If you have determined that your child is a Problem Feeder, looking for a feeding specialist in your area is a great next step. While there are a lot of strategies and things you can do at home, it is likely that your child has some skill deficits that are interfering with the typical eating development and will require a consult with a professional to address. Because eating is such a complex task, there are lots of areas for things to go wrong, and a professional can help to make sure these areas are addressed and strengthened to support your child and family.
Red Flags that your child would benefit from feeding therapy include:
Being fed by a NG or G-Tube
An infant who cries and/or arches at most meals (“fights” the breast or bottle), or primarily only eats when asleep
Relying on breastmilk or a baby/toddler formula (Pediasure, Carnation Instant Breakfast) for the majority of your child’s nutrition after 18 months of age
Your child still eats mostly just baby food purees and they are older than 18 months of age
Ongoing poor weight gain (dropping percentiles on the growth curve) or weight loss
Ongoing choking, gagging, coughing or vomiting during meals
History of a traumatic choking incident followed by a decrease in food intake and weight loss
A food range of fewer than 20 foods, especially if foods are being dropped over time without new foods being added to replace them
Your family is fighting about food and feeding (Meals are battles)
Your child is difficult for EVERYONE to feed
What Types of Therapy Approaches Are Out There?
There are a wide variety of different therapy approaches available to parents and caregivers. What is important to understand is what is the philosophy behind the approach that you choose. All available feeding therapies fall within one of two philosophical camps; Systematic Desensitization or Flooding. Here is a quick summary of the differences between the two philosophies:
In this approach, children are allowed to get used to easy things about food and eating first, and then gradually helped to progress up to eating harder foods using more mature skills.
The child’s ability to move up a series of steps towards eating is respected by the therapist.
The goal is to stay calm and enjoyably engaged while learning to eat a variety of new foods.
The best example of systematic desensitization would be if you were teaching a child to swim, and you allowed them to first play next to the pool for a while, and then put their feet in the pool when they are comfortable. Next, they would slowly walk into the shallow end of the pool and play there until comfortable. They would then put their face in the water while holding the side of the pool and happily kick their feet. Gradually, they would be ready to let go and learn swimming strokes.
Programs can create lasting behavior changes because the child builds the skill required for eating
These programs follow typical development, which is how children normally learn to eat
Programs build internal motivation for eating (child learns to enjoy the experience of eating)
Therapy is fun for everyone
The child is an active participant in mealtimes, and learns to eat independently
These programs take time to learn new skills fully – remember, it takes a typically developing child around 2 and a half years to learn to eat a full table foods diet.
In this approach, children are believed to have a natural ability (or instinct) to do the task.
The child is asked from the start to do the most difficult and highest skill in the steps to eating (chewing and swallowing), usually in exchange for a reward.
The child is not allowed to leave the table until they eat the pre-set volume of food and fluid (all escape is prevented).
The goal is to learn to eat/drink a variety of foods/fluids without exhibiting any undesirable avoidance behaviors.
Continuing with our example of different philosophies for teaching children how to swim, in a flooding approach, the child will be taken to the deep end and thrown in the pool. They are assumed to have the natural ability to get to the side of the pool. What method the child uses to get to the side of the pool is not initially important.
Programs can teach the child to swallow liquids/purees quickly (sometimes in just a few weeks)
High relapse rate after you complete the program (i.e. child goes back to their old way of eating)
Children in these programs are put on pureed and fluid diets because these are the easiest foods to manage.
Creates external motivation to eat (due to eating in exchange for a reward or to escape the table)
Programs rely on passive participation (the child is often fed, versus feeding themselves)
If mealtimes are a constant battle in your home, finding a skilled feeding therapist in your community can make a huge difference. We hope this information is helpful as you consider your choices.