Tripp Trapp Chair

I get lots of enquiries about this topic, parents up and down the country struggle to feed their children. Mealtimes with toddlers can sometimes feel like a war zone!

Reasons

The reasons for food refusal are many and very varied. Perhaps your child was born prematurely and had lots of tubes and things sticking to his or her face? Or maybe your child had gastro-oesophageal reflux and this caused pain every time he or she swallowed. Some children have motor problems so it was hard to coordinate swallowing with breathing and caused frustration and anxiety? Many children have sensory integration difficulties and these make it difficult for them to grasp all the different textures and colours they are eating.

When I take a case history for a new feeding client, I always try to first establish how the child learned not to feed/eat. I use the word ‘learned’ here with intent as eating is a learned behaviour. We tend to think that it must just be instinctive and natural but this is not the case. Instinct is a small part of the very beginning of feeding, in that a baby naturally roots for the breast but this only works out well and leads to more natural ‘instinctive’ feeding if that initial instinct is not interrupted or impacted on negatively by any of the above reasons.

So just as a baby learns to eat or drink the milk it can also learn not to do so. The baby can learn to avoid eating in order to bypass discomfort, or — and this is another important factor — in order to gain more positive attention from the caregiver!

Research shows that we learn about food in two ways:

1. A connection is made between a food and a physical reaction. This needs to happen only once and it can stick: think about feeling sick after a binge on a certain food/drink… You won’t want to go near that very food again for some time, if ever! If a certain food causes pain then that connection can be made quickly and we won’t want to touch this food again.
2.  We learn through reinforcement and punishment:

1. Reinforcement:

• If we get praised for eating our plate with a pudding, then we tend to eat more to get the pudding.
• Equally if granny sits with us for hours at the table reading us a story because we do not eat or don’t eat much/quickly, we will continue this because we want granny to keep reading for us.

2. Punishment can work in two ways:

• Child gets punished for not eating and will eat more to avoid punishment.
• Child eats less as the fear of punishment is so unpleasant and leads to total lack of appetite.

As speech therapists we do not endorse any of those above strategies because none of them give us the desired effect.

What do we want to achieve? We want our children to eat naturally, with enjoyment. We don’t want them to over eat, to binge eat, or to starve themselves. Eating needs to become a joyful, natural and organic behaviour if our child is to be healthy and thrive.

Recommendations

Here are three top recommendations I make regularly with good effect:

1. Structure: have a routine at mealtimes, eating at the table, in the same room with our favourite utensils. Always helping in food preparation, perhaps setting out the table placemats etc, and then tidying up — taking the plate to the kitchen counter, scraping left overs into the recycle bin can be part of this. This way we can introduce repetition to our food/eating learning.

• Positioning: the right chair with a good footrest, supporting our child’s trunk well, and facilitating our child eating at the table (instead of sitting in a high chair with a tray) is one of my first and favourite tips. I do favour a Tripp Trapp style chair (I have no association with that company).

Tube fed children ought to also sit at the table with the rest of the family and first of all be offered foods and drinks to handle or play with. Some tube fed children are able to eat a small amount of pureed foods and they ought to be offered this first before being topped up with their tube feeds, whilst sitting down. Lying down for your tube feed is not a normal way of eating. Tube feed infants should be offered a pacifier whilst being tube fed and be in an upright position so that they start having an association between getting full/feeling satiated and their mouth.

• Sociability: I encourage family mealtimes, or at least the caregiver eating with their child together, so that the child is able to copy and observe what normal eating looks like. We need to be super positive about eating and food consumption so that our child can see and copy this. If the parent is a fussy eater then this may cause the child to copy exactly the same behaviour. Many parents who come to me with their fussy children are themselves also picky about food.

There are many other tips and strategies and I will be more than pleased to assist, please contact me.

Sonja McGeachie

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Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.