Hungry for Compassion

Feeding children with delays.

Feeding Can Be Difficult

Feeding any young child can be frustrating. Parents with delayed children are even more likely to encounter difficulties.

One reason parents experience difficulties: Many parents see food as a way to get necessary nutrients into their child, as if the child has no inner sense of what is occurring. While infants know nothing about calories, nutrients or average weights, they have some inherent sense about eating. For all children, food is more a form of communication than a way to get nutrients. And, communication changes as your child grows and develops, no matter what his or her pace of development.

Brazelton, president of the Society for Research in Child Development, and other child development specialists determined that infants and children communicate their feeding needs but not their nutrient needs. Continue reading to understand how to partner with your child— who may be too young or unable to speak— in order to help give him or her needed foods. Keep in mind, developmental specialists who work with delayed children see feeding as a set of roles and innate drives.

Roles and Drives

Roles are expressed in two ways.

  1. The parent decides what to serve, and when and where to serve the food.
  2. The child decides whether or not to eat.

The basic feeding drives are expressed as milestones in terms of drinking from cups, eating finger foods and using spoons independently. Delayed children, however, may not be able to meet these standard milestones.
The delays that prevent developmentally delayed children from meeting milestones do not eliminate the developmental drives behind the milestones. Delays merely confuse and retard the developmental process toward the child’s need for mastery. Parents, therefore, need to be alert to subtle signals that delayed children give. In this short article it is impossible to cover all variations of signals from infants and children. But, it is possible to give a picture of what to look for and what type of help to get.

Before the 6th Month

Early sucking problems are common developmental difficulties. Before a child reaches 6 months of age, occupational or feeding therapists who address oral motor problems usually manage delays. Infants may have reflux and avoid feedings, and such therapists understand the relationship between eating and reflux. Genetic anomalies may also contribute to poor feeding in the early months.

Even at this early stage, parents must pay attention to the communicative aspects of feeding. An infant should participate in eating via hunger cues like voluntarily opening his mouth. A willingly opened mouth indicates that baby wants to eat. Parents should also look for satiety or refusal. Keep in mind that eye contact creates emotional closeness with an infant and serves as the basic tool of observation.

A common parental mistake is trying to get an infant to take just a little more nourishment by jiggling his or her bottle. Doing so removes the infant’s need to accept or reject feeding. Research on the “just a bit more method” of bottle feeding finds that babies actually gain less when parents tamper with the child’s natural appetite. Another common mistake is pushing a feeding when it is clear that baby does not want more. This bothers baby, and feeding will eventually become an unpleasant chore for everyone. If your baby’s pediatrician sees the need for more calories, he or she can advise under-diluting formula or adding olive oil or microlipids to formula. If your child experienced time in the NICU and prematurity occurred, you may want to contact developmentally trained NIDCAP specialists if sucking and feeding are confused.

After the 6th Month

When solid foods are introduced, the roles still apply. Parents provide; children eat or do not eat. If the child’s interest and responses are not met within the individual developmental context, a low weight and refusals often occur. Being underweight generally stems from insufficient calories, but often continues when parents and therapists pay too little attention to drives during feedings and refusals. Most infants want to eat solids, use a cup at 6 months and take finger foods at 7 months. They do not know they have a delay if they have an expressed desire. The trick is to figure out a way to match the developmental drives with the state of development.

Look for readiness cues like your child’s curious eyes and gestures toward your cup. For solids, his eyes focus on food and his mouth is open as if he is ready to eat. Is his head erect? An erect head signals that liquids may be taken from cups and solids may be taken without overconcern for choking. For many delayed infants and children, maintaining an erect head is a problem. Parents should speak with the therapist to tend to this issue. Perhaps a special chair or simply supporting the child’s head will help your child to use a cup by himself or take solids. Your baby might also be satisfied if you hold the cup and place his little hands on it.

Should you even introduce solids? Oral motor problems often interfere with infant’s drives to take solids. If your baby expresses interest, work with the therapist to help your baby join family meals. Put any food for baby in the blender. Just be mindful that babies often know they are not getting the same food as Mom and Dad.

Sometimes, your great feeding therapist gets baby’s lips, jaws, tongue and throat to work together, but your baby still refuses solids. Are there sensory issues? It is certainly possible that sensory problems are creating complications. Try the following to see if sensory issues and developmental drives are making matters worse. Place a spoon at your child’s lips, not in his mouth. Spoons placed involuntarily in your baby’s mouth eliminates his ability to make a choice.

Finger Foods

The standard sign to start offering finger foods is the presence of the pincer grasp— when baby connects the tips of his index finger and thumb. The pincer grasp relates to swallowing ability. Sometimes the pincer milestone will be met later. In other cases, there is no pincer grasp due to real or suspected delays. Is there emotional readiness? Is spoon feeding going well? If it is, maybe try placing a puff at his lips. If your child takes the puff with no trouble, consider other early starter solids like banana bits. Place the finger foods at the lips. If there is no interest or ability, waiting is appropriate. Speak with your pediatrician or feeding therapist for further guidance.

The Spoon Drive

At 9 months, babies typically want to hold their spoons. Is your child showing interest in using a spoon himself? Or, is he starting to refuse spoon feedings, but currently lacks the ability to hold a spoon? Stand behind your child. Hold his hand while he holds the spoon. Sometimes, the occupational therapist can adapt spoons, making them easier for children to grasp. If your child likes feeding himself, you will know. You’ve tapped into his developmental drives. If he shows no interest or pleasure in personal feedings, the task can wait. If he resists feeding himself, wait. Try the task again in a few weeks.

The answer to many feeding developmental problems is patience and love. If feeding difficulties predominantly result from parent-child interaction problems, then such problems are likely to pass with informed parenting.