Hot Topic Blog - Feeding, Eating, & Drinking
THE IMPORTANCE OF A RELATIONAL FOCUS IN FEEDING THERAPYBy Jenny McGlothlin, Certified Speech-Language Pathologist in Dallas, Texas
As a speech-language pathologist (SLP) running a feeding therapy program, I train graduate students, work with parents, and help kids learn to enjoy eating. Parents typically find my program through word-of-mouth and are either at the start of their feeding therapy journey or are jaded by years of marginally successful therapy and looking for a new approach.
My approach to feeding therapy began with my interest in the connection between the sensory and motor systems and how that integration affects a child’s preferences and early learning of feeding skills. Through the years, I’ve found that just as you can’t separate the sensory and motor systems when viewing feeding skills, it’s also true that you can’t separate the child’s reactions to food from the larger feeding context. It is through the relationship with the parent that the child learns what and who to trust when it comes to food, so it makes sense that the child’s challenges are filtered through that dynamic.
Parents are just people doing their best to feed infants and children, and this is perhaps the most important job we do in those early years. And, as people, parents bring their own feelings, frustrations, and history to the table. That unique set of skills, emotions, and expectations drives their reactions to what comes next. When a child doesn’t fit into the parameters for what the parent has been told to expect, things can get a bit messy.
-How does a parent respond to a child who refuses the bottle or breast and doesn’t gain weight?
-What does the parent do to get his or her 9-month-old to eat more purees from a spoon?
-What does a parent say to the 2 ½-year-old who refuses to eat all but five favorite foods?
These children may be showing normal variations in feeding skills and behaviors. But, if further investigation reveals that their skills or behaviors are negatively impacting their emotional, physical, or social development, we call them extreme or disordered picky-eaters, and we may recommend therapy. How the parent reacts to those behaviors is a piece of the puzzle that has been missing from traditional approaches to therapy that focus solely on what is going on in the child’s mouth (or what isn’t!).
Enter the feeding therapist: she knows a lot about the sensory and motor systems and the development of feeding skills. She has seen many children with feeding disorders and has lots of tricks in her bag to facilitate things like tongue movement, jaw stability, and sensory normalization. She is great at getting kids to do things with their mouths and to try foods they haven’t been willing to try at home. I often have parents tell me, “I just wish you could move in with us!”
Herein lies the problem. The feeding therapist isn’t the person doing 99% of the feeding. The mom or dad (or grandma or day care provider) is, and they are struggling. So why is it that the child might branch out in therapy but not at home? The relationship the child has with the therapist is fundamentally different than the one he or she has with the primary feeder. If there is a “negative tilt” in the feeding situation at home or daycare, as Marsha Dunn-Klein calls it, engagement is low, there is an overall sense of anxiety, and no one is particularly happy to be there. The child’s eating seems to get worse, anxiety increases, and pressure from the feeder goes up which may cause even more resistance. It is a vicious cycle.
If the therapist is doing the job of getting permission during therapy, however, the child learns to trust that the therapist isn’t going to push the child too far, too fast and that the child's preferences and needs will be respected. And THAT is why the child eats in therapy but perhaps not at home.
Integrating a relational focus into therapy that has previously centered solely on the child’s skills requires a shift in thinking for the therapist. He or she must now focus on the parents and their expectations of and reactions to their child’s feeding challenges. Helping parents consider the perspective of their child, learn about why their child struggles, and change their view of what success looks like, at least in the short-term, goes a long way toward helping the child. Feeding therapy is about partnership: parent with child, therapist with child, and therapist with parent.
When you bring parents into the circle of trust you have built with the child, they can become their child’s best feeding partner. You will help them heal months or years of anxiety around food due to pressure, coercion to eat, or force-feeding. You allow the parent to see the child through a different lens - not what the child can’t or won’t do, but what he or she can or will do given time. You give parents freedom to facilitate exploration and curiosity in their child’s feeding process rather than anxiety and fear.
During therapy, your goal as a feeding therapist will be to:
-Guide parents toward reasonable mealtime expectations
-Uncover counterproductive feeding practices
-Coach parents on how to respond to different mealtime situations
-Help develop a structured mealtime routine
-Teach parents how to support oral sensory-motor skill development
-Problem-solve and brainstorm appropriate food choices
-Highlight progress and steps in the right direction
Through the STEPS+ approach to feeding, children can develop their feeding skills at their own pace, with gentle facilitation from the adults in their lives. Therapists are excellent at facilitation, but when it comes to kids and eating, helping mend the relationship between parent and child goes much farther than our direct intervention can go. Facilitating food enjoyment is my job, and I want to make it the parents’ job too.
For a more detailed look at how this approach can work for you and your clients, check out our book Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide to Overcoming Selective Eating, Food Aversion, and Feeding Disorders.
About the Author
Jenny McGlothlin, MS, CCC-SLP, is a certified speech-language pathologist specializing in the evaluation and treatment of feeding disorders for children from birth through the teen years. McGlothlin developed the STEPS feeding program at the Callier Center for Communication Disorders at the University of Texas at Dallas, where she works with families on a daily basis to foster feeding skills that will serve a child for a lifetime. Her passion is teaching children how to eat when they just can’t figure it out on their own, and McGlothlin has been inducted into the Texas Speech-Language-Hearing Association’s Hall of Fame for her work in the field. McGlothlin has spent many years teaching graduate-level courses on feeding as well as early child development. She frequently provides feeding workshops for parents and continuing education seminars and webinars for therapists. As a mother of three young children, McGlothlin makes family meals a priority. She also enjoys reading and spending time with her friends.