Every time I visit a Grocery store and spot the shelf filled with various packs of baby cereals, I long to reach out and grab a pack or two for Ikemefuna, my two year old son who has been diagnosed with developmental delay, but I cringe at the thought of the ‘war’ that breaks out in my home during meal times. I have tried every single suggestion from other parents, yet it’s still really tough getting food down his throat. He would scream at the sight of feeding utensils and does not tolerate the family meal. “Amala and Ewedu soup would do the magic” My trusted matron advised two weeks ago, and I happily prepared the meal, only to have it in my hair, dress, the sofa, his neck, head, everywhere except his mouth. The only meal he adores is Ribena and very watery meals that can never be recognized as noodles!
Summary of Feeding Disorders
- Difficulties with eating/drinking that affects weight and nutrition
- Food or fluid refusal or selectivity
- Behavioural problems during mealtimes
- Skill deficits: A chain of behaviours, each serving as a prompt for the next one
About eighty percent of children with developmental challenges experience feeding disorders. Children with autism display higher incidence of feeding problems, while children with Cerebral Palsy experience swallowing disorders. Some of the similar traits are;
- Needing specific utensils
- Specific food presentation
- Acceptance of meals with lower texture
Pre-Interventions
Before you try any type of intervention for your child, ensure that your child is evaluated based on Biological factors such as;
- Gastro-oesophageal reflux
- Constipation
- Diarrhoea
- Food intolerances/allergies
- Oral motor delays
- Dysphasia
- Delayed gastric discharge/mobility problems
You have a huge role to play before inviting the behavioural therapist to help your child overcome the feeding challenges. Your major role is Observation. Just step back and watch, then take notes based on the following:
- Try to see what truly goes on during mealtimes.
- Each feeder has his/her own technique
- Common approaches to meals:
(i) Terminate the meal/avoidance
(ii) Coaxing/begging
(iii) Games/toys
(iv) Change foods
(v) Random threats
Define a Goal
- What do you want out of the intervention? Be specific!
- Communicate priorities with service provider
- Determine a terminal goal
Find intermediary or interim steps within first… (Do it at home)
- Increase food texture
- Increase variety
- Increase amount
- Become a ‘self-feeder’
- Decrease the “fight”
- “Happy Meal” goal
Intervention
Step 1: Addressing Behavioural Problems, Sleep irregularities, aggressiveness and tantrums are some of the behavioural issues to be dealt with prior to the intervention.
Step 2: Never Reward a Child for Eating? When is the right time for rewards?
It is a common phrase used by many caregivers and parents, but for children needing this amount of extra effort, the “internal” motivation of hunger and the reward of the taste of food is not enough. So when are rewards used wrongly? Initial goal; a huge Yes! Mid-goal: quite possibly, but not often. Terminal goal, No! This is actually the wrong method of rewarding a child; this approach is known as bribery.
There’s a huge difference between Reward and Bribery.
- Reward = Giving an item to someone after they complete a desired task.
- Bribery = Giving an item to someone before they complete a (typically) illegal/ immoral task in order to induce him to do it.
Step 3: Find Out What the Child Likes Most parents would quickly give you a list quoting, “I know what my child likes and doesn’t like!”…it is better as a therapist to ask the child directly! Just because you like something does not mean that it will work for you and if it is the wrong approach, what your child likes might not be strong enough to use as a motivation.
- Complete a mental inventory: favourite colour, toy, book, movie, place, music, game etc.
- Ask the child
- Physically assess him or her
To be continued in the next edition. Have a wonderful month. Ciao