By Valerie Gent
Feeding difficulties in early childhood are common and can affect approximately 25% of typically developing children and up to 80% of children with special needs.
The cause of feeding difficulties can be numerous including:
1. Oral motor delays (difficulties with chewing)
2. Difficulties with swallowing
3. Oral aversiveness and hypersensitivity
There are also resulting and compounding factors related to anxiety with food and behavioural difficulties around mealtimes as well as nutrition and poor growth (tube feeding etc.) issues.
Underlying issues causing food refusal and feeding difficulties can also include prematurity and other diagnoses as well as allergies and reflux.
A good feeding assessment is one that takes all of these potential factors into consideration (with further referrals to other specialists as needed) as well as team collaboration with other allied health professionals.
If you are looking at getting some support for your child’s feeding/fussy eating difficulties, please make sure that your therapist:
A) Helps identify with you what the underlying issues are that might have contributed to your child’s feeding difficulties – a thorough feeding assessment will do this. An oral motor assessment by a speech pathologist will also assess the muscles in your child’s mouth and identify any physical issues at play.
B) Works with you to individualise a program that focuses on:
- The strengths of your child: some children are quiet, some are chatty, some need time to process, some are very busy.
- The difficulties for your child: sensory issues, chewing issues, swallowing issues, communication and motor issues.
- Your goals as a family – what foods would you like your child to eat? For example, perhaps you eat capsicum all the time and this is a common vegetable for your children. What meals would you like your child to be able to join in as a family (e.g. we love eating tacos and this is a frequent weekly meal for us), where would you like your child to eat (e.g. we eat together as a family at the dinner table and eating at cafes and pubs is a common family outing for us).
- Your goals for your child – what do you hope to achieve with feeding therapy?
The challenge is that every feeding program is different and as a parent I encourage you to understand why your therapist picked that program for your child:
• Some are very structured and will use “time out” and “spoon removal” techniques to make a child eat.
• Some are less structured but still therapist-directed where a therapist plays with food whilst systematically getting the child to touch, smell and finally eat a food.
• Moving towards less therapist directed programs; these are programs that encourage therapists to understand the sensory world of a child and their family to help the feeding situation at home.
• And the most child directed program and opposite to the “time out” technique is the “parents provide – children decide” philosophy.
The first approach listed above is not my personal preference. I prefer a more trust- based approach that helps a child explore and ultimately love food – not to be forced to eat. But that’s a conversation you need to have with your therapist.
I’ve just scratched the surface of the different types of feeding programs available so that you know as a parent that there are many ways to help your child’s feeding; it isn’t “one size fits all”.
My take home message to you as the parent seeking feeding therapy for your child….
Please be involved in therapy for your child – understand what the session is working on and how it helps move towards your life goals for your child. Always be in the room with your child, therapy must first “do no harm” and if you or your child are not happy then trust your gut instinct.
The sign of a good feeding therapist when you meet for the first time, is one who doesn’t jump to the only feeding program they know. It’s one who starts trying to understand your child. It is one who communicates and works as a team with your other therapists, doctors and teachers so that your child’s needs are best supported before they even begin therapy.
It’s one who truly stops and listens to you – your journey, your fears and your hopes for your child.
It’s like finding the pieces of a puzzle and helping a family begin to put those pieces back together again. And for a short while, walking that feeding journey with the child and their family, a truly humbling and rewarding experience for me as a feeding therapist and speech pathologist.
Valerie Gent is a Newcastle based speech pathologist with 15 years of experience in children and babies with feeding difficulties. She has worked in hospitals and in special need schools and rehab teams. She currently runs a private practice ‘Let’s Eat! Paediatric Speech Pathology’ in Newcastle NSW. You can follow her on her blog and find more details via her website www.letseatspeech.com.au