Including the Covid-19 pandemic stay-at-home restrictions, vacations, new schools, a family move, or illness.
When children and their families are undergoing major changes in their lives, whether this is related to stress or a positive life event, any child’s eating or feeding can be easily disrupted. This is even more true for children with feeding or eating challenges. Interestingly, for some children and families, these life changes actually create opportunities for improvements in eating. For other children and families, a change is more likely to create a serious disruption in the child’s eating or feeding. So let’s take this issue apart and see if we can differentiate between families who do well and those who don’t during changing or stressful times.
Issue #1: Routine and/or Schedule Changes
Whether a family goes on vacation, changes schools, or moves to a new house (or goes on lockdown), the child’s routine and/or schedule has been changed. During times of change, unfortunately, some families will give up previously successful routines, and more often, the schedule goes out the window completely. So the #1 key in any of these situations is to KEEP as close to your child’s usual routine AND schedule that you can, EVEN when children are sick.
- If changes are occurring that are not related to a child being ill, start by identifying how close to keeping them on their regular schedule can you can manage. For example, if you are going on vacation and there is a 2-hour time change, can your family stay on your usual time zone and just eat at different times than other people? (often this helps restaurants to be less crowded and you will be out doing the activities when everyone else is inside eating). If you are moving, can you set alarms for yourself to remind you of when you need to make sure a meal is being ordered or cooked and served so you stay on schedule? Can you plan the moving activities around your child’s eating schedule, and if not, can you arrange for child care that can do that? If you are changing schools (or school years), you will need to establish a new schedule as soon as possible.
- Also, identify what pieces of your usual meal routine you can keep in place in the new situation. The minimum is to think about your child’s seating and what you need to do to maximize postural stability.
- Can you wait to bring out any toys or games or video screens until after the 10 or 20-minute mark and seeing how much your child can eat at the start of the meal without these things FIRST? Especially when we are on a vacation and at a restaurant, we are typically not following our child’s usual mealtime routine because as parents, we are just trying to keep our children quiet and busy so they don’t disturb everyone else. This means that in addition to being off schedule, we are letting our children bring toys to the table and/or we may forego any hand washing. Maybe when your food arrives, all the games and coloring pages go away, and then you do a quick hand washing in the bathroom (or hand sanitizer at the table) before eating.
Issue #2: Child Expectations Change
Especially when children are sick, we as adults feel sorry for them and don’t expect them to do anything. The less you expect them to do and the more pampering you give them, the more difficult it will be for the child to get back into their usual routine and onto their typical schedule. This is a really fine balance. When our children are ill, they do need to be pampered and they will not be able to participate in meals at the same level. However, especially when we as the adults are stressed (e.g. on lockdown), we may feel even more sorry for our children and feel even more obligated to try and “make everything better” when an illness occurs. “Wow, our kids have already been getting a bad deal because of COVID-19 and now they are sick too! I really need to figure out how to make this better/special”. Do you see how this might lead to overcompensation on a Parent’s part? If you are letting them eat every meal/snack lying down in front of the TV or iPad, it is going to be really hard to come back to the table when they feel better.
- When your child is ill, try to offer them something to eat and/or drink that will help them feel better as close to their usual eating times as possible. Because a sick child often cannot eat enough in one sitting, you may have to be feeding them a little bit every 2 hours or so (sometimes every 1.5 hours). Remember, children are supposed to eat every 2.5 to 3 hours across the course of the day (with the first meal happening 30 minutes after the child wakes up for the day).
- When your child is ill, what can they do comfortably within your usual meal routine?
- First, consider what you can do to help make coming back to the table easier vs. immediately letting them lie down in front of the TV. Can they go back into the high chair or booster seat because that makes them feel more comfortable? Can they sit on your lap? Can they sit on the floor in front of the coffee table with their back against the couch? Make sure you have their placemat! Can they at least sit up and have a Breakfast Tray if they are eating on the couch or in their bed?
- Second, consider what your Menu is. This is the place you really want to simplify and make it easier. Choose favorite and easy-to-chew foods that will make their stomach feel better. For many children, just having a really easy menu will help them come to the table even when they are sick.
- Third, figure out if they need you to feed them or if they can feed themselves. Sometimes children will come to the table if they know you will help to feed them when they don’t feel well.
Issue #3: The Reason Behind a Change Isn’t Communicated
If you are making changes to your routine, schedule, or expectations, regardless of whether it is a change due to location or illness, make it clear to your child that the family is doing something different because of X and that “we will go back to our usual way when X is over”. Many families do not make it clear to their children that the changes occurring are temporary and for a specific reason. Not doing this makes it harder for many children to transition back to the old way, especially if the new way is easier and more fun.
- Tell your child when it is time “we are A (home now; feeling better now), so we can get back to our regular B (way of doing things, schedule, etc.)”.
- If they are protesting, problem-solve with them how your “family can make regular meals more fun today, to help us get back in the swing of things”. Maybe you can have a theme to your meal (e.g. color every food orange; make every food into a star shape). Maybe they get to use a kitchen tool at meals for a bit (e.g. cookie cutters, choppers, plastic knives). Maybe you play a Food Game today (e.g. “I spy with my little eye, a food that is green”; naming all the foods that start with a certain letter of the alphabet).
- Consider having your child help prepare/cook a meal that they really like and that makes them feel better. This can really help with the transition back to the table, especially if they get to serve a part of the meal. At a minimum, consider having them help you plan the menu for their first meal back home/back feeling better/on vacation, etc. even if they can’t help you make that meal.
Issue #4: Stress Decreases Appetite
Any type of change, even a fun one, can introduce a component of stress for your child. The problem with stress (good or bad) is that it activates our Fight-Flight-Fright system and turns on Adrenaline. Adrenaline goes to the appetite center of the brain and tells the brain to turn off the appetite so that your body’s resources can be pushed to running away versus digestion. The more stressed a child is, the less appetite they will have. The lack of appetite can just make everything that much worse.
- Deep breathing at the start of the meal is one of the best ways to decrease Adrenaline and to activate the opposing system = Endorphins.
- Depending on the age of your child, just telling them to take 5 deep breaths is not going to work very well. Instead, engage them in deep breathing by playing blowing games (pinwheels, bubbles, singing, blowing tissue across the table, etc.) and/or having them do a physical exercise just before eating that will increase their breathing rate (e.g. bouncing on a large ball, jumping on a trampoline, climbing up and down the stairs several times).
How long does being sick disrupt a child’s appetite?
Children who do not have active feeding problems usually get sick and recover within 2-5 days. They will often lose weight, especially if they are sick for a longer time and completely stop eating. However, when they feel better, these children will also typically come back to the table fairly easily because they are ravenous. They will eat “double time” and make up the lost weight from being ill AND gain the weight they should have if they had not gotten ill, within about a week’s time frame.
Children who are still struggling with feeding difficulties do not follow this typical pattern as well. They appear to take longer to recover from the illness and take longer to get to the point of feeling better than the other family members who got the same illness. They lose more weight and they do not come back to the table as easily because they do not appear to have the “ravenous” appetite kick back in. Very generally, it takes about 2 weeks for them to gain back the lost weight and potentially another 2 weeks to get back onto their growth curve. This is why it is very important to do the recommendations above to help a child with a feeding problem when they get sick.