Changing Colors: The Blog of Spectrum Pediatrics

August 18, 2014

Feeding Aversions: Skill vs. Dysfunction

By: Jennifer Berry, OTR/L
Those of you who have children with feeding disorders are well aware of how dramatic and difficult helping a child overcome a feeding aversion can be.  The most loving parents and the most skilled practitioners are all working towards the same goal.  Working and working and working.  It has been my experience that there is one real key to changing that dynamic from one of “work” to one of enjoying a natural family mealtime.  Until the team, with the family at the helm, understands that feeding aversion is a “Skill” and not a “Dysfunction”, that this cycle of challenging mealtimes will continue.  I realize that thinking of something as challenging as a feeding aversion as being a “positive” when it so clearly has so many “negative” connotations for families and children can be a difficult concept to wrap your brain around.  Let me try to explain.
Most children with true feeding aversions have a past that creates a negative and complicated relationship with food.  Here are just a few examples:
  • They learned to be afraid of food because they didn’t initially have the coordination to manage it comfortably.
  • They learned to be afraid of food because they were aspirating (food going into the lungs rather than into the stomach), and food or liquids put them at risk of choking or having respiratory problems.
  • They had reflux and learned “the more I eat, the more it hurts”.
  • They and their families experienced stressful mealtimes due to pressure and desire for improvement.
  • They learned to fear food or anything near their mouths due to multiple medical procedures.
  • They learned to related to food in contrived and clinical settings.
  • They learned that food was “work” and that they had no control over their bodies in regards to food.
If these things are true, doesn’t it follow that these children SHOULD be aversive to food??  Don’t we want our children to avoid things that hurt them or that they view as dangerous?  Isn’t it our job to discourage our children from eating for external reasons?  Don’t we want our children to listen to their own bodies and feel in control of them?  The answer to all of these questions is a strong and firm “YES”.
At Spectrum Pediatrics we firmly believe that teaching children to have positive relationships with food in which their experiences and fears are honored is the key to unlocking this puzzle.  What do we do:
  1. First, Do No Harm –  We recommend that families end any therapies or activities that they are engaging in that could be confusing the child’s relationship with food or even deteriorating it inadvertently.
  2. Mealtime Coaching – Work WITH the family to give real world and at-the-table recommendations about what to do to return meal times to “normal” and decrease the pressure on the child and on every member of the family.  This can involve changing the environment, changing our patterns of speech and volume, what we are saying, and how much attention is placed on food and eating.  During meals we should be relaxed and not feel “on stage”.
  3. Rest in Neutral – Allow the child and family to “rest” for a brief time in order to decrease stress and turn the new mealtimes strategies into habits.
  4. Child-Directed Progress – Our therapists coach families about how to introduce new foods and textures in a loving, supportive and natural way that honors the child’s aversion instead of reinforcing it.  The child gives permission, the adults learn to read the child’s cues, and we help our families get back to basics.
As a family begins to embrace the idea that feeding aversion is a learned skill versus a dysfunction, they can finally begin to be set-free from the struggle of unnatural mealtimes.  They can leave behind the institutional and clinical approaches to meals and literally get back to the table.  The kitchen table.

 

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