are organising for many children. It helps reduce sensory defensiveness when done before mealtimes. It also helps children who have low tone and reduced postural stability gain better steadiness for more controlled movements. Some suggested activities are:
How is your voice when speaking to your child during feeding? Are you talking too loud? too fast? Sometimes, as adults, we have the tendency to “entertain” our children during meal times. However, for children who have heightened anxiety on food, it adds another level of stress to their currently “stressed” state. Bring down the volume of your voice and the complexity of your words. you can use sign language and gestures, pictures or visual schedules to lessen auditory output.
Manage the environment. Check for people talking in the background while eating, squeaky chairs he’s sitting on, the noise of doors shutting, cell phones ringing, etc. Other children may be comfortable wearing ear muffs or hats to muffle the noise.
Use natural lighting where possible. No fluorescent lights as these lights tend to flicker. Remember, you are giving your child a calm experience while eating. When choosing food for your child, try to start with neutral colours (brown, white, yellow), which are less excitatory. Bright coloured food such as red, blue or green is more likely to excite your child. What you want is for your child to maintain a calm state as he tries new food.
Try using whole foods then start making changes to it. You can cut food into recognisable and fun shapes using cookie cutters. However, try not to put too much food on the table. Free tables space of clutter immediately by putting food in or under a bowl/cup or under another food.
When exploring food, your child may refuse to even touch the food in front of him. You can offer to use a “tool” to initially interact with the food. It can be a spoon, fork, straw, towel, gloves or ziplock bags. You can ask him to touch the food through the napkin or a bag. You can put the food in a ziplock bag or have him wear gloves before touching the food.
Always have towel ready placed at the back of your child’s chair so he knows that he has always the option to wipe his hands when it gets messy and too overwhelming.
Consider the intensity of flavours and smell of food you are presenting. When giving food with big smell or taste, consider presenting it on a washcloth. Cover up big smells or wave the smell away. You can also allow your child to brush or wash his/her tongue off with a washcloth.
Change the taste of familiar food by adding spices. However, you may want to start adding spices that do not have burn sensation such cinnamon, dill, etc.
When your child starts asking for food he prefers instead of the food given to him, avoid saying “no”. Instead, stall as long as you can. You can say, “Yes, we will eat ice cream. You can take a bite while I get the ice cream” and take your sweet time taking the ice cream out.
Reassure him/her that it’s okay to react the way he/she did. You can use vocalisations such as “Oh-ooh, it’s okay. You can put it on one side…” You want your child to know that you know that they are having a difficult time. You can use gestures to tell them about the food they are having. For example, wrinkle your nose or pinch your nose and say “Oh, bad smell!”. This way, we can teach our children self/body sensory recognition.
There are a number of strategies and approaches available out there to manage feeding issues among children and sensory approach is just one of them. Consider the points mentioned above and I hope you’ll have fun exploring different food with your child! Let us know your comments and questions below.
K.A. Toomey and E.R. Ross, When Children Won’t Eat: Picky Eaters s. Problem Feeders. Assessment and treatment Using the SOS Approach to Feeding, 2017