Q. Help! My 11-month-old girl does not like to eat. When she is distracted with toys, a book or the TV, she can eat the whole jar of food! She will only take some food if she is distracted. I am so tired of feeding her that way as it is difficult to do this in public. She throws tantrums when she sees you with a spoon. I need advice: should I carry on with playtime at meal times or not?
A. In general, it is never a good idea to eat with distraction, for the many reasons I will discuss below.
First of all, when you are distracted, you do not process the activity on hand. If the only way your child will eat is with something distracting her, the distraction will inhibit her ability to participate in the feeding process. She will not be cognitively aware of the process of eating and will continue to avoid eating when she is aware of eating. Participating in the process of eating is vitally important in helping your body understand when it is hungry and when it is full. Children who do not actively participate in the process of eating tend to have long-standing issues with eating.
If you have a child that requires distraction to eat, you'd probably agree that at first the distractions required are little and not so disruptive. Maybe a small toy or a book. Your child probably got bored easily with this distraction, and the distraction had to become bigger and bigger. At Carolina Pediatric Dysphagia we once had a family tell us the only way their child would eat is if dad fed her while mom did cartwheels in the living room. Shocked? This is a true story.
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Keep in mind that as long as there are no medical complications, children naturally like to eat, and they know how much food they need to maintain a healthy body. Many parents are afraid to stop the distractions during feeding because they are afraid that their child will stop eating. In general, volume does decrease slightly as you work through the process, but quickly the volume increases. Most children can tolerate a few days of smaller volumes. Before starting, it is highly recommended to work with a professional and to consult with your child’s medical team to make sure that there is no physiological or anatomical reason for the feeding refusals or required distractions to eat.
The first requirement on the road to peaceful mealtimes is requiring that your child sit during the entire meal. Often, distracted mealtimes start because the child won’t sit in her chair for meals. Have you ever walked into a daycare at lunchtime? Are you ever amazed that all of the children are seated in their chairs for the entire meal and often they are not even strapped in? They stay seated because sitting during meals is a mealtime rule. That is it. They are not allowed to cruise around during meals. If they want to eat, they must sit. Now, I can hear parent say, "My child won’t do that." I say, "I bet they will." If all feeding disorders and gastrointestinal disorders are ruled out, the only reason that your child will not sit during mealtime is because either she does not know that sitting is a rule or the rule is not enforced. Why sit and eat when you can play and eat? If your child gets out of the chair, that is ok. Make sure that she understands that the mealtime is now over and that she is not allowed back in. Eating is only allowed in the chair.
The next key to success is to schedule consistent meal and snack times in a consistent place. Consistency helps children know when they get to eat and where they get to eat. Children like consistency. Children need consistency.
Here are some other things to keep in mind:
- Keep mealtimes short. 10-20 minute meals are plenty long.
- If she is playing or refuses to eat her food, take it away. No coaxing or warnings. Your child will not die from missing a meal. She will probably be very whiny, especially if she is not used to your new rule. You must not give in; it's hard to do. She will quickly learn that "if I don't eat my food, I won't get any." Children like to eat. If she doesn’t like to eat, a feeding evaluation is warranted.
- It is OK if a child misses a meal. Make sure that the food at snack time is equally as healthy as the food at meal time. Once you take the issue of control and negative attention out of feeding, it will become smoother sailing.
- Take away all of the distractions. Your child needs to focus on the food. This will be very difficult at first, but it is a step that needs to be taken.
- Allow your child the opportunity to explore food. This will increase her interest in food.
- Allow your child to participate in feeding. A spoon or two for your child and one for you. If age appropriate, place food on a spoon or fork and let your child self-feed.
- Feed your child only when she gives you permission. Never bribe, trick or sneak food in your child’s mouth. You will lose your child’s trust if you use these unhelpful techniques, which often worsen feeding problems.
Following these simple guidelines should, within a few days, enable you and your child to enjoy distraction-free meals. You must be consistent and follow through on all of the rules. Do not give in. If this is too daunting of a task, if you would like some help or if you cannot rule out feeding or GI problems, seek professional help.
Joan Dietrich Comrie of Carolina Pediatric Dysphagia has dedicated her entire career to studying, teaching and practicing in the area of dysphagia, specifically pediatric dysphagia. She received her bachelor of science degree and then her master of science degree in the area of speech pathology at the University of Wisconsin-Madison in 1986. Before starting Carolina Pediatric Dysphagia in 1996, she worked at several hospitals (Cardinal Hill Rehabilitation Hospital, Lexington, Ky., Vanderbilt Medical Center, Nashville, Tenn., and WakeMed, Raleigh) where she developed or reorganized the hospital's pediatric dysphagia program.
Joan has spoken on the topic of pediatric dysphagia nationally and internationally. She has published in a professional journal. She co-taught the first dysphagia course offered at UNC and continues to guest lecture to several university graduate level speech pathology programs and to the UNC Medical Students who complete their rotation at WakeMed. She has served as chairman and member of a subcommittee of the Special Interest Division #13 of the American Speech Language Hearing Association (ASHA). She has received her certificate of clinical competence (CCC) through ASHA and is licensed in the state of North Carolina.