I have the fun of meeting a LOT of cute kids in my practice as a feeding therapist and likewise, the honor of meeting some great parents. Sometimes the kiddos have Down syndrome or a gastrointestinal tube for liquid tube feedings or autism or for one reason or another are just darn-picky eaters. Know what the common denominator is among all these families, regardless of a child’s diagnosis? STRESS. Parenting a child who does not eat well is STRESSFUL and it’s a very unexpected problem to have in a family. I have never met a new mom who cradled her brand new baby and said, “Gosh, I hope he eats his broccoli.” It never occurs to a new parent that their child will have difficulty eating.
When I meet a child for the first time, my role is to assess much more than just what foods he will or will not eat. When I teach my seminar entitled Feeding Therapy: It’s Not Just about Swallowing, I describe it this way to other therapists in the audience: Assessing WHY a child won’t eat is similar to building a tower of blocks. I call my assessments “stacking”.
The first stack or the foundation for our tower is Physiology. When we speak about a child’s physiology, we are asking “How does this little guy’s body function?” We consider the whole body in a multitude of ways and one major part of that is the gastrointestinal system. If the child is coming to me for any sort of difficulty eating, I always ask that the parents consult with a pediatric GI physician. Even if the GI doc doesn’t suspect any sort of GI issues, I want his/her experienced hands on that belly. I want a baseline of information to begin to put all the pieces of the puzzle together.
Another important piece of physiology is the child’s sensory system. How does his little engine run? Is he a sensory seeker or a sensory avoider? What sorts of tastes, temperatures, textures, auditory input (yes, every food has its own sound), olfactory and visual stimuli does he tolerate, enjoy, resist or avoid with all his might? How about his vestibular system and his proprioceptive system: how comfortable is he with movement, balance and input through this joints and muscles?
Here’s an example you might relate to: Try sitting (balancing) on a bar stool with no foot rest, your gorgeous high-heels dangling while you hold a filled-to-the-brim martini glass (up, extra olives, extra cold…well, that’s my preference). Let’s see how skillful you are at taking a sip without spilling. That also requires the ability to grade your arm smoothly though air, knowing just where it is in space till it reaches your lips. I have to admit it – I’ve stabbed myself in the cheek once or twice with the sword holding my “extra olives” in my dirty martini. That’s is definitely my poor proprioceptive system at work! See how important your vestibular and proprioceptive system is for eating?
The second stack is Motor Skills – both gross and fine motor skills. Did you know that development of age appropriate fine motor skills requires strong & stable gross motor skills? When I treat a 9-month old child with low muscle tone who has trouble sitting up on his own, I know he is going to have trouble with the fine motor skill of moving his jaw, lips and tongue to clean applesauce off a spoon, even if I am feeding it to him. I’m going to have to come up with strategies to provide additional stability for his mouth to work in an optimal manner. Fine motor skills are always dependent on gross motor skill development, whether it’s the first bites of puree from a spoon presented by a parent or learning to self-feed Cheerios™ from his own high chair tray.
The third stack at the very top of the tower is “behavior”. What sorts of behavior am I seeing that is helpful for eating or perhaps hinders eating? What has the child learned to do to avoid trying new foods? What has he learned to do to request or even demand favorite foods? Does he scream till gets his chicken nuggets? Does he toss the broccoli on the floor or, just dump the entire plate? Now, keep in mind that the term “behavior” includes desired behaviors and I’m watching closely for those too. Does he run to the high chair and eagerly climb up when it’s lunch time? I’m trying to see the big picture and learn how the child’s physiology and motor skills influenced certain behaviors to develop. In my 14 years of practice, I have only met one child whose feeding challenges were truly 100% “behavioral”. They may come to me after the gastroenterologist has solved their tummy issues or after the best OT has helped to balance their sensory system, or even after dental surgery has resolved chronic tooth pain, but those issues were stacked beneath and now, the top stack or behaviors remain.
Behavior also includes the family’s behavior and family dynamics that may or may not influence how a child learns to eat. Here’s one thing I know for sure: I’ve never met a parent who didn’t love and adore their child. They genuinely want to find a solution to their kiddo’s difficulties with food. Typically, parents are open to feedback and guidance regarding what I observe is going well and what they might want to tweak in terms of their own behavior around mealtimes. It’s not always easy to change, but the first step is being open to hearing what the possibilities may be.
Likewise, I need to keep an open ear and an open heart. While I can certainly empathize (One of my own kids was a picky eater thanks to some mild sensory issues), each family’s situation is different and each child’s stack of symptoms is unique. That’s why I love being a therapist – it requires a little detective work to figure out all the pieces of the puzzle. Ultimately, the final piece is the one that reads “JOY”. Feeding therapy is about bringing joy back to the family table. It’s a journey and we simply take it step by step, keeping it fun and light, decreasing the stress over time and replacing it with happier mealtimes for the entire family.
About Melanie Potock and My Munch Bug:
Melanie is a national speaker, author and feeding therapist who treats young children who have difficulty eating a variety of foods. She is the executive producer of the 2012 Grammy submitted children’s CD and winner of Creative Play Magazine’s CD of the Year award for children (nutrition) entitled Dancing in the Kitchen: Songs that Celebrate the Joy of Food! Her book, Happy Mealtimes with Happy Kid, (Creative Play Magazine’s 2012 Book of the Year for Parents) and the CD are available via various therapy catalogues, on Amazon.com and on sale through her website at www.mymunchbug.com. Mel can be contacted at Melanie@MyMunchBug.com.