Many Facets of Feeding

 

Every parent is concerned with providing the right nutrition to their child. This becomes particularly important when the child first starts solid food and then progresses to complex foods as growth occurs. Parents generally worry about their child’s food intake because they want to ensure that the child is growing well physically. There is much more to foods and feeding than just providing nutrition and caring about growth.

It is generally recognized that a baby can be given solid foods when they are able to sit. Every culture has its own set of rules about how and what babies are fed. But broadly, the rules remain similar: starting with soft or pureed foods and gradually progressing to regular table foods. Whether you eat with fingers or use a spoon right from the start is also a cultural trait.

In India, a regular meal consists of varying food textures that are solid, soupy, mushy, and crispy. At home, many of us eat mushy foods such as khichdi, dal-chawal, and sambar-rice using fingers and without much spilling.

Tactile Input or Touch

Young children, as early as 6-7 months, start touching food when offered to them. Besides touching, they also play with food by pressing, crushing, squeezing, and transferring food from one container to another. Some children roll food into small balls using the palmar grasp. Around 9-10 months, they can pick up bits of food using a pincer grasp. These are attempts to learn about different food textures before bringing it to the mouth.

More than 4 decades ago, I would often hear my grandmother tell young mothers in the family or in the neighbourhood to let the child feed themselves. She would say that when offered food, whether rice or pieces of roti, the child will spill or waste half the quantity while self-feeding. And that is normal. She would emphatically opine that a young child feels better satisfied when they gradually learn to feed themselves. I think that my grandmother, and many other grandmothers of that time, already knew the importance of a child eating on their own. What they described as satisfaction or learning to self-feed......translates to feeling the various food textures, developing finger dexterity while picking up foods, and practicing hand-to-mouth coordination. Didn’t they have that wisdom which possibly was passed on along generations of mothers?

In my clinic at Activ Kaarya, besides children with special needs, I also see grade school children who have issues such as fine motor skills and handwriting. I often ask children what they ate for breakfast or lunch. Very few children even come up with a response. In most cases, it is “I forgot”. Over the years, I presumed that many of these children are fed at home by a mom or nanny. Therefore, they are not into the habit of eating on their own at school. Moms do complain to me that their child’s lunchbox is barely half finished or the child stays hungry at school. These children do not have autism or special needs, have at least average cognition, can follow instructions, and have good speech and language. And yet, they have not learned to eat a meal independently. When I dive deeper into reasons (trying to find out any oral-motor issues), moms have given me an array of reasons such as – in the morning there is a rush to leave for school, so I feed breakfast… she takes a long time to finish lunch, so I feed… we have a very loving nanny who likes to feed my child. The last one being an exasperating reason to me; how can you expect a child to finish their lunch box in school when they do not eat independently at home?

At a personal front, I am a mother, a woman who has frequently taken care of many cousins in my teenage years, and watched many children grow up in the neighbourhood. I have witnessed many children feed themselves. And therefore, I feel that every child should be provided opportunities to engage in self-feeding. Children who are developing in the neurotypical range and have no oral-motor issues should be encouraged to feed themselves right since their early days of eating solid foods (following my grandmother’s advice). They should be permitted to use their fingers and mess with food while eating. As they grow, they should be allowed to experiment with holding a spoon.

While at home, we use our fingers to finish a whole Indian meal. We are adept at breaking a roti or a dosa or a chilla using fingers of one hand, we are skillful at using fingers to pick up morsels of mushy foods like daal-chawal and khichdi and bring it to our mouth without spilling. This has been a result of years of practicing to eat independently. Years ago, as a young therapist in USA, I found myself arguing with an OT friend as to how eating with fingers could also be a fine motor skill.

When using fingers, we learn so much about the temperature and texture; and just feeling the food with fingers makes it interesting to eat. (Outside of home, we use the spoon or fork, mostly for etiquette and reasons of hygiene. And therefore, it's important to learn to use a spoon and fork early on in life).

When a child learns to eat independently, mealtimes are opportunities to learn about the names of vegetables, fruit, daal, and different dishes. There are times when we can bring in conversations about whether the food is spicy, salty, or sour, and how it feels in the mouth.

Challenges of Chewing-Swallowing and Oral Sensitivities

Many children do present with feeding challenges early on. These can range from being a picky eater, to gagging, to avoidance of certain or many foods. The child may have chewing difficulties and hence may just swallow the mushy food without feeling or chewing it. The child may just not accept certain food textures.

It is highly likely for children with autism to demonstrate feeding difficulties. At the same time, there are many children with feeding issues in the absence of signs and symptoms of autism or any other diagnosis. They may display oral sensitivities or a sensory processing difference when it comes to foods.

As a clinician looking into sensory-motor issues, I have several questions for parents regarding their child’s feeding habits and the variety of foods that the child consumes. This information is important for detecting oral-motor issues. Besides providing nutrition, our gut health also depends on the variety of foods that we consume.

Most parents report that their child with autism will self-feed finger foods such as chips, papad, bhujia, and biscuits; and may also verbally express or reach out for these foods through nonverbal gestures. (well, these are not ‘real’ foods because they have poor nutritive value and do not form a part of our daily regular meals).

I would like to know whether the child is not eating mushy textures at all. Or foods such as rice or poha that are grains separate from each other, are being rejected due to oral sensitivities. So many children with autism do not eat raw salads, fruit, and dry-fruit. Is the child consuming at least a reasonable number of foods, are they being fed, do they use a spoon, or do they touch mushy food with their fingers? All this information provides me with an idea about their tactile processing through hands and mouth.

Wait for my next post on strategies of feeding your child!