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Natural Strategies to Help Children Achieve Feeding Milestones

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The best way for parents and caregivers to help infants and toddlers achieve developmental feeding milestones is to let the child guide the feeding. This means that the adult needs to set aside all of their own stress, worries, fears, fatigue, etc. and be fully in the present moment with the baby. Once we, as adults, can fully focus on the infant, then we are able to pay closer attention to our baby’s signals and cues about what they need. We are talking about being able to read an infant’s subtle body cues to tell us what is going on with them so we can correctly judge how to make it better. Does the child cry because they are hungry or bored or tired or have a dirty diaper? If we do not read the baby’s signals correctly, we will do the wrong intervention and the infant will not be happy. When we do read our baby’s cues correctly, and then intervene appropriately, our child reinforces us as the caregiver for this by settling down, becoming calm and interactive, and/or resting quietly. Dr. Daniel Siegel (2001) refers to this ability to correctly read a baby’s cues as the parental skill of Attunement. By being attuned and meeting the baby’s needs, we are teaching them that we, and the world, are trustworthy.

Expanding this concept of Attunement to feeding, Ellyn Satter (2000) talks about a concept she calls the “division of responsibility”. At different stages of feeding, the baby has a job and the parent/caregiver has a job. From Birth-to-4 Months, the infant’s job is to get themselves physiologically regulated including moving onto a feeding schedule and controlling how much they eat. The caregiver’s job is to decide how the baby will be fed (breast or bottle or both), and what the baby will be fed (breast milk or which formula). The Parent also needs to be well attuned to understand when the baby needs to eat versus needing some help with a different physiological system.

The adult’s need to focus on correctly reading the baby’s physical cues continues into the introduction of baby food purees (4-6 months of age). We need to identify as the caregivers, whether our baby has stable enough head control when placed in sitting to keep the head steady for 3-5 seconds. If the infant can do this, then they are ready to try spoon feedings.

Once we mix the first rice cereal/breast milk or formula mixture, we have to carefully watch to see how our baby responds. Did we make it thin and runny enough that the puree is similar to breast milk or formula from the spoon? Or, is our baby grimacing and possibly showing us that the mix is too thick or they are not sure about this new activity? During initial spoon feedings, the most important thing is for the adult to use a very happy face and voice to help their child know that this experience is going to be fun and enjoyable. Then the caregiver needs to give the baby just a taste of puree at first, by dipping the spoon in the thin mixture and letting most of it run off. The caregiver can then place the tip of the spoon on the outside border of their baby’s lips. The adult needs to role model how to happily lick their lips and smack their lips up and down to get the taste into one’s mouth. If the baby does this motion, gets the taste in and looks okay with it, then the parent can put a small taste just inside the lip borders. If their baby does well with this experience, the parent can put a taste inside the baby’s mouth onto the tip of the tongue. Always when feeding very young children, we need to use small volumes at first, making sure the child is handling that amount, and then slowly weaning up on the volumes while maintaining our own happy faces.

Very often babies make funny faces or seem confused or unsure when first experiencing being spoon-fed. The adult’s job is to role model what to do correctly and to maintain a big, happy face. Remember, after 6 months of age, eating is a learned behavior. The way children learn to eat is because their parents teach them how. It is important, therefore, for parents/caregivers to come to the table thinking about themselves as teachers NOT dietitians. Baby food purees are not about volume or even vitamins and minerals. Baby foods and spoon-feeding are all about developing a child’s flavor palate and helping them begin to learn the mechanics of handling food versus fluid in their mouths. Caregivers should think about every meal as a class in which they teach their baby (the student) how to happily and easily eat.

If a baby is having severe gagging or cries with the spoon, they are not ready for solids yet. The caregiver should give them a 2-week break and then try again later. If their infant still reacts very adversely to the spoon-feeding after this break and they are older than 7 months of age, the parent may want to consult with a Feeding Therapist/Specialist.

This stage between 4 months and 8 months during which pureed foods are introduced, is known as the age of “Focalizing Attachment” (Lieberman and Birch, 1985). During this age and stage, the caregiver’s job is to read the baby’s cues and teach them the mechanics of spoon-feeding. The infant’s job is to manage the physical tasks of sitting up with stable head control, opening for the spoon, managing the puree in their mouths and swallowing with good control. If both the parent and child each do their jobs, they will be experiencing positive social reciprocity. Social reciprocity is when each person in a “give and take” interaction reinforces the other. The parent reinforces the infant by introducing the baby food slowly, by going at a steady slow pace and using happy facial and vocal expressions. The baby reinforces the caregiver by happily coming to midline, opening their mouth and managing the next bite at a steady pace. Therefore, spoon-feeding is a great way to work on consolidating the attachment between the parent/caregiver and infant. This is the piece of spoon-feeding that is being missed by proponents of Baby Led Weaning. Offering pureed foods is not about the volume. Pureed foods are about social reciprocity, building a flavor palate, increasing texture tolerance and consolidating attachment.

With the introduction of finger foods around 8-9 months of age and soft cubes (9-10 months), this watching of the baby’s body language and teaching them how to eat continues (attunement). It is helpful to begin the infant around 8 months of age on very hard Biter Biscuits. These foods teach the baby about having hard foods in their mouths and how to begin to move their tongue side-to-side voluntarily. A Biter Biscuit should be hard enough that the baby can’t get a piece free. If it starts to get soggy, give the child a new Biter Biscuit. Around 9 months, small meltable foods (baby cereal puffs) and/or very meltable stick-shaped foods (e.g. Calbee Snap Pea Crisps) are good first finger foods to introduce. The adult needs to show the child how to correctly place the food in the mouth with one’s finger and then to use the tongue to move the foods to the side, then to munch up and down on this food. Therefore, the best way an adult can support a child transitioning from one textured food to the next is to teach the child how to do the actual motions needed for the task through role modeling. The caregiver should be doing the correct oral-motor movements themselves with their mouth open so the baby can see inside the adult’s mouth. Parental role modeling in this manner, along with social reinforcement through smiling and cooing, cheering, and giving praise is how children typically learn to eat well.

The baby will show the parent/caregiver when they are ready to move on to another type of food texture by being able to easily and happily manage the foods offered first without gagging a lot or grimacing. However, it is important to note that some gagging will occur as a child learns how to deal correctly with food pieces in their mouths. This is because at first, babies are not very good at controlling the food in their mouths, so the food will sometimes surprise them and fall too far back in their mouths. As they learn how to control the food better, they will gag less frequently. Remember, gagging is a protective mechanism and is a good thing! Babies can use their gag reflex to help them avoid choking.

When the caregiver sees that the infant is able to move a small piece of soft food to the back molar area with the tip and side of the tongue, they can introduce “soft mechanical” textured foods that require some chewing (e.g. pasta, lunch meat, vegetables with skins such as peas, mandarin oranges etc.). This stage from 8 months to 14 months is known as the age of “initiative and the balance of exploration and attachment” (Lieberman and Birch, 1985). At the beginning of this stage, the caregiver is doing most of the spoon-feeding. However, around 12-14 months of age, the infant will shift to wanting to be more independent in feeding themselves more and more finger-type-foods.

From about 12/14 months to 16/18 months, children work on consolidating their basic skills of tongue tip lateralization and rotary chewing with larger and larger pieces of harder and harder to chew table foods. Around 15/16 months, the toddlers begin to learn how to manage foods that shatter in their mouths by developing a tongue sweeping, or bolus collection, skill. The child will now sweep their tongue throughout their mouth to gather up all the pieces of food and place them on the back molars as they are chewing.

Because the toddler has become self-aware and is becoming more independent, the parent’s job is to focus on teaching their child the mechanics of the task of eating textured foods versus trying to get their baby to eat more and more volumes. The caregiver should shift now into Co-Feeding with their child. When co-feeding, the toddler is putting foods in their own mouths while the caregiver watches carefully to see when they (the adult) can get in a bite of food from the spoon or fork. Over time, the child with be feeding themselves mostly and the adult will only be getting in an occasional bite of food from the spoon or fork. The parent/caregiver needs to watch their toddler carefully to see that he/she is mastering the oral skills of eating table foods and self-feeding. If not, the caregiver then needs to continue to cut the child’s food into smaller pieces, present softer or meltable foods in stick shapes and/or give small pieces of food to the child on a child’s fork or cocktail fork. The parent/caregiver needs to provide the structure and boundaries within which their child will be able to freely explore new foods in a way that is physically manageable for their child WITHOUT engaging in power struggles.

The developmental stage from 18 months to 30 months is known by many as “the terrible two’s”. However, Lieberman and Birch (1985) talk about it as the age of “emerging internalization”. Young babies learn that they are their own person with an opinion they can express and act on. They can say “no”, “mine”, “me do”. Infants shift into being toddlers who are becoming their own independent person separate from their primary caregivers. Their job in feeding is to learn how to eat a wide range of textured table foods and begin to use utensils more efficiently. They may also decide to not eat what is offered because they are now aware of what does and does not work so well for their bodies. Or, they might decide to not eat at all as a way to express their independence and separateness from their parents. The caregiver’s job is to give their child freedom to do this exploration within a structure of scheduled meals, avoiding short-order cooking, family-style serving, having a mealtime routine and not allowing their child to “food jag” (= eating the same food, prepared the same way over and over again).

References

Lieberman, A., & Birch, L. L. (1985). Interactional developmental approach. In D. Drotar (Ed.), Failure to thrive (pp. 259-277). New York: Plenum Press.

Satter, E. (2000). Child of mine: Feeding with love and good sense. Berkeley, CA: Bull Publishers. Distributed in the USA by Publishers Group West.

Siegel, D. (2001). Towards an interpersonal neurobiology of the developing mind: Attachment relationships, “mindsight” and neural integration. Infant Mental Health Journal, 22(1-2), 67-94.

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