Originally had these great dreams of cooking all our own baby food and being quite natural about we fed Meredith. We pureed peaches and pears, tried making our own oatmeal from oats instead of using the boxed stuff, and introduced solids to Meredith at about 6 months. Looking back, I can say with absolute certainty that SHE WAS NOT READY. Even with a special chair provided by the physical therapist and multiple suggestions from a speech therapist, many of the bites that went in, came right back out. By the time she was a year old, she was finally starting to swallow purees, but meal time was literally show-time at our house. We sang songs constantly while spoon feeding her and even employed those cute little singing stuffed animals as distractions for when we just couldn't do another verse of Old MacDonald's Farm on our own. This worked for a while--by which I mean Meredith built up a repetoire of about 6-8 pureed foods that she ate--but we pretty much stalled there.
Somewhere over the course of introducing foods, Meredith learned to eat marshmallows...and we rejoiced! We thought they would be the key to introducing puffs and Cheerios and yogurt melts--all the typical first finger foods for toddlers--but, unfortunately, they were just marshmallows. A much loved treat, but not the gateway snack we hoped they would be.
When Meredith was about 2, we finally pushed for and received help from an occupational therapist to address the sensory issues we were fairly certain were the underlying cause of Meredith's struggles with eating. At about that same time last summer, though, as we prepared for our move to Pennsylvania, between us being busy, stressed parents and Meredith being stressed by our stress and distraction, she not only failed to make any progress with foods but regressed to eating pretty much just yogurt.
Luckily, with our move to Pennsylvania, Meredith's therapy schedule increased and she was paired with an occupational therapist (OT) who has an incredible amount of experience working with children (and parents) who are experiencing feeding difficulties. Here is a summary of what I have learned:
- There is a heirarchy of tolerance regarding food--see, touch, smell, taste (or lick) and then eat. Children first need to literally be able to accept that a new food is going to sit on their plate and stay there. Then they need to touch it to learn what it feels like--they have to be comfortable with what it feels like on their hands before they will be comfortable with it in their mouth. Then they need to smell it--some smells might be really offensive to certain kids at first. They they need to be allowed to lick or taste the food without any pressure to actually consume it. Eventually, once they master that, they may be ready to try eating the food. Certain steps will be more critical to your routine depending on your child's needs and where they are with eating in general...lower level steps will be more important to a child just learning to eat than one who is more comfortable trying new things. However, there will be days where some or all of these steps need to be re-emphasized even with foods your child ate without a problem the day before. (Touch is big for us! We often find that if Mer refuses a familiar food, it is helpful to ask her to finger feed a bit to one of us--messy, but it encourages her to touch the food without being asked to eat it. Often, after one turn for Mom or Dad, she is ready to take a turn eating the food herself.)
- Kids need to know exactly what they are expected to do when they put food in their mouths...and what will happen to the food. This was the first BIG key to success for us...I sat and watched as our OT picked up a bite of a veggie straw and put it on her tongue. She then showed Meredith how she moved the bite over to her molars and crunched on it with her teeth. She had Mer listen to the crunch she made and made a big deal over the sound--"Listen, it crunches!" She also specifically pointed out the "chewing teeth"--both on herself and on Meredith--so she would know not to try to chew food with her front teeth. For a long time we practiced with crunchy food--beginning with yogurt melts broken into thirds and veggie straws and pretzels. Then we introduced squishy foods--like yogurt covered raisins and dried blueberries. Other things have come along since then, but all are generally classified as "squishy" or "crunchy" before being eaten.
- Sauces are amazing--we have been fairly successful at using sauces, such as ketchup, bar-b-que sauce, and Nutella to bridge the gap between similar foods. For example, hot dogs were the first meat that we introduced Meredith to--and we did so covered in ketchup. Since then, we've added sausage, meatballs, and ravioli (not a meat, but a main dish) all covered in ketchup. When I recently introduced chicken nuggets, I said something to the effect of, "We're going to try this. It's chicken nuggets--it's a meat, like a hot dog, and we're going to eat it with ketchup," and it went quite well! Sauces can also soften and hide the texture of foods--like the crust of chicken nuggets--letting your child be successful with a new food while softening some of the challenges it might present. The amount of sauce you use can always be reduced as your child gets more familiar with the food itself.
- Introduce foods that are similar to something your child already eats in some way---color, texture, shape.
- Offer really small bites of new foods or foods with funny textures. Really small. Like can only fit on one tine of a fork small. More than that might be overwhelming to your child's mouth.
- Begin the meal with foods your child feels comfortable with and serve as a warm up to the meal. For example, we started all meals with 3 or 4 "crunchies" of some sort (yogurt melts or veggie straws) for a long time. This was a "safe" food that got Meredith used to the idea that she was going to be chewing things that would crumble in her mouth during the meal. If she is trying a new food or is particularly resistant to a food at a certain time for any reason, we often go back and try this again and then move on to the new food.
- Be aware of the level of other sensory input in the room. For ages, I thought Meredith didn't like crunchy or crumbly foods. As it turns out, she does--they just provided input that she didn't know what to do with. Yogurt provided almost no input--it was so smooth--so she had very little to react to and could eat it anywhere, regardless of how loud or busy the place she was eating was. In fact, our singing probably allowed her to almost forget she was eating at all because it distracted her from what she was doing. (Yogurt is, by the way, still the back-up food at daycare where she eats with 10 other 2-year-olds!) However, if she is eating in a familiar, relatively quiet place, she is more likely to be able to handle the sensory input of foods with texture--and it provides enough input that she doesn't need a lot of distraction to eat. In fact, if you try to get her to eat foods she is only partially comfortable with at a loud, busy place, she is likely to not even tolerate the food on her plate.
- Keep in mind that meal time is work and is stressful for your child--and it shouldn't all have to be therapy. Some days you'll try new things--others you'll go with the comfortable favorites. Some days your child will work on physically feeding herself--other days you'll man the fork or spoon.
- Don't make meal time a fight. You hear this everywhere, but it is so true. Set a timer--kids are probably only going to be engaged for about 20 minutes anyway and if you try to drag it out until they've eaten "enough", you're both going to be miserable. Celebrate small victories--let your child know how proud you are of them when they touch or taste a new food for the first time--even if it doesn't get swallowed! Make it funny--when food slips off the fork, talk about how silly that is, rather than groaning at all that wasted effort.
- Focus on small goals that are important to you and your family. I would love Meredith to eat vegetables other than pickles, but right now it's more important to us that she learn to eat a few of the kid friendly meals offered at daycare and restaurants, like macaroni and hot dogs. This past February, as I was starting to think about Mer's upcoming third birthday, I decided I wanted her to be able to eat cake at her party--she had never really done much more than tolerate seeing it on her plate before. Our OT helped us build off of her love to chocolate to introduce chocolate chips in a cake and then really fudge-y brownies and finally chocolate cake before the big day so that she could be successful enjoying her own cake after the candles were blown out.