An OT, a Mom, and a Picky Toddler walk into a… feeding therapy session; A Quick Guide to Structuring Mealtime

A toddler, his mother, and I are sitting around the table in feeding therapy, playing with crackers. The crackers were a new food we were introducing to the toddler. From the second we placed the crackers on the table, I could tell that he was interested in them. My work begins- the cracker turns into a train, a rocket, and a puppy dog; the toddler is giggling and loving it. He starts to participate with me, touching the cracker, pretending that it’s different vehicles and animals, successfully exploring the touch and smell of it. Naturally, his mom gets excited; she sees as I do that he is starting to like this new food. I see my chance, and I begin to nonchalantly eat the cracker. As I’m eating, I’m exclaiming “mmmmm,” commenting that this cracker is “yummy, crunchy, and tastes salty. I see the toddler look at the cracker, contemplate bringing it to his mouth, and start to move it closer to his lips. He stops, looks to his mom and hands it to her instead. It’s as if he’s saying, “Mom, I just want to make sure this is okay, what do you think about it? Do you like it? Is it safe?”  His mother takes the cracker, takes a bite, and exclaims how delicious it is. He smiles; he knows it’s safe to try. The mother, thinking that the child is finally in a state to taste the cracker, abruptly presses the cracker against the child’s lips stating “here, take a bite!” The toddler, in a fit of desperation, puts his hands up in front of his mouth, turns his head, and starts crying. He screams, “All Done! AAALLL DONEEEEE!” and gets down from his chair, no longer interested in eating.

Now, imagine that there was an alternative scenario where the mother, instead of trying to feed the child the cracker herself, placed that cracker back on her toddler’s tray after she described how delicious it was….

… The toddler picks the cracker up, looks at it again, and brings it towards his mouth. Upon touching it to his lips, his mother smiles and puts her own cracker to her lips, telling him “great job! I love how you’re touching that cracker with your lips! We can kiss it!” The toddler smiles and continues to interact with the cracker, making kiss noises along with his mother and I, each time we bring the cracker to our lips. The mother then models putting the cracker between her teeth, which the toddler easily follows and imitates. Next, we are sharks holding the cracker between our big strong teeth, getting ready to crunch our prey. This progression continues until the toddler takes a singular, small bite of the cracker, his mother and I right there with him.

In the first example, the toddler is wary of this new cracker, but is participating in play and positive interaction with people he trusts. The mother misread her son’s cues and thought he was ready to eat the cracker, leading to her attempt to put a bite in his mouth. Picky eaters like the toddler in this example are often very sensitive to smells, textures, and tastes.  New foods bring new sensory properties that may require acclimation before a child will initiate trying a food. When this time for acclimation does not happen, controlling what goes in their mouth is how a picky eater might attempt to “survive;“ they are protecting themselves from something they see as potentially offensive. When the toddler’s mother moved the cracker towards his mouth, he felt out of control and as a result was defensive. He lacked sufficient positive interaction in order to feel comfortable moving forward, resulting in the tearful conclusion.

In the second example, the mother let the toddler lead the way, modeling and providing opportunities for the toddler to make small and meaningful steps forward. Though he was cautious, he interacted with the food for an extended period of time with his mother. He was always in control of when and how he interacted with the cracker. When he was ready to try it, he placed the cracker in his own mouth. The end result was a safe, positive and fun interaction with a new food.

My feeding therapy sessions very intentionally provide an atmosphere where the child is ultimately in control of their own progression.  The goal is to establish a trusting environment in which a child can succeed, and to educate parents on how to do the same. There’s an art to making a child feel safe while providing them with opportunities to move out of their food-based comfort zone. When parents use these same techniques at home in the child’s natural environment, I see a higher occurrence of successful diet expansion.

There are a host of additional considerations for each individual child. Picky eating can be compounded by medical conditions, motor deficits, and sensory processing deficits that require physician care and individualized therapy services. However, the examples I have outlined below are practical ways to help foster more mealtime success.

  1. Relate the food to something they know:
  • Describe the food. Use phrases that familiarize your child with the new food and that help them draw on past experiences. “This cracker is crunchy,” “this food tastes salty; like the chips you like,” or “these mashed potatoes are soft and smooth.” This way, your picky eater knows a little more of what to expect and can connect it to positive food experiences they’ve had in the past. They may think “oh, I like chips that are crunchy and salty, so this cracker might be good like that.”
  1. Make the child feel safe:
  • Allow the child to feed themselves whenever possible. Like the example above, giving your child control over what goes in their mouth is an important part of making them feel safe when presented new or challenging foods. Force feeding a child has never been successful in my experience. Parents of course can choose what goes on their child’s plate, but the child should be the one in control of bringing it to their mouth.
  • Suggest something they can do, instead of commanding it. Instead of “take a bite,” try phrases that include “you can” or “I like to.” For example, “you can lick this piece of chicken to see what it tastes like,” or “I like to put it on my teeth to find out if it’s crunchy or soft.” Presenting them with options of what they can do and modeling it can provide much needed confidence that is more likely to lead to forward progression.
  • Never hide food. Hiding a new food in a food that a child already likes in order to “sneak” it in can ruin the established trust between the parent and the picky eater. A trusting relationship is necessary if the child is going to move forward in trying new foods. In addition, hiding foods can cause the child to stop eating a previously tolerated food, as they may then associate it as now being unsafe.
  1. Guide positive interaction:
  • Provide choices. “Do you want to take a big bite or a small bite?” “Would you like cheese on your noodles or just plain?” Do you want these chicken nuggets cut in small pieces or strips?” Providing children with choices keeps children in control. The choices you give should ultimately end up with the result you want, which is eating the food, but giving kids control of how they get there can go a long way.
  • Set an example. There is nothing more powerful than a child seeing his parents and family enjoy eating. If each family member has the same food on their plate, the child can see his/her parents enjoying the same foods they are hesitant of. Children are sponges that notice your reactions to foods and often imitate what they see, so providing them with good models is important.
  1. Reinforce positive interaction:
  • Praise. Praise every positive interaction the child has with the food, even if it’s not eating it. “Great job touching the broccoli with your fork,” “I like how you brought that piece up to smell it.” Children love to please their parents and receive praise, and it helps direct the behavior you want to see. Letting your child know when you are proud of them for making a positive step forward can motivate them to do more.

When children feel safe, encouraged, and motivated to explore new foods in such an environment, meal time can be transformed into a more positive experience for parents and children alike. These suggestions take time, energy, and patience, but the effects of structuring mealtime in this way are significant and longer lasting results for your picky eater.

 

 

If you are concerned about your child’s nutritional intake, please consult with your pediatrician and inquire about a feeding therapist in your area.

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