Mess is essential for the kind of learning infant and toddlers like when learning to eat on their own. Self-feeding is part of the human drive to mastery and the abilities associated with eating on one’s own is associated with neurological development and appropriate weight gain. The child’s wish to grow and acquire their parents’ skills is balanced and framed by culture. Parents have to balance their child’s need to acquire food culture with the normal wish to keep chores to a minimum. Offering small portions and maximizing opportunities for modeling are two supportive ways to minimize mess. Infant and toddler tummies are the size of their fists.
The first sign of infant readiness for food is when they get excited and interested in your food. That interest may come as early as 4 months. Your pediatrician will let you how to proceed. Infants attain the ability grasp foods and a cup at around 6 months. Usually, finger feeding is linked to the ability to connect the index finger to the thumb. Self-spoon use begins around the 9th or 10th month. Typically-developing children completely self-feed by 15 months. That’s it, except for the mess. Parents have all the power they want to control the mess but children cannot be completely controlled. They need balance. Over-control leads children to refuse to eat or eat passively, eating only when fed by parents or while watching a video.
Sometimes, a child may have limited ability while showing the usual readiness cues. One day, a mother came in telling me about her underweight, two year old daughter who was resisting being fed. In this case, mother thought she had to feed her child because she had no hands! Mom’s grief and the future availability of prosthetics were discussed. Mother was advised to place the food in front of her child on the highchair and let her eat with her head leaning forward. Her child met her own developmental needs and ate well. Mother took the road mess travelled. This strong mother, at each meal, had to see her child’s resilience, weakness and, then, clean mess. Mother kept the strength and managed her own sadness instead of giving to her daughter.
A successful balance between control and creativity occurs in a scene from Ray, the Ray Charles. In this scene (https://www.youtube.com/watch?v=4U8OhVXtnQA), the white music producer knows that he has the power of money, contract, production costs and race, which he must marry with the artist’s need for self-expression in order to score that hit. Meanwhile, the African American artist needs support to reach his buried ‘star power’ which is founded on the artist’s need for artistic expression. Ray’s musical messes get tolerated until the producer and Ray work to reach that creative balance. The producer is like us ‘good enough’ parents who want their child to develop. This pivotal encounter leads Ray Charles to his first hit, The Mess Around. How appropriate. Help your own star to shine at the table while he does the mess around.
There’s a spirited article in the Summer 2015 issue of Egg Nutrition Close-Up. The article is by Lisa Katic a dietitian specializing in wine. Lisa consults on wine and food. She blogs at Katic’s Korner where Food+Wine=Health.
People ask me what are my sessions are like and how long it takes to get a result. Well, it depends. Here is a vignette of a three-session case that took two months from beginning to end.
Setting the stage
A father called about his 14-year-old daughter. His first stated concern was maybe his daughter had a sensory issue in her mouth. After his description, my thought was that this child might need a feeding therapist to mediate sensory issues. Father did not want a feeding therapist. He said he was not clear. The real issue, he thought, was that his daughter did not eat vegetables. I told dad that it would be a healthier practice if his daughter, Mary (not her real name), ate vegetables. Vegetables have a bitter taste, I told him, that some people simply do not like. Some of these flavors come from sulfur compounds. These compounds prevent cancer and other illnesses. Sulfur compounds, such as isothiocyanates in broccoli, are health powerhouses that taste bad to some people. I wondered, if there was an eating disorder or another problem that, for some reason, could not be disclosed over the phone. We made an appointment.
There’s a practical rule for parents feeding children: Keep meals to 20 to 30 minutes. Most meals take about that amount of time. If meals are a difficult time at your house, 20 to 30 minutes is enough discomfort for everyone. There is also a time to break the 20/30 rule. Reasons for breaking the rule come from the relatively recent discovery of mirror neurons and a case history. Mirror neurons explain how we learn by copying without conscious cognition. The specialized nerves use the eye or ears to bypass the word driven teaching styles and help us with social cues. Mirror neurons help pre-verbal infants and toddlers learn by watching and listening. When you and another adult enjoy a postprandial chat, staying at table models conviviality for your child.
Beatrice Beebe, an important infant researcher, shows a video demonstrating how fast moms and their babies copy each others facial gestures. Famed child psychoanalyst Theodore Gaensbauer thinks that mirror neurons explain how infants as young as three months link gestures and emotions by copying. Enjoy family and social meals together with your child as soon as possible after the birth.
Nutrition information comes to us from many directions. I want to let you know about one reliable source: Food and Nutrition magazine. Food and Nutrition (FaN) is published by the Academy of Nutrition and Dietetics (AND), the largest group of dietetic professionals in the US. The Academy also publishes one of the prestigious scientific, nutrition journals, The Journal of the Academy of Nutrition and Dietetics. AND is also the certification body for Registered Dietitians (RDs). Lately, AND added the word nutritionist to the RD credential, and some dietitians can opt to have the initials RDN attached to their name as a registered dietitian nutritionist. FaN provides a snapshot of the way many dietetic professionals see their work.
Dietetics and nutrition make up a vast field. Fan’s coverage is, therefore, wider than most of us might expect. Articles can range from, for example, the latest in how maple syrup is made on farms and the upcoming changes in the quality ratings that govern maple syrup labeling, to ethnic and religious foodways as well as the expected health topics.
Some of my favorite professional moments are from the moments the parents get the fundamental ideas of helping their child eat. The parents have become creative and gone beyond struggle, worry about weight, calories and developmental status. The parents connected deeply with themselves and their child. This connection helps the child progress. When the parents’ creativity sparks, I also learn. Today, I am writing about a simple technique with stuffed animals that helped one mother and her child. Maybe, it will help you.
Mom, Fatima, discovered that her son’s favorite toys, stuffed monkeys keep him focused on eating. Her son, Yunus, has lots of monkeys. Fatima placed two of Yunus’ stuffed monkeys at the table to keep her son company and more. The monkey’s kept Yunus, her son, company and engaged in eating without some of the bother and worry that had been going on before. Fatima let me post two of the photographs of her idea in action. Here is the first:
Stuffed animals are what psychologists call transitional objects. Transitional objects help toddlers mediate between their inner world and the outer world. Some children prefer blankets or teddy bears. In this case, monkeys did the trick for Yunus.
One morning in New York City public clinic, a mother sits down and tells me her 4 month old son has been vomiting his formula for the past 3 months. The boy’s weight and height were adequate. Enough formula was being digested. Maybe the child needed something other than the standard formula. “What did the doctor tell you?” I asked. Mother told me she had not told any of this to her son’s pediatrician. I was concerned because chronic vomiting can corrode her child’s esophagus, throat and vocal chords.
Mother told the pediatrician nothing about the vomiting because of something going on between her husband and herself. Father, in her opinion, was chronically anxious for their first child. It appeared as if when Father thought his son needed more care, Mother reacted by thinking their child needed less. The child was caught in the crossfire with a possibly damaging condition.
One day, I watched a father hold the bus’ back door open for his, around, 3 year old son. He expected his son to get down from the bus to the sidewalk on his own. The boy hesitated. Rather than use words to urge the son past his hesitation, the father simply held the boy’s hand, perhaps, to help him down. The son suddenly jumped down to the street. Dad’s silent, connecting hand enabled an existing ability.
Delayed children also want their leap and use gestures, like pausing, to be understood. Kelly, for example, wanted and needed to eat more. Born at 23.5 weeks, at her 20th month the IFSP report stated she had been through seizures, bleeding in the brain, and pulmonary problems. She has hydrocephalus, vision problems, cannot sit on her own, move her left arm or hand much. Her right arm and hand could move some. When we met at her 24th month, she could intentionally move her head a bit to the right even though the IFSP stated that she had no control over her head. Her parents had trouble feeding her and were concerned with her weight. She ate barely enough of pureed food and had a feeding tube in her history. I wanted to keep tube feedings in the past. I wondered how I could help before I even met the family.
Wondering is part of a three step process for developmentally based therapy. Developmentally based therapy is about meeting the child’s needs from the child’s perspective. The other two steps are watching and waiting. Developmental therapists have to be patient and know that their particular disciplinary knowledge must fit in to the child’s desires expressed in gestures or words. Like the father on the bus, the therapist has to watch and learn about the child to help the child solve their own problem. Waiting, like quietly holding a hand, helps the child take the next step because we can see the child’s wishes.
I met with Eric Chessen, an experienced exercise physiologist specializing in the needs of children with autism. You can visit his website at ericchessen.com. Here is what he has to say about autism and fitness for kids:
This coming Monday, 7April at 6pm, WaHi neighbor and respected childhood nutritionist, Richard Kahn (PhD, RD) will present at the Castle Village Community Room; he’ll address the hurdles many families jump when trying to feed their small kids.
Richard will offer simple ways to think about nutrition and ways to minimize feeding woes and weight concerns. Location: The Carriage House at 110 Cabrini (through the rod iron gate) Price: $20 per adult ($15 for CV residents), payable at the door Have a look at Richard’s website: http://www.richardkahnnutrition.com/
If you can’t make the seminar, he makes HOUSE CALLS! Cheers!
Please share this with pals with tots, neighborhood cyber lists and/or professionals serving this audience)