The Feeding Family

How many questions do we ask our children in a day? In an hour? Maybe 5, 10, 100? Often it depends on the day, activity, and our mood (and that of the child!). What do you want to eat? How was school today? Why are you crying? Which book do you want to read?

Questions are a wonderful tool to gain knowledge and understanding of our world and of the thoughts and feelings of others. The way we ask questions of our children can give us more or less information, just by choosing our words carefully. 

When we ask a question, we expect an answer. Think about the question, "What color is that carrot?" It requires a very specific answer, usually only one word. What do we learn from our child's answer? At most we are likely to find out if they know their colors. A great way to ask the same "question" is to say, "Tell me about that carrot." This question is open-ended and invites the child to think critically about many elements of that food. They may respond with their feelings about carrots, or they may describe the carrot's shape, texture, temperature, color, or smell. A simple change in our words can open up a deeper conversation about everyday experiences.

How about this situation, your child is sitting at the table with food in front of them and a sour look on their face. What do we say to them? Often we ask our child, "Do you like/want it?" or even, "You don't like it?" When we ask these questions, however innocently, we can sometimes plant seeds in their little brains that maybe there IS something not to like or try! Next time you see that look, try this instead: "I wonder what you're thinking about that food." Instead of a question, this is a statement which encourages your child to also reflect on how they feel, negative or positive. You might be surprised by what your child replies with!

Questions are an important part of teaching our children about language and about the world around them. With a few simple changes to our words, we find that our children have a lot to teach us as well!

Our Sunday Fun-Day posts feature fun, easy, food-related activities for you and your family to enjoy. These include ways to explore new food textures or flavors outside of the pressure of a "mealtime". We hope that this "food-play" will allow a new opportunity for your little ones to learn to love food.

This Sunday we continue our multi-week feature on ways to encourage food education and exploration at the grocery store. For picky eaters or children who are hesitant to try new foods, the grocery store can be a broad landscape of new experiences that may lead to new food choices at home. Other children with sensory aversions or sensitivities may have a harder time with the overwhelming sights, sounds, and smells at the grocery store. Think about situations that may be challenging for your child and modify these activities as needed. (For example, try "shopping" in your very own pantry or fridge as you are preparing for a meal)

Today's Grocery Adventure is great for children in the early elementary-school years or children who are learning about categories. The grocery store offers us endless options for food in a relatively organized fashion. Next time that you are shopping with your kids, point out the way that foods are grouped together. Challenge your little ones to describe the ways that the foods are similar or different. Here are a few examples.

Produce: Fruits and veggies are the primary foods found here. How are they grouped? Round foods together? Leafy foods together? Is there a section for produce that is from another part of the world?

Dairy: What kinds of foods make up the dairy section? Cheeses, yogurt, milk, and maybe a few other treats. Talk about why these foods all belong in the same category (made from milk, cold, etc.)

Canned Goods: This section takes a little more detective work. What kinds of foods come in a can? Look for pictures to find out! Are there some foods that are not in a can? Cucumbers? Bread? Berries?

Meats/Fish: It's always important to know where our foods come from. The best place to see these foods might be the butcher counter. What foods are red, pink, white, gray, or even black? What animals do they come from? Be careful, you might end up with some little vegetarians on your hands! 

Our Sunday Fun-Day posts feature fun, easy, food-related activities for you and your family to enjoy. These include ways to explore new food textures or flavors outside of the pressure of a "mealtime". We hope that this "food-play" will allow a new opportunity for your little ones to learn to love food.

This Sunday we are starting a multi-week feature on ways to encourage food education and exploration at the grocery store. For picky eaters or children who are hesitant to try new foods, the grocery store can be a broad landscape of new experiences that may lead to new food choices at home. Other children with sensory aversions or sensitivities may have a harder time with the overwhelming sights, sounds, and smells at the grocery store. Think about situations that may be challenging for your child and modify these activities as needed. (For example, try "shopping" in your very own pantry or fridge as you are preparing for a meal)

This week's adventure is a Grocery Shelf Scavenger Hunt. This activity teaches children about following directions, listening skills, letter/number/color recognition, and best of all about FOOD!

1. As you are shopping, challenge each child to find something on the shelf nearby. 
2. Give clues like, "find a food in a blue box" or "find a food that is round".
3. Teach your child to ask questions if they are having trouble, for example: "Bobby, you look like you are having a hard time finding that food, I wonder if you could ask a question to get another clue?"
4. Always give your child praise when they bring back a food item. This activity is not meant to have a "winner", only to engage children in the process of selecting and purchasing food that will later be prepared and eaten.

Children respond well when they are given choices in many day-to-day activities. This includes eating and mealtimes. Giving a child choices when they are grocery shopping gives them a small amount of control over their mealtime experiences later. It can also help children feel more comfortable trying new things if they are exposed to new foods in a "non-mealtime" environment like grocery shopping. 

When preparing new foods at home or when serving a meal, talk about how your child helped you shop. This will help to associate that new food with feelings of pride and success. Encourage children to explore the new foods, even if they are not quite ready to taste them.

Sarah’s family was like many families of children with feeding disorders. They had a happy, healthy baby girl who just wasn’t eating like the other babies. She spit up more. She fought the bottle at feeding times. And, she just didn’t seem to enjoy being fed. Her brother had been a great eater and never had a problem growing and gaining weight. Her parents just couldn’t figure out what was wrong with their baby. Would she grow out of it? Were they doing something wrong?

So, Sarah’s parents did what any family would do; they asked their pediatrician.

He referred them to the state’s 0-3 early childhood program for an evaluation and also to our feeding clinic for an evaluation. The 0-3 program physical therapist (PT) found Sarah to have a moderate delay in her gross motor skills. The PT and the feeding team recommended weekly therapy. After 3 months of weekly therapy, a developmental therapist (DT) and occupational therapist (OT) completed a re-evaluation and suggested adding weekly DT and OT to the family’s services. After about 6 months of therapy services, the family was referred by their GI doctor to an out-of-state intensive inpatient feeding program. The program staff included a team of psychologists, another speech therapist, a dietician, another GI doctor, and an ENT (ear, nose, and throat doctor). So, let’s review. Sarah and her family were then seen by the following specialists:

• 1 Pediatrician
  
• 2 Pediatric GI doctors
  
• 1 ENT
  
• 1 Psychology team
  
• 2 SLPs
  
• 1 PT, 1 OT, and 1 DT
  
• 2 Dietitians

In summary, that is 12 specialists at 4 hospital systems. What started as a small
concern for this family quickly spiraled into a much larger problem with many
different systems to navigate. As with many families of children with feeding delays, Sarah’s parents were thrust into the role of telephone operator. We spent the beginning of many sessions just catching up on the multitude of recommendations and changes made by the many other members of the feeding team. Sarah’s family was often confused or uncertain when given conflicting recommendations by different team members.

Lesson #3: Build a core team, preferably with members who are willing and able to communicate frequently.

When a child is diagnosed with a feeding delay or disorder, some families respond by wanting as much information as possible. Second and third opinions are an excellent idea and trying a few therapists can be essential in finding someone who you and your child feel comfortable working with. But, eventually it’s best to build a core team of doctors and specialists who can help create a treatment plan encompassing all aspects of your child’s development. If needed, additional specialties can be added as consultants to the team, with the core team members integrating the new recommendations into the common treatment plan. The members of the team should be willing to communicate frequently with other team members, whether in a monthly staffing of your child’s case or via telephone/email communication.

Building a solid team that communicates well will lesson the pressure on families and parents to pass along recommendations. Parents are able to focus on the content of each session without furiously taking notes they can pass on to the next therapist or physician. Also, understanding what each member of the team is focusing on can help you, as a therapist, better design your treatment activities and home program to mesh within the global treatment plan.