Question
How can meal times and snack times be used to help children with feeding issues?
Answer
One measure that can be used to help children with feeding issues is to encourage family meal time (or, in the early childhood education setting, group snack/meal time). For one of the preschools that I consult with, we changed the way that we did our snack time and our meal time, and it helped with feeding. When you have family meals, the child should not be the highlight: the food is the focus. Additionally, meals need to be enjoyable, remembering that adrenaline and stress are appetite suppressants. If a child does not enjoy being at that meal, they're not going to eat.
Involve the child as much as possible during meal or snack time. Have the child help prepare the meal/snack, help set the table, and allow them to help with serving the meal/snack. The more they're involved, the more exposure that they're going to have around that food. It takes ten times for a typical child to try a new food. If we can get them more exposure to the food, it can help increase the likelihood that they might add that food to their repertoire.
Another big change that we made at our preschool was to start serving snacks and meals family-style. Instead of handing out single snacks to each child, we started using containers to hold all the snacks. We made sure that there was something that everyone liked. The children would practice taking a snack, putting it onto their plates, and passing the container from peer to peer. This also serves to hone the children's social skills. Whenever we serve family style, it increases their exposure to that food. You may not wish to serve family-style at every single meal, but choose a few meals that you're going to target. When doing this, it's important to make sure to include one preferred snack that every child likes. If a child does not like any of the food offered, the child will not want to sit there. At our preschool, we had ten children, and a few of them have autism. One of the children only liked spicy hot Doritos. We made sure to offer a bowl of spicy hot Doritos, so that child was sure to get something that he liked.
At first, the goal is to have the child eat the preferred item, and start learning about non-preferred items. Our goal is not to emphasize the quantity of food: it's to introduce diversity. When children have a diverse diet, and when they eat a lot of different foods, they eat more food. In the past, I've always been worried about the total amount of food, but now I worry more about the diversity and the variety of food offered.
We also want to reduce distractions during meal/snack time. Turn off the television, and put away the iPads and the toys. The goal of these meals is to learn about the food. We use a learning plate for children who are having difficulty during meal times. Some children have a hard time even tolerating food being on their plates. For those children, we'll put a learning plate in front of them, and as we're serving family style, they can either put it on their plate or on the learning plate. The learning plate is not their plate, but it's teaching them gradual exposure to that food. It's still there, they're still interacting with the food, but it's not on their plate, because that might be too stressful for them. We want to set reasonable expectations for families. Have them start with small steps. At first, family-style meals could be implemented during one or two meals per week. Make sure it fits within their routine and their schedule so that it is not a stressful environment.
Tips for family meals. Use reinforcement with caution. I used to be bad at using reinforcement to get children to eat food, which sets food on a hierarchy, versus teaching them about food. Use the same place, schedule, and routine at each meal to maintain consistency. For instance, we all wash our hands, we sing some songs, we get our plates, and then we sit at the same table each time. Thinking about the size of bites on the plate: are they a good size for the child to manipulate? Children with feeding issues might have trouble biting and manipulating the food in their mouths, and that might be why they're not eating it. Could you cut it into smaller bites that make it easier for them to manipulate? A general rule is one tablespoon of food per one year of age.
Keep the time in mind, and don't make children sit there for a long time. Snack time should be no more than 15 minutes; meal times should last no more than 30 minutes. Also, spread out meals and snacks 2.5 to 3 hours apart. Once again, we want to re-teach that appetite, where every couple of hours, we offer either a snack or a meal, and eliminate anything in between (e.g., additional snacking, milk, juice -- anything that might curb a child's appetite). Another valuable thing I've learned is that sweets are an appetite suppressant. You'll see these children who are grazers, where if they are hungry, they will eat a few sweets, and then it suppresses their appetite such that they can go longer without eating.
This Ask the Expert is an edited excerpt from the course entitled Feeding Tips for Young Children, by Tara Warwick, MS, OTR/L.
