Problems with Eating- the Mechanics
What do you do when your child won’t eat?
Eating. Something that we’re all born with the natural ability to do, for survival. Right? Wrong! Eating is not our number one priority, breathing is. Breathing is followed by postural control and our need to be upright, leaving eating in third position.
Over the years we have worked with many children who have issues around food, whether that be eating too much or eating too little. Whilst there have been a variety of underlying reasons that a child might experience problems with food and eating, there is one thing that can be more or less guaranteed and that is that their parents experience a great deal of anxiety about it. We would certainly empathise with the idea that there is very little that can compare with the drive a parent feels to see their eating-resistant-child eat well. But it’s really easy to make lots of assumptions about eating because there is certainly a lot more to it than we often realise. That’s why it’s incredibly important to try to look at the bigger picture around food, to stand back a little and consider the issue in a holistic context.
Eating is actually quite a complex process that is only instinctive in the first month of our lives. After that, we need to develop our ability to be able to carry out and effectively string together the 32 separate steps in the eating process. Our reflexes still make a natural contribution between the ages of 1 and 6 months but after 6 months of age, everything needs to be learned. So where can it go wrong and which professionals can we approach for support?
Our first survival instinct is to breathe. If something in our mouth is compromising our ability to breathe, we spit it out. If a young person feels they can’t breathe when they are eating, they’re not going to want to do it. Recall a time when you had a blocked nose, how comfortable was it to eat? I can remember chewing quickly to get food down so I could breathe again, eating with a blocked nose felt like suffocation. For some young people, the physical skills needed to guide food away from the windpipe are not developed enough to make eating safe. This is where a speech therapist could help. Speech therapists can do a dysphagia (swallowing) assessment which could pave the way to strategies to help with eating. Strategies could include therapy to learn new swallowing techniques, changing food consistencies or looking at other ways of feeding.
Our second natural instinct is to keep upright. Without postural control, it is unlikely that any food swallowed will have a clear journey through the body. My natural initial response to indigestion is to sit up and really straighten my body. For me this mostly does the job. The moral of the story? Sit up when you’re eating. However for some young people, this is easier said than done and additional support might be needed to achieve a better posture. An occupational therapist can support with exercises and strategies to improve core strength. For some young people further strategies will be needed and this might be where work with a physiotherapist on a seating system might come in.
There are some common myths around eating which can distract us from the core skills involved. If a young person is not eating, we might think that they will eat when they are ready as they will not starve themselves. This is not the case and young people can be hospitalised if they are not taking on enough nutrition. That makes it really important for us to become eating detectives. Just as behaviour has an underlying message, so does not eating. So what could some of these be? Not feeding themselves? Does the young person have the skills needed to get food to their mouth? Bear in mind we can’t see our mouths so it does take some doing. To be able to feed ourselves, we also need to be able to cross our midline ie reach our hands across our bodies. If the young person is not doing this, an occupational therapist could help. Not chewing? Chewing requires a circular jaw movement. If a young person’s jaw only goes up and down, specialists support may be required. This would apply too if a young person can’t move their tongue left and right as they may not be able to move food around their mouth. Likes to play with food? This is a natural and normal step of eating development. Toddlers will often wear their food but this helps them to develop necessary skills for eating. An apron can be a good friend at mealtimes if your young person likes to play!
Appears to be a picky eater? There is a distinct difference between picky eaters and young people who have problems with eating. Picky eaters are likely to eat more than 30 foods but problem eaters less than 20. Picky eaters will eat with alongside others although they may be eating something different . Problem eaters prefer to be more solitary when eating. Problem eaters will also cut out whole food groups, whether it be carbs/ proteins/anything that’s smooth. ARFID (avoidant/restrictive food intake disorder) is more likely to affect young people with a diagnosis of autism or a degree of learning need. Medical support would be needed to make a diagnosis but having a diagnosis can open doorways in terms of other support.
Only likes a certain yogurt brand? This could be to do with rigidity, particularly for young people with a diagnosis of autism. However, by always having the same yogurt brand, a young person would know exactly what to expect in terms of colour, texture and taste. These are all things which could be related to sensory food needs. If a young person doesn’t like a yogurt with bits in but they know the one they always have is smooth, why would they change? If you are concerned about a young person only accepting a small range of food, an occupational therapist could support a food programme to increase the range tolerated. This can involve playing with food, after all, if you’re not going to hold something, it’s unlikely you’d put it in your mouth.
We have spent a little bit of time in this blog looking briefly at the mechanics of eating here and we are incredibly grateful to our colleagues at Midlands Occupational Therapy for helping us to develop our working knowledge in this area. Next week we will come back to the topic of eating to take a look at appetite and the things that can affect this. Do let us know if you have found this helpful and if you would like any further support from our multidisciplinary team drop us an email or contact us through our social media accounts. You can find the links to all of these in our side bar.