What is the best approach to problem feeding in kids?
There is a difference between a fussy eater and a problem eater. Both fussy and problem feeding are stressful for parents to deal with, and make us question whether our children are getting the nutrition they need to grow and develop properly. While the management of fussy feeding is mostly behavioural, as we discussed in a previous blog, specific strategies and interventions by a team of health professionals may be required in cases of persistent problem feeding.
So, what exactly is problem feeding?
Problem feeding is where a child has a chronic difficulty with feeding. There is very restricted dietary variety and the child’s nutritional requirements are usually not being met, both of which are often associated with behavioural difficulties at mealtimes and significant parental stress. Specific difficulties with swallowing, chewing, choking, gagging, vomiting or aspiration of food or fluid into the child’s lungs may be occurring. Up to 25 per cent of typically developing children can have problems with feeding, whereas in children with developmental disabilities, the number is drastically higher – up to 85 per cent. Problem feeding can be short term, but will become even more problematic if it persists.
Problem feeding is commonly associated with the following conditions:
- Structural abnormalities of the nose, mouth or jaw (such as those found in children with a cleft palate); of the airways or feeding tube (such as Trache-Oesophageal Fistula, or TOF, where there is a connection between the main breathing tube [trachea] and feeding tube [oesophagus]).
- Neurodevelopmental problems such as cerebral palsy, where the control of movements responsible for ingesting food or drink may not be coordinated.
- Sensory and behavioural difficulties that can affect a child’s willingness to eat.
- Following illness, or after a period of necessary tube feeding, where a child may have had negative experiences associated with food.
- Gastro-intestinal discomfort including reflux or dietary intolerances that also cause negative associations with early feeding experiences.
- Forceful feeding in early infancy.
At any stage of development, interruptions or changes to a child’s eating and drinking skills can occur, and affect how problem feeding presents.
The Eating, Drinking and Swallowing Clinic
This clinic at RCH is comprised of a team that deals with problem feeding, and I’d like to share their wholistic approach to this difficult issue with you.
The first step is to recognise when there is a problem with a child’s feeding, which is often quite clear. The more difficult step is for parents to understand how they are reacting to their child as a result of the feeding problems, to understand the range of factors that might be affecting their child’s ability and desire to eat and drink, and knowing what to do about it.
Many professionals can be a part of a child’s ‘feeding team’, including a lactation consultant, Maternal and Child Health Nurse (M&CHN), paediatrician or medical professional, occupational therapist (OT), speech pathologist, dietitian, physiotherapist and infant mental health clinician. These professionals may see you individually, with communication between team members being vital for success.
The feeding team will always assess a child’s:
- Physical development, including their motor and sensory skills, and nutrition.
- Developmental stage and milestones, as well as their communication around food, e.g. their ability to request and refuse food, their ability to get their hands to their mouth to self-feed.
- Social and emotional development, especially the child’s relationship with their main carer(s).
- Mealtime experience i.e. the home environment and family routines around mealtimes.
It’s a problem when a child is distressed during a mealtime. Kids need to enjoy and feel included in mealtimes, as well as have some control over what they eat and drink. It’s important for a child’s future wellbeing that they build a positive relationship with food. The RCH team supports parents to recognise and follow their child’s hunger and feeding cues, to STOP feeding despite the burning need to ‘make sure the child eats’, and to allow their child to regain some control over mealtimes.
I will describe strategies for specific difficulties such as choking or gagging on foods or difficulties with certain food textures, in more detail in a future blog.
When should you seek help?
In cases where your child’s growth and nutrition are compromised, stress at mealtimes is impacting on family mental health, or your child is unable to comfortably manage to eat a range of foods as expected, it is important to consult your GP or M&CHN. A local speech pathologist, dietitian or OT with experience in paediatric feeding may be a good starting point. These professionals can be accessed either through a community health service or in private practice, however, choose a service that offers a team management approach to problem feeding in children. A speech pathology referral for the Eating, Drinking and Swallowing Clinic at RCH may be indicated. Your treating medical professional or M&CHN can make this referral if needed.
It can take a significant period of time and lots of small steps to change chronic problem feeding for the better. A consistent approach, tackling challenges when they present, and having a team of professionals alongside to assist you with goal setting, will help you to support your child to overcome their feeding difficulties and to start enjoying mealtimes.
Some further reading:
- www.feedingmatters.org – US based webinars and other resources for professionals and parents.
- Ellyn Satter Institute’s Division of Responsibility in Feeding document http://bit.ly/1gh25mv
- RCH resource for health professionals, that is also of interest to parents and carers: www.rch.org.au/feedingdifficulties
Please note: Dr Margie is no longer monitoring this blog. If you are concerned about your child, please contact your child health nurse or GP for further advice.