mealtime challenges
TRANSCRIPT
OBJECTIVES
1. LEARN WHAT INFLUENCES TRAUMA MAY HAVE ON MEALTIME CHALLENGES
2. UNDERSTAND THE SENSORY COMPONENTS OF FOOD AND EATING
3. UNDERSTAND THE MOTOR SKILLS NEEDED TO EAT
4. IDENTIFY WHAT ROLE NUTRITION MAY PLAY IN EATING CHALLENGES
5. LEARN WAYS TO FACILITATE JOYFUL EATING
FOOD IS CONNECTION
How parents care for their children
Very social event
often a main part of celebrations, holidays and festivities
But it’s not easy!
CHALLENGES ARE COMMON
strong preferences
limited variety or restricted number of foods
avoiding new foods
rigid about how food looks, is prepared or brand
upset by being pressured to eat
struggles between parents and child
served separate meals/separate mealtimes
takes a long time to eat or eats fast
will not stay at table/in seat
low or high weight, low nutrition
CONTRIBUTING FACTORS• PREMATURE BIRTH
• DEVELOPMENTAL DELAYS
• DISABILITIES
• TRAUMA
• GI DISTRESS/PAIN
• PATTERN OF “NOT EATING”
• COMBINATION OF MANY FACTORS
• OR NO FACTORS AT ALL
FOR PARENTS:TIME CONSUMING, STRESSFUL, FRUSTRATING, SCARY
D. Garding - licensed under CC BY-NC-SA 2.0
= FOOD IS NOT FUN!
sean dreilinger - licensed under CC BY-NC-SA 2.0
TRAUMA INFLUENCES
FOOD INSECURITY
HOARDING
EATING QUICKLY/STUFFING
DO NOT LIKE PEOPLE EATING OFF THEIR PLATE
NOT EATING AT MEALTIMES BUT SECRETLY/ALONE
SNEAKING/HIDING FOOD
BEING UPSET WHEN FOOD IS RESTRICTED (EX. NO EATING BETWEEN MEALS)
SELF REGULATION INCIDENT
CHOKING INCIDENT
GI DISTRESS
DENTAL ISSUE
EMOTIONAL/SITUATIONAL TRAUMA AT TIME OF EATING
PARENT ANXIETY/STRESS
lindseywb - licensed under CC BY-SA 2.0
OVERCOMING TRAUMA CHALLENGES
FOOD SECURITY:
• SECURITY = KNOWING FOOD WILL BE AVAILABLE
• WORK TOWARD 3 MEALS AND 2 SNACKS A DAY
• DEDICATED DRAWER IN THE FRIDGE, SHELF IN THE PANTRY,
BOX IN THEIR ROOM OR BAR IN THEIR POCKET
• ALWAYS ALLOWED LIST OF SNACKS (FRUITS, VEGGIES,
NUTS)
• AS ONE MEAL ENDS STATE WHEN THE NEXT ONE WILL BE
• CONSIDER A VISUAL SCHEDULE OF MEALS AND SNACKS
TRAUMA AND EATING DISORDERS
Feeding challenges vs. eating disorders
More common in women than men
Factors: genetics, family history,
abuseUsed as a control
mechanism
Stress may lead to over or under
eating
Picky eating and mealtime challenges
do NOT lead to eating disorders
SENSORY• 5 SENSES: SMELL, SIGHT, SOUND, TEXTURE, TASTE
• PLUS 3 MORE: PROPRIOCEPTION, VESTIBULAR,
INTEROCEPTION
• DEFINE SENSORY PROCESSING: TAKING INFORMATION
IN THROUGH THE SENSES, ORGANIZING IT IN YOUR
BRAIN AND REACTING TO IT
SENSORYOVER RESPONSIVE
tentative, fearful, defiant
avoid looking at/touching
push food away/off table,
or push self away from table
turn head away from table
frequent eye watering/blinking
coughing/ gagging/ vomiting
does not put lips on utensil/use teeth instead
frequent hand wiping
SENSORY
LITTLE KNOWN FACTS:
SENSORY REACTIONS ARE OUT OF THE CHILD'S CONSCIOUS
CONTROL
IT MAY TAKE 20-30 EXPOSURES TO LIKE IT OR CHOOSE TO
EAT IT
THE FLAVOR OF MOM’S AMNIOTIC FLUID COMES FROM
WHAT MOM EATS AND INFLUENCES CHILD FLAVOR
PREFERENCES
OVERCOMING SENSORY CHALLENGES
OVER RESPONSIVE• PARENT DECIDES WHAT, WHEN AND WHERE TO EAT, CHILD
DECIDES IF AND HOW MUCH
• SERVE ONE MEAL FOR THE FAMILY (NO SHORT ORDER COOKS)
• ALWAYS SERVE ONE THING THE CHILD WILL EAT
• FAMILY STYLE: GIVE THEM CONTROL
• ASK THE CHILD TO TAKE A LITTLE OF EVERYTHING
• SEAT CHILD AT THE TABLE WITH THE REST OF THE FAMILY AS SOON AS POSSIBLE
• NOTHING TO EAT OR DRINK EXCEPT WATER FOR 1.5 - 2 HOURS BEFORE MEAL
• KEEP THEM IN THEIR CHAIR A LITTLE LONGER
• POSITIVE ENCOURAGEMENT - NO BATTLES, COERCION, BRIBING
• POINT OUT LITTLE THINGS THEY HAVE DONE WELL
Leonid Mamchenkov - licensed under CC BY 2.0
OVERCOMING SENSORY CONT’D
• BABY STEPS TO INTERACTING WITH THE FOOD
• SEQUENCE OF ACCEPTANCE: TOLERATE, INTERACT WITH,
SMELL, TOUCH, TASTE, EAT
• ALLOW FOOD PLAY
• USE UTENSIL IF THEY DON’T WANT TO TOUCH IT
• USE DIPS
• ALLOW CHILD TO SPIT OUT FOOD
• CHANGE ONE SMALL THING
• SINGLE TEXTURE BEFORE MIXED
• LEARNING PLATEcc.photoshare, licensed under CC BY 2.0
OVERCOMING SENSORY FOR BIG
KIDS
• DON’T SHAME OR LABEL
• ENCOURAGE INDEPENDENCE BUT REMAIN IN
CONTROL OF WHEN/WHERE/WHAT
• USE THEIR INTERESTS
• POST A WEEKLY MENU PLAN
• HAVE THEM HELP PLAN, SHOP, PREP/COOK
• TAKE A COOKING CLASSdaniellehelm - licensed under CC BY 2.0
WHEN TO GET HELP
• EATS LESS THAN 20 FOODS
• IF THEY TIRE OF A FOOD, THEY WILL NEVER EAT IT AGAIN
• MELTDOWN WITH INTRODUCTION OF NEW FOODS
• NOT EATING FAMILY MEALS OR AT FAMILY MEALTIME
• REFUSES ENTIRE CATEGORIES OR TEXTURES OF FOOD
• REPORTED AS PICKY EATER AT MULTIPLE WELL VISITS
SENSORYUNDER RESPONSIVE
overstuffing mouth
pocketing food
swallow food whole or barely chewed
little or no reaction to spicy/sour foods
does not notice food on face
OVERCOMING SENSORY CHALLENGES UNDER-RESPONSIVE
Wake the body up before sitting
1Wake the mouth up before eating
2Eat in front of a mirror
3
MOTOR
• BABIES –
• INITIALLY ALL THEY HAVE TO DO IS SUCK
• STARTS AS A REFLEX
• BRAIN AND BODY DEVELOP THE SKILL
MOTORKIDS—
BODY IN THE CHAIR
• SUCK
• LIPS AROUND BREAST/BOTTLE/SPOON
• TONGUE MOVEMENTS
• JAW MOVEMENTS
• BREATHING
• STABILITY
• WITHOUT STABILITY:
• SLOUCH, LEAN, PROP ON ARMS, STAND, WALK AROUND, SLIDE OFF CHAIR, BE IN CONSTANT MOTION
HANDS AND FINGERS
• GRASP USED ON FOOD OR UTENSIL
• EYE HAND COORDINATION
• HOW HARD TO HOLD OR SQUEEZE
LIPS AND TONGUE
OVERCOMING MOTOR
CHALLENGES
SEATING:
• FEET FLAT ON SOMETHING (FLOOR, BOX, FOOTREST)
• KNEES AND HIPS AT RIGHT ANGLES (90 DEGREES)
• TRAY OR TABLE SHOULD BE BETWEEN BELLY BUTTON
AND BREAST AREA
• REMEMBER TO REASSESS AS THE CHILD GROWS
IF YOUR CHILD HAS DIFFICULTY WITH FINGER, HAND, LIPS, TONGUE, OR JAW MOVEMENTS FOR FEEDING CONSULT
WITH A FEEDING THERAPIST
NUTRITION
Impact on behavior - dyes, chemicals from growing process, preservatives
Low zinc - may affect smell and taste
Food allergies - causing eczema/rash/hives, wheezing/coughing, stomach pain
Common allergens: dairy, eggs, wheat, soy, nuts, shellfish
OVERCOMING NUTRITION CHALLENGES
1. RULE OUT MEDICAL PROBLEMS
• REFLUX
• GI ISSUES
• ALLERGIES
• SENSITIVITIES
2. BALANCED DIET AT EVERY MEAL:
• PROTEIN
• STARCH
• FRUIT AND/OR VEGETABLE
3. AVOID:• DYES/ARTIFICIAL COLORS
• PRESERVATIVES, CHEMICALS
• MSG
LET’S CREATE A POSITIVE EATING ENVIRONMENT
Tetra Pak - licensed under CC BY-SA 2.0
JOYFUL MEALTIMES
GET HUNGRY!• DO NOT EAT 1.5-2
HOURS BEFORE MEALTIME
• VEGGIE APPETIZERS
• GRAZING TAKES EDGE OFF APPETITE = LESS MOTIVATION FOR NEW FOODS
JOYFUL MEALTIMES
ENJOY THE FOOD AND EACH OTHER!• MODEL ENJOYMENT OF EATING
• TALK ABOUT THE FOOD – TASTE, SMELL, FLAVOR
• CHILDREN ARE MORE LIKELY TO TRY NEW FOOD IF PARENT IS EATING SAME FOOD
• CONNECT - SLOW DOWN, TALK, MAKE EYE CONTACT, ENJOY EACH OTHER
• NO JUDGEMENT = OPENS CONNECTIONS FOR FUTURE CONVERSATIONS
• TRY TO AVOID SCREENS
• SET ASIDE MANNERS LESSONS FOR NOW
JOYFUL MEALTIMES
GET YOUR CHILD INVOLVED• GROWING FOOD
• MEAL PLANNING
• MAKING DINNER
• MAKE IT A GAME OR A COOKING SHOW
• FOSTER A CURIOSITY ABOUT FOOD AND EATING
KEY TAKEAWAYS!
• THERE ARE MANY COMPONENTS TO EATING AND MANY FACTORS AFFECTING A CHILD’S ABILITY TO EAT AND INTEREST IN EATING - BACKGROUND, MOTOR SKILL, SENSORY PREFERENCES, FAMILY DYNAMICS, NUTRITION.
• REASSURE YOUR CHILD THERE WILL ALWAYS BE FOOD BY WORDS AND ACTIONS
• CREATE A JOYFUL EATING ENVIRONMENT BY TABLE SET UP AND ATTITUDE
• GIVE CONTROL TO YOUR CHILD ABOUT WHAT AND HOW MUCH TO EAT FROM WHAT YOU HAVE SERVED
• CREATE WAYS TO FIND JOY IN EATING AND USE THE TIME FOR CONNECTION AND BONDING
REFERENCES
• DORFMAN, K. (2013). CURE YOUR CHILD WITH FOOD: THE HIDDEN CONNECTION BETWEEN NUTRITION AND CHILDHOOD AILMENTS. NEW YORK: WORKMAN PUBLISHING COMPANY.
• GIBSON-JUDKINS, C. (2019, NOVEMBER 08). THE ROLE OF CHILDHOOD TRAUMA IN EATING DISORDERS. RETRIEVED FROM HTTPS://WWW.EGGLESTONYOUTHCENTER.ORG/BLOG/THE-LINK-BETWEEN-CHILDHOOD-TRAUMA-AND-EATING-DISORDERS/
• GROGAN, A., (2020, MARCH 20). PICKY EATER TIPS FOR OLDER KIDS. RETRIEVED FROM HTTPS://YOURKIDSTABLE.COM/PICKY-EATER-TIPS-FOR-OLDER-KIDS/
• GROGAN, A., (2021, JUNE 23). TODDLER WON'T EAT DINNER? 5 QUICK TRICKS TO TRY. RETRIEVED FROM HTTPS://YOURKIDSTABLE.COM/TODDLER-WONT-EAT-DINNER/
• ROWELL, K., (2021, JULY 12). HEALING FROM FOOD INSECURITY: BEYOND THE STASH. RETRIEVED FROM HTTPS://WWW.NACAC.ORG/RESOURCE/HEALING-FROM-FOOD-INSECURITY/
• ROWELL, K., WONG, G., CORMACK, J., & MORELAND, H. (2020, AUGUST 16). RFT VALUES AND PRACTICE WHITE PAPER. RETRIEVED FROM HTTPS://WWW.RESPONSIVEFEEDINGTHERAPY.COM/RFT-VALUES-AND-PRINCIPLES
• SATTER, E. (1986). THE FEEDING RELATIONSHIP. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION, 86(3), 352-356.
• TOOMEY, K., FOSTER, M., KNIFFEN, S. (2021, MARCH). WHEN CHILDREN WON’T EAT: PICKY EATERS VS. PROBLEM FEEDERS [ONLINE CONFERENCE] ASSESSMENT AND TREATMENT USING THE SOS APPROACH TO FEEDING. DENVER, CO