The Trauma Trap: Impact on Families and Feeding

Trauma: • an injury (such as a wound) to living tissue caused by an extrinsic agent • a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury • an emotional upset   We don’t usually use the word trauma when discussing feeding disorders, but we should.   Children who have experienced significant emotional stress during feeding because of GI discomfort, poor oral control, cardio-respiratory issues, or forced feeding are at risk for disordered behavioral responses around feeding for many months (or years) to come. Infants born prematurely exhibit feeding problems due to neurological and respiratory immaturity and the myriad of issues that can arise while in the NICU. These challenges follow them out of the NICU and into the home, and while being able to go home is a milestone in and of itself, there are many more milestones to overcome when it comes to feeding. “During development, the cognitive, motor, emotional and ‘state’-regulating areas of the brain organize in response to experiences. And in each of the diverse brain systems which mediate specific functions, some element of previous experience is stored.” (Perry, 1999) The infant’s early experiences (good or bad) and their responses during feeding down the road are inevitably linked. Take Nash*, an 18 month old (corrected age) who struggles to get through a meal without gagging and vomiting. Born at 30 weeks gestation, he relied on a naso-gastric (NG) tube for nutrition for 6 months, which involved the trauma of reinsertion when the tube had to be changed as well as the chronic discomfort inherent in the placement of a...

Confessions of a Mommy Feeding Therapist

Working with families who struggle to feed their children on a daily basis, I often hear, “Your kids must be great eaters!” or “I bet you don’t have any trouble at the table with your kids!”.  Well, let me tell you, it isn’t quite that simple. As a feeding therapist, I am confident that what I am suggesting to parents will at least help, and not hinder, their child’s progress with eating. When I am working with someone else’s child, I can see their issues objectively. That makes it fairly easy to navigate next steps and to tease apart what may be going wrong. I have done loads of research and reading on the topic, wrote a book, and provide therapy for children from newborns to teenagers. I do trainings for other therapists, physicians, and students. So you would think I would have all the answers with my own three kids, right? Not so much. At home, things are a little more complicated. Do my kids sit at the table and eat at most meals? Yes. Are mealtimes a beautifully harmonious experience where all three of my children eat complicated dishes with a smile on their face? Hasn’t happened yet- I am still waiting. So what does a feeding therapist’s family mealtime actually look like?  Here is a window into my world: Setting:  We eat at our kitchen table for all meals, using family-style serving. I do a lot of “pile-on” and deconstructed meals and we don’t pre-plate the kids’ food. I work full-time and the kids have lots of activities, so our meals are fairly simple, and I get take-out about once a week....

REFERENCES for ASHA 2016: Provision of Feeding Intervention in the Context of Responsive Feeding

Jenny presented at the National American Speech Language and Hearing Convention (ASHA) this week, along with the clinical coordinator of the Tube Weaning Program, Heidi Moreland, SLP at Spectrum Pediatrics. There were extensive references included in their presentation and this research supports our work with responsive feeding and creating a healthy relationship with food for new and fragile eaters.  We thought others might find these references to be helpful as well. If you are interested in learning more about the book or responsive feeding therapy you can look here and if you want to know more about the intensive tube weaning program at Spectrum Pediatrics check out their post here.   References   Addessi, Elsa, et al. “Specific social influences on the acceptance of novel foods in 2–5-year-old children.” Appetite 45.3 (2005): 264-271. Ainsworth, M. D., S., & Bell, S. M. (1969). Some contemporary patterns of mother-infant interaction in the feeding situation. In A. Ambrose   (Ed.), Stimulation in early infancy (pp. 133-170). New York, Academic Press. American Speech-Language-Hearing Association. Van der Horst, Klazine. “Overcoming picky eating. Eating enjoyment as a central aspect of children’s eating behaviors.” Appetite 58.2 (2012): 567-574 (2001). Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders:   Technical Report [Technical Report]. Available from www.asha.org/policy. American Speech-Language-Hearing Association. (1990). Issues in oral motor, feeding, swallowing, and respiratory-phonatory assessment and   intervention. [A Building Blocks Module]. Alexander, R. (1987). Oral-motor treatment for infants and young children with cerebral palsy. Seminars in Speech and Language, 8(1). 87-100. Babbitt, R. L., Hoch, T. A., Coe, D. A., Cataldo, M. F., Kelly, K. J., Stackhouse, C., et al. (1994). Behavioral assessment and treatment of pediatric   feeding disorders. Journal of developmental and Behavioral Pediatrics, 15, 248-291....

Navigating Relational Feeding in a Medically-Minded World: When Calories Aren’t the Whole Picture

For many families, weekly (sometimes daily) doctor and therapy appointments are the norm rather than the exception. They strive to make everything fit into the schedule, because doing so keeps their child “well”- or at least not sick- and hopefully making medical or developmental gains due to professional, sometimes intensive intervention.  This may be a temporary scenario, or not. For parents of chronically ill or medically fragile children, every day begins with a status check: Is he running a fever? Is she going to hold down her feeds today? Did I give her all of her meds on time? Why is he doing X? Then on to the scheduling and phone calls- to the doctor’s office to sign a request for records to be sent to the out-of-state specialist, to the insurance company to fight yet another battle about payment for the child’s numerous procedures and office visits. For the parents who live this reality, it can be mind-numbing and terrifying all at once. Having a child who is well is the exception rather than the rule. Being truly well, however, is not the same as not being sick. For many kids, they have never been truly “healthy”, as the WHO states: “Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” What about these situations in otherwise “healthy” children? the baby who screams every time she sees a bottle, but takes a small amount when it is forced into her mouth the toddler who throws up at least once a day after being fed the preschooler who exists on Pediasure because he doesn’t...

The Manners Monster: 5 Tips for Taming the Beast at the Table

Do you ever find yourself wanting to pull out your hair at mealtimes because your children’s manners are atrocious? I do. From my almost-tween putting his feet on other people’s chairs and sitting sideways while he eats, to my second son burping loudly and using his hands to eat, to my preschooler throwing her food at her brothers (among other things). Sigh. It is a daily occurrence, and it requires even the most Zen of parents to dig deep for that calm place. I find myself asking my husband, “Are we raising a brood of Neanderthals?” But, we aren’t (even though I could swear it at times!). We are raising children, and they are not little adults. They don’t have the social awareness to know that their behavior isn’t appropriate, and it is up to us to gently guide them so they won’t end up being shunned from social gatherings. However, even though we know what the end goal is, there are considerations when we are talking about the acquisition of manners. Much of what seems like bad manners may actually be typical development, or may help children with sensory issues learn about their food. Using hands instead of utensils is normal as little ones explore the physical properties of their food and gain skills with utensils. They may switch back and forth for a while, depending on what type of food it is, how hungry they are, and what their experience and comfort is with that particular food. There is also the possibility that your child actually can’t help it. Consider the elementary-aged child who was constantly told to chew with her mouth closed; she finally was able to...

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