| Hungry
for Compassion
Feeding children with delays.
by Richard Kahn, MS, RD
Feeding Can Be Difficult
Feeding any young child can be frustrating. Parents with delayed children
are even more likely to encounter difficulties.
One reason parents experience difficulties: Many parents see food as
a way to get necessary nutrients into their child, as if the child has
no inner sense of what is occurring. While infants know nothing about
calories, nutrients or average weights, they have some inherent sense
about eating. For all children, food is more a form of communication
than a way to get nutrients. And, communication changes as your child
grows and develops, no matter what his or her pace of development.
Brazelton, president of the Society for Research in Child Development,
and other child development specialists determined that infants and
children communicate their feeding needs but not their nutrient needs.
Continue reading to understand how to partner with your child—
who may be too young or unable to speak— in order to help give
him or her needed foods. Keep in mind, developmental specialists who
work with delayed children see feeding as a set of roles and innate
drives.
Roles and Drives
Roles are expressed in two ways.
1. The parent decides what to serve, and when and where
to serve the food.
2. The child decides whether or not to eat.
The basic feeding drives are expressed as milestones
in terms of drinking from cups, eating finger foods and using spoons
independently. Delayed children, however, may not be able to meet these
standard milestones.
The delays that prevent developmentally delayed children from meeting
milestones do not eliminate the developmental drives behind the milestones.
Delays merely confuse and retard the developmental process toward the
child’s need for mastery. Parents, therefore, need to be alert
to subtle signals that delayed children give. In this short article
it is impossible to cover all variations of signals from infants and
children. But, it is possible to give a picture of what to look for
and what type of help to get.
Before the 6th Month
Early sucking problems are common developmental difficulties. Before
a child reaches 6 months of age, occupational or feeding therapists
who address oral motor problems usually manage delays. Infants may have
reflux and avoid feedings, and such therapists understand the relationship
between eating and reflux. Genetic anomalies may also contribute to
poor feeding in the early months.
Even at this early stage, parents must pay attention to the communicative
aspects of feeding. An infant should participate in eating via hunger
cues like voluntarily opening his mouth. A willingly opened mouth indicates
that baby wants to eat. Parents should also look for satiety or refusal.
Keep in mind that eye contact creates emotional closeness with an infant
and serves as the basic tool of observation.
A common parental mistake is trying to get an infant to take just a
little more nourishment by jiggling his or her bottle. Doing so removes
the infant’s need to accept or reject feeding. Research on the
“just a bit more method” of bottle feeding finds that babies
actually gain less when parents tamper with the child’s natural
appetite. Another common mistake is pushing a feeding when it is clear
that baby does not want more. This bothers baby, and feeding will eventually
become an unpleasant chore for everyone. If your baby’s pediatrician
sees the need for more calories, he or she can advise under-diluting
formula or adding olive oil or microlipids to formula. If your child
experienced time in the NICU and prematurity occurred, you may want
to contact developmentally trained NIDCAP specialists if sucking and
feeding are confused.
After the 6th Month
When solid foods are introduced, the roles still apply. Parents provide;
children eat or do not eat. If the child’s interest and responses
are not met within the individual developmental context, a low weight
and refusals often occur. Being underweight generally stems from insufficient
calories, but often continues when parents and therapists pay too little
attention to drives during feedings and refusals. Most infants want
to eat solids, use a cup at 6 months and take finger foods at 7 months.
They do not know they have a delay if they have an expressed desire.
The trick is to figure out a way to match the developmental drives with
the state of development.
Look for readiness cues like your child’s curious eyes and gestures
toward your cup. For solids, his eyes focus on food and his mouth is
open as if he is ready to eat. Is his head erect? An erect head signals
that liquids may be taken from cups and solids may be taken without
overconcern for choking. For many delayed infants and children, maintaining
an erect head is a problem. Parents should speak with the therapist
to tend to this issue. Perhaps a special chair or simply supporting
the child’s head will help your child to use a cup by himself
or take solids. Your baby might also be satisfied if you hold the cup
and place his little hands on it.
Should you even introduce solids? Oral motor problems often interfere
with infant’s drives to take solids. If your baby expresses interest,
work with the therapist to help your baby join family meals. Put any
food for baby in the blender. Just be mindful that babies often know
they are not getting the same food as Mom and Dad.
Sometimes, your great feeding therapist gets baby’s lips, jaws,
tongue and throat to work together, but your baby still refuses solids.
Are there sensory issues? It is certainly possible that sensory problems
are creating complications. Try the following to see if sensory issues
and developmental drives are making matters worse. Place a spoon at
your child’s lips, not in his mouth. Spoons placed involuntarily
in your baby’s mouth eliminates his ability to make a choice.
Finger Foods
The standard sign to start offering finger foods is the presence of
the pincer grasp— when baby connects the tips of his index finger
and thumb. The pincer grasp relates to swallowing ability. Sometimes
the pincer milestone will be met later. In other cases, there is no
pincer grasp due to real or suspected delays. Is there emotional readiness?
Is spoon feeding going well? If it is, maybe try placing a puff at his
lips. If your child takes the puff with no trouble, consider other early
starter solids like banana bits. Place the finger foods at the lips.
If there is no interest or ability, waiting is appropriate. Speak with
your pediatrician or feeding therapist for further guidance.
The Spoon Drive
At 9 months, babies typically want to hold their spoons. Is your child
showing interest in using a spoon himself? Or, is he starting to refuse
spoon feedings, but currently lacks the ability to hold a spoon? Stand
behind your child. Hold his hand while he holds the spoon. Sometimes,
the occupational therapist can adapt spoons, making them easier for
children to grasp. If your child likes feeding himself, you will know.
You’ve tapped into his developmental drives. If he shows no interest
or pleasure in personal feedings, the task can wait. If he resists feeding
himself, wait. Try the task again in a few weeks.
The answer to many feeding developmental problems is
patience and love. If feeding difficulties predominantly result from
parent-child interaction problems, then such problems are likely to
pass with informed parenting.
Richard Kahn, MS, RD, is a nutritionist who specializes
in working with families of children with developmental delays. He is
pursuing doctoral research in the psychosocial aspects of failure to
thrive.
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