Does my child have a feeding problem?

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It is easy for parents to become worried, confused and agitated with their child’s eating habits.  Meal times are supposed to be relaxed, social bonding episodes in a busy day.  Toddler can be lovable one moment and then stubborn as rocks the next.  Some toddlers do not handle change well and in may ways cannot handle change.  Today’s life style is busy, so much to get done in such a short period.  It can be hard to cook a healthy meal and consistently gather kids around a table.  Quick, drive-thru meals and simple recipes with ingredients that happen to be in the home have become the norm, at least in my home. With this trend, the foods consumed  has become less variable and kids are often eating on the run. Even families who are able to consistently cook can find mealtime expectations to be a struggle.   When is he full?  When do I push? What should I expect? When do I know what is best?

Experts agree on one thing, structure, rules, expectations, variety and family meal-times routines are necessary for any child to develop good eating habits.

When you add into the mix, children with prematurity, low tone, reflux, respiratory difficulties, seizures, problems with sucking,  and/or a history of aggressive medical intervention (especially if it involved the mouth/face); you have the recipe for the development of a feeding problem. For kids, like Mel, who have Spina Bifida, Hydrocephalus and Chiari Malformation can also impact a the ability to eat.

Mel was diagnosed at a young age with feeding difficulties.  She was at risk for aspiration.   Mel has a shunt, is sensitive to lactose, and has a Chiari Malformation. By five months of age Mel was struggling with weight gain, took a long time to drink and was coughing after drinking.  A video swallow was recommended.  The video swallow revealed penetration into her airway.  Thicken liquids were recommended.  We were lucky, this was caught early.  When feeding difficulties are not caught early, important developmental milestones are missed. The child learns to chew and swallow in inefficient ways. The child then has to be taught how to chew correctly.   I’m grateful, by 12 months, Mel’s feeding difficulties resolved.  Mel is now seventeen years old. She still shows remnants of her old struggles; she still continues to eat slowly.  The family, long ago, learned to not rush her.  An extra five or ten minutes is usually needed for Mel to finish her meal. That’s  ok, eating slowly has its benefits.

Many children have feeding problems from birth.  Others develop over time.   Many have heard of the Pavlov’s dog study and classical conditioning. There is another study that can help parents understand why their child continues to have food aversions; long after medical difficulties have been resolved.   The “Little Albert” experiment was conducted by behaviorist, J.  Watson.  Mr Watson developed a fear of soft white objects in Little Albert by pairing white rats with a loud noise.  At nine months of age Little Albert was very sensitive to loud sounds.  However; at 9 months, he had no problems interacting with animals such as white rats.   J. Watson used classical conditioning and soon, Little Albert cried and screamed when soft, white objects appeared.  Little Albert developed this fear by association. Every time Little Albert saw a pet, white mouse, a load bell rang.  Soon, he hated the bell and white rats.  This than generalized to other soft white animals and materials, even when a loud noise was no longer being paired.  How does this relate?  Let’s think about it.  If every time you opened your front door, you got hit in the face with a bat; would you not want to stop opening that door?  Could other doors cause you anxiety?  The study has a few validity problems but I can see how one might over-generalize a fear based on pasts experiences. 

When a child eats and that food or his body has an adverse reaction, that child may decide eating is not good.   Many things can cause a child to decide eating is not a fun thing to do.  Silent reflux, food sensitivities, poor chewing, repeated medical interventions (oral surgeries or tubes being placed down their throat) can make a child not want to eat.  Sometimes, no matter how hard a parents tries and how much they study the child’s past, the trigger cannot be located.  Just be aware, kids seldom refuse to eat for no reason.  And yes, some kids will go days with no food.  The child “will eat when hungry” manta does not work for kids with feeding problems. 

What is a parent to do?  How does one know if they are dealing with a fussy infant, a strong-willed two-year old or a child with a feeding problem.  My first suggestion would be to video a difficult meal and bring the video to your pediatrician.  It can be hard for a pediatrician to comprehend what a parent is talking about when they are describing a possible feeding problem. Let’s face it, all kids go through phases, some kids are selective in their eating, & many toddlers are stubborn. 

HOWEVER; THIS COULD ALSO BE THE CHILD SAYING “SOMETHING IS NOT RIGHT”.

Common signs of early feeding problems are: arching or stiffening of the body during feeding, consistently refusing food or drink, taking more than 20 minutes to feed a typical amount, coughing or gagging during meals, excessive loss of food or liquid during meals, frequent spitting up, a different sounding voice after meals, a history of pneumonia, frequent ear infection, frequent respirator distress or poor weight gain.

Feeding problems might not be identified until a child is a little older.  Again, a video can be helpful for your medical team.  If your child eats; less than 20 foods, is missing entire food groups from his or her diet, will not even taste new foods, does not eat different textures (ie eats only puree – like pudding or easy dissolvable foods – like crackers), you are consistently cooking special meals or making new meals for a child, or your child only eats in certain circumstances (only chicken nuggets from McDonald’s and/or only french fries from one package), you may have a child with a true feeding problem.

It is ok to seek help if:  you think your child is not eating correctly, not happy at meals, not enjoying food or if your life revolves around feeding your child.  The earlier help is received the quicker this difficulty may be resolved.  Retraining a child to chew correctly is not easy. 

If you think your child is struggling with eating, a medical evaluation is highly recommended.  I have included a few resources to help you have a better discussion with your child’s medical team.  The resources may also help you understand feeding disorders, know what to expect during a feeding evaluation and review techniques parents maybe taught as one learns to help a child enjoy foods and the social experience of eating.

I urge others to post resources they may have found helpful.

https://www.feedingmatters.org/  Feeding Matters is a web site developed by parents to support parents.

“Just Take a Bite” by Lore Ernsperger  and “Food Chaining” by Cheri Fraker –  These are excellent books to explore the reasons why kids are picky eaters, learn strategies to help overcome this difficulty, help in selecting foods your child may have an easier time trying and guidelines to help parents understand the approach a medical team may take in helping the child develop better feeding skills.

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