By Lori Caplan-Colon, SLP
Owner, Montclair Speech Therapy
Each May, we celebrate Better Hearing and Speech Month to build awareness of the role of Speech Language Pathologists. This year as our lives have been turned upside down and physical distancing all over the world has led to increased isolation, we celebrate this year’s American Speech and Hearing Association theme of building connections. As SLPs we have the luxury of treating speech, language, cognitive, swallowing and feeding from infancy through end of life with a myriad of diagnoses in a variety of settings. This diversity lured me to the field but it was the ability to truly make connections with clients and families that has allowed me to remain inspired and passionate every day for the past 17 years.
During this time, I have honed my practice and feel most energized when supporting clients and their families challenged by pediatric feeding disorders. As a SLP with pediatric feeding expertise, I come into contact daily with many families who struggle with their child’s diet or mealtime behaviors. I am often asked how to help a child expand his/her diet. I have been given the opportunity to share some tips with this audience.
Keeping mealtimes and snack times positive is a constant conversation in my practice. Children learn through play. I want children to feel safe, have fun, and enjoy the process of meal preparation and feeding as much as possible. Kids learn about how foods will feel in their mouth by interacting with the foods at their fingertips, hands, arms, faces and how it smells so they can predict how it may taste and feel inside of their mouths.
Allowing and encouraging a child to play with food is such a valuable experience and one that I use in all of my sessions to help a child really get familiar with a food. The research shows that children will be much more likely to consume food that they have been exposed to through a variety of sources. These experiences can include promoting teamwork in the kitchen, having the child assist in food preparation, or adding creativity into meals: Foods can become vehicles, superheroes, animals, face paint, fairy dust, and so much more. Allowing our children to experience these foods at the multisensory level, get comfortable, and trust the process that brings these once-unfamiliar foods closer to their mouths prepares them to take their first bites. A successful feeding session is one in which a kid has made a mess, has food on their face, extremities and most importantly, a smile on their face.
I want children to come to the table with the ability to tolerate, interact, and eventually consume a variety of foods from different food groups, different consistencies, different flavors, different colors, different sizes, etc. I encourage our kiddos to be "little food scientists" so they can discover what makes food taste better, or not. I focus on modifying and giving them control while building their skills.
Ultimately, the focus at mealtimes should be the social aspects and the family time that occurs, not the food. If a child is in a heightened state of anxiety due to a variety of reasons, mealtimes are not perceived as positive and the battles will begin. Oftentimes, families come to me with a feeding methodology that just doesn't work for so many of the kids who I work with. I have to recognize the child's sensory system, motor abilities, previous feeding experiences, GI/medical system and all behaviors that they come to the table with.
Setting up a schedule: Children and their parents thrive with routine. The best tool a child can bring to the table is an appetite —unfortunately, a key element that many of my clients are missing due to negative eating experiences or anxiety about eating. I encourage my families to get their children “coming to the table” to have positive mealtime experiences every two hours or so.
Making mealtime a positive experience for the child helps establish a good relationship with food. By establishing this “feeding time,” we are preparing and getting the child on a schedule, even if the child doesn’t eat much. This heightens the child’s expectations that there are set times for eating.
If you are concerned about your little eater, I think parents should always trust their guts. If a parent senses that there is an issue, they should bring it to their pediatrician's attention. If a parent is experiencing mealtime stress, the child is as well. At times, Pediatricians won’t recommend intervention because they see they are growing fine, but it's so much more than the numbers on the scale or the curve on their charts. If intervention happens only when a child drops weight, doesn't gain, etc., then we are waiting too long - as children by that time already have noticeable weight loss, and can be building up their negative associations with feeding and meals. This can take years to undo.
Building children’s confidence to approach the table thinking, “I can eat that,” is important for their food and nutrition intake, of course, but is also critical for enhancing mealtime socialization with family and friends. Just as important is supporting the caregivers’ engagement with the child during mealtime and empowering their capacity to implement feeding interventions on their own at home. Feeding specialists, like myself, are available to help children and can support the child and family to get on the path to become more successful and competent feeders. It is our job to better educate our communities that we are available for these situations.
Lori Caplan-Colon is a leading speech language pathologist specializing in pediatric feeding disorder and founder of Montclair Speech Therapy, a family friendly practice that provides services for infants, children, adults and seniors.