Q&A with Nicola Pratt

You’ve been an SLP and feeding therapist for over 20-years, what do parents most often ask you when you first meet?

• Why won’t my child eat?
• When will my child eat?
• How can I get my child to eat?

What is your background with pediatric feeding issues?

I have provided frontline homecare with children aged 0-18 years for over 2 decades, working closely with physicians, other therapists, and hospitals to help children with feeding and swallowing issues. I have worked with babies, toddlers, and older children, and teens with a wide range of medical and developmental issues impacting their feeding.

What are some specific types of feeding issues you see in children?

• Breast/bottle feeding problems
• Problems transitioning to solids/purees
• Difficulty transitioning from purees to table foods
• Oral motor (mouth muscle) or chewing delays
• Gagging or choking
• Dream-feedings
• Picky Eating
• Meal scheduling challenges
• Requires distractions to eat
• Force feeding
• Slow growth
• Tube feeding dependency
• Not self-feeding
• No finger/table foods
• Not seated for meals/poor routine
• Picky Eater
• Swallowing issues

How do a child’s feeding issues impact families?

Feeding a child involves so much more than physical growth. Food represents love, and connection. We show love through food…weddings, birthday parties, funerals, family BBQs…food is offered for both comfort and celebration. It is central in our lives and socialization. Mealtimes allow us to share our personal values and family traditions. Food represents our personal history…our sense of family, culture, and community.  Healthy feeding experiences represent relaxation, habit, and a break in routine. Mealtimes awaken all of our senses. Most of us look forward to our next meal; however, when a child has feeding issues and does not look forward to mealtimes, it can have a huge emotional impact on families.

Tell us more about the emotional side for parents of children with feeding issues?

Parents of children with feeding issues express a range of feelings and emotions:

• Grief and Loss. The feeling of what should/could have been.
• Fear: What will the future hold? Will their child grow and thrive?
• Anger and Frustration: Why did this happen to our child?
• Burn Out: Working with a child with feeding issues is exhausting.
• Failure: Feeling like they are not a good parent or doing things wrong,.
• Embarrassment and Judgement from others (family members and friends)

What about the child’s experience?

I’m glad you asked this question. It’s so important to consider the child’s experience at mealtimes. Children often feel stressed, overwhelmed, and even scared at mealtimes. There can be a breakdown of trust between feeder and child, which puts the child in “fight or flight” mode. This in turns reduces appetite. Older children often sense their parents’ stress and frustration at mealtimes and may feel that they are disappointing their parents. Feeding issues are challenging on both sides of the table. I will talk more about the child’s lens on mealtimes in a future blog post.

How do you help?

• Of course, it’s always essential that any underlying medical issues have been addressed to provide a foundation for successful feeding intervention.
• In my experience, the most important aspect of feeding successful feeding therapy is that it is child-directed and positive.
• Forcing, pushing and coercing kids to eat does not work.
• Research shows the more we pressure kids to eat, the more they refuse.
• I have a toolbox full of tips and tricks to help children progress with feeding.
• Tools might include letting your child get messy during feedings, how to avoid the bib fight, teaching self-feeding, increasing food texture, or transitioning from a bottle to a cup.
• There are also many tried and true products that I have used over the years to support kids with their feeding development.

If we could finish with one important message about feeding what would it be?

Try to take a breath and enjoy mealtimes with your child. Talk about something at mealtimes other than eating. If you’re feeling too stressed, try to walk away and take a break. Pressuring kids to eat does not work. Play with food and have fun…if your child feels less stressed at meals, she will eventually eat better.