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Eosinophilic Esophagitis Clinic :: Tips for Parenting Difficult Feeders
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Parenting a child who has difficulty feeding can be frustrating. Caregivers parenting difficult feeders, should always try to:
  • Make eating a family affair and encourage the entire family to have family-style meals. 
  • Combine foods the child likes with those the child does not like to eat. A plate full of foods the child doesn’t like turn into a losing battle. Including foods the child likes will improve his or her attitude toward new foods or foods he or she doesn’t love.
  • Use small sensory shifts when introducing foods. Change one thing at a time (shape, color, taste, texture).
  • Follow routines with meals. Children thrive on routine and feel safe when they know what to expect. 
  • Give the child time to imitate or comply. It may take the child a while to take a bite or swallow. Be patient and encourage even small successes when it comes to food introduction.
 
If a child is having difficulty accepting foods, our feeding specialists recommend the following:
 
Social modeling
Social modeling is demonstrating the right way to eat for the child. Parents should not only model the right way to eat but model good behaviors associated with eating. Meals should be eaten one-on-one with the child. The one-to-one ratio with no other distractions will make mealtime much less stressful for the child. The focus of the meal should be the food, not the child and the conversation should center on food. The child should stay at the table for the duration of the meal time, even if they are not eating and should never be punished for eating incorrectly or not at all.
 
Structured meal and snack times
Snacks and meals should be eaten in the same place according to the same time schedule every day. Meals should be limited to 30 minutes and snacks to 20 minutes. Children should be presented with three meals and two to three snacks each day. At each meal or snack, we recommend placing several foods on the table for exposure.
 
Predictable meal-time routines 
  1. Warning 
    Provide the child with a verbal warning such as, “We’ll be eating in ten minutes.”
     
  2. Sensory preparation 
    Bring the child into the kitchen to smell or see the food. Also consider providing the child with physical activities that can prepare him or her for the process of eating. Our specialist recommend activities including swinging, jumping, pushing or pulling toys, listening to calming music, running in circles, rocking in a rocking chair, or brushing his or her teeth with a vibrating toothbrush.
     
  3. Transition activity 
    Ask the child to set the table and wash his or her hands. 
     
  4. Sit at the table 
    The child should go to the table with an empty plate. Part of the mealtime is a learning experience that includes talking about food and having the child allow food to be put on their plate. Consider making it a game, using fancy dishes for older children, providing a “learning plate” for younger children or dressing up for meals.
     
  5. Family-style serving  
    If the child prefers, allow him or her to dish out the food to him or herself and the adult.
     
  6. Eat
    Remember the child needs to stay at the table for 20 to 30 minutes even if they are not eating. Make sure to keep the conversation light.
     
  7. Clean up routine 
    Ask the child to assist with the process of clearing off the table. It may be helpful for some children to throw one piece of every food into the trash.
Be aware of portion size, food size and food type
The amount or size of food can be overwhelming. Foods should be presented in manageable bites. Children should not be overwhelmed by too much food. We recommend one tablespoon of each food per year of age. To make the meal more pleasureable, offer one of the child’s “preferred foods” at every meal (if allowed).
 
Prevent Food Jags
A food jag is the same food prepared the same way every day or at every meal. Children will get tired of the same thing prepared the same way and can burn out on it permanently. It is important to offer any one particular food only every other day. If it is early in the child’s food reintroduction process, we recommend changing the foods the child does eat in this order:
  1. Change the shape
  2. Change the color
  3. Change the taste
  4. Change the texture
It often takes two to three weeks of changing on thing (i.e. shape or color) before the child is okay with it. The change should be large enough to be noticed but small enough that the child will still eat the food
 
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