Most parents will be familiar with the following scenario: you have spent the last hour chopping vegetables, simmering stock and browning beef to create the perfect salt/additive/colour free bolognese. Moreover, you have managed this while a toddler impatiently clings to your ankle. You serve up the dish with gusto; within 5 minutes most of the meal ends up on the floor, stuck to hair, covering your clothes and certainly nowhere near your child’s mouth. Then your friend phones you and casually drops into the conversation her wee darling has polished off a kale and avocado burger with a side of asparagus dippers. Cue sharp intake of breath and counting to ten!
Who knew that the acts of eating, drinking, swallowing, chewing, sucking and biting could be so complicated – and so expensive (the variation of bottles, cups, spoons available on the supermarket shelf is astounding). As a Speech and Language Therapist trained to assess and provide therapy to children with eating and drinking difficulties, I work closely with children who experience a wide range of challenges in this area. Put simply, my primary responsibility is to assess the safety of a child’s swallow and the effectiveness of their chewing and oral motor skills. However, the physical act of eating cannot be separated from the emotional, behavioural and sensory components that go with it. Therefore, I provide advice to families considering all aspects of the feeding process. Every child is different and so they benefit from different approaches to supporting their feeding skills but the following general top tips are often helpful.
Tip 1: Introduce cup drinking from a free flow cup at 6 months.
Free flow cups are more useful than non-spill cups because they encourage a child to sip which is good exercise for the muscles involved in controlling movements of the lips and tongue. In turn, this helps the lips and tongue prepare for making sounds for speech. In my experience babies don’t get really good at cup drinking until 10-12 months of age. Expect them to throw the water around initially but persevere and offer water from a cup with every meal. They will soon be a pro and this will avoid the need to offer drinks from a bottle.
Tip 2: Get children self-feeding from the start.
Children can be offered soft finger foods from 6 months which they love squeezing, smearing and practising bringing to their mouth. Getting used to feeling food in their hands helps children prepare for chewing it in their mouths. When offering children spoon fed meals, I have found the ‘two spoon’ approach is almost always a winner. Give your child a little of the mash or puree on their own spoon while you feed them the rest from a different spoon. This helps them feel involved, in control and lets them practise self-feeding.
Tip 3: Invest in a long sleeve bib.
The best ones are from IKEA and wipe clean!
Tip 4: Cut food up like a chip.
Apples, bread and butter, biscuits, pizza – whatever. Children find a longish stick of food easy to hold and chew. It also encourages them to put the food to the side of their mouth and between their teeth which encourages side to side tongue movements which are important for developing chewing. I also like the food pouches you can buy from most supermarkets for the early stages of weaning. You can pop food in and let your child chew and munch away – getting used to tastes and practising chewing.
Tip 5: Be prepared for gagging.
Babies gag as a normal part of developing their eating skills. At times, this can be scary for a parent to watch – their eyes might water and their faces go red. Most of the time babies bring the food forward and spit it out by themselves. Sometimes you might need to give them a bit of a pat on the back or bring them forwards. Babies around the age of weaning are primed to gag. It is a protective mechanism that keeps food from reaching their airway while they are practising eating. As much as you can, try not to react too much to episodes of gagging. This will help your child stay calm and not become anxious about it happening again. As a parent it is of course important to be able to recognise and know what to do if your child chokes – see www.redcross.org.uk for advice.
Tip 6: Try, try and try again.
Children will have foods they don’t like and there will be days they will eat a food type and other days they won’t. Try to remember adults are like this too - sometimes we feel like pizza and really don’t fancy a curry but next week go for the curry. When introducing new foods to children we often have to offer them lots of attempts before they can get used to a taste and decide if they like it.
Tip 7: Avoid placing importance or extra value on certain foods.
We have all done it: “finish your broccoli and then you have your ice cream.” This works when you have a child who doesn’t find eating challenging. But when every mealtime is a real battle, this usually leads to a frustrating power struggle. To avoid this, try seeing mealtimes as a whole; put everything you have prepared out at once (yes, custard creams with the macaroni and peas) and let your child dig in. It sounds counter intuitive and one assumes that children will polish off the sweet treat and leave the rest. However, over time this strategy almost always makes children more relaxed during mealtimes and happier to eat more of what is put in front of them; there is no more battling or bargaining to be had. If you are doubtful try it for a week and see if your child eats more or less of their savoury food – you might be surprised.
Tip 8: Be a mealtime partner.
I know some parents who have found it useful to stick this mantra to their fridge: ‘At mealtimes we share responsibilities. It is my responsibility to decide what a meal is and when it is; it is my child’s responsibility to decide how much they eat.’ Aside from cases when there is a real concern about a child’s weight gain, this has taken the pressure out of mealtimes for many parents I have worked with. So when your child says “I’m all done” you can say “OK, good stuff” and finish your own meal without trying to convince them to have more. Easier said than done I know, but again give it a try for a week.
Nearly all children naturally want to enjoy eating. If they do not and the problem is persistent, there is usually an underlying barrier. Always seek advice from your Health Visitor in the first instance.