From Messy to Mastery: Encouraging Self Feeding and Communication during meal times. By Dr. Lakshmi Venkatesh

Hi All,

The below post is related to a topic which was part of the Conference / Workshop organized by Vasantham. Below are the details of the session:

Conference – Workshop cum conference on Best Practices in the rehabilitation of individuals with special needs
Topic – From Messy to Mastery: Encouraging Self Feeding and Communication during meal times.
Date – 17th March 2023   16:30 PM
Mode of Presentation – Offline Venue – Sengai Meenakshi Mahal, Mogappair, Chennai – 37
Speaker – Dr.Lakshmi Venkatesh, Speech Language Pathologist, Associate Professor, Department of Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai

Below are the points shared in the presentation:

The biggest milestone in feeding is “Self Feeding”. 

Development stages of Feeding:

0 to 6 months

1) Only Mothers feed during this time frame

2) At this phase the tongue can only suck, it does not do any other movements.

3) Only when the breast feeding steps are done correctly, subsequent development happens naturally. Important steps in Breast Feeding are:

a) Whole body of the baby is closely held and supported by the Mother

b) Eye contact between mother and the baby

c) Neck is Straight

d) Baby is close to mother

e) Body is turned towards mother .

6 to 9 Months

1) In addition to Breast feeding, we should start a complementary feeding.

2) The complimentary food can be Ragi Porridge, Cerelac, mashed vegetables, fruit, dark green vegetables rich in vitamin A and Iron and animal source foods.etc. Energy Rich nutritious food.

3) It is important that these foods are introduced in a timely manner and not delayed. When there is a delay in introducing new foods, it is reflected in food preferences at a later point of time

4) By 6 months, baby will develop the ability to sit , neck control would have been estabilished etc. , which means gross motor skills would have been developed. This is the reason why we are introducing solid foods after 6 months, the babys body has grown for the food they can take.

5) Even if there is a delay in the milestones, we should slowly introduce new foods by 7 months atleast with the help of physiotherapy and occupational therapy.

6) The consistency of the mashed foods should stay on the spoon even when you turn it up side down, it should not fall down. For certain items the consistency can be up the extent of a puree as well.

7) Thicker the food means it has more nutrition in it, if the food is watery or liquid, the nutrition element is lost. 

8) The quantity is half cup for 6 to 9 months.i.e. Start gradually from 1 or 2 spoons a day and build it up to half a cup.

9-12 Months

1) Use different complementary foods

2) Introduce chopped foods that can be picked up by babies and eaten, also called as finger foods. This develops pincer grasp.

3) Introduce chewable items and encourage chewing.

4) Quantity is half a cup.

5) Encourage Self feeding

If you continue to feed the babies with mashed foods even at this stage, you are restraining the development of the baby. The Food which you put in mixier jar to make it mashed , as a parent will you eat it ? What does it taste like ?

12-18 months

1) Expose child to all textures

2) Lateral Tongue action develops

After 2 years

1) Quantity should be 1 full cup and 3 meals a day

2) Tougher solids i.e. what the adult eats in the family has to be given to the child. No special meals for the child.

Common Mistakes

When you introduce a new food to the child, say mashed papaya. The child will definitely spit it first, so you decide that he dislikes it and stop giving it to him, which is the major problem from parent.

As a parent you have to be persistent, it will take 10-15 days for the baby to accept a new food. Take one or two new foods and try for 10-15 days consistently.

Meal time is supposed to be messy, do not teach/expect table manners during this phase. Messy eating provides sensory exploration. Child has to feel the food they are eating. Some parents will always have a napkin on their hand and wipe the lips and mouth of the baby after every bite or spoon. This should be avoided, because you are giving a negative experience to the child.

Feeding the infant along with the family. In our culture we feed the babies or children first often and then only we eat. Each family members eat at different time periods. As much as possible or at least one meal a day have the family eat together with the child. This provides a chance for the child to observe how other family members eat and imitate.

Responsive Feeding means we communicate and respond to the child. Responding to Cues of the children. Respect the hunger cue and stopping cues. There are multiple stages of hunger cues, crying is the last one. It starts with sucking sounds, then licking the fingers, move to the place where food is and put hands together etc.. are signs of hunger cues.

Similarly stopping queues should be understood and respected, like if the baby’s stomach is full they will turn away their head, they will spit the food, etc..If you do not understand the stopping queue and continue feeding, it will result in FORCED feeding.  Provide an opportunity for the child to self Regulate, instead of neglecting.

Minimum distraction during feeding. When the child is fed with distraction, child is not aware of what he is eating. Distraction feeding is also considered as Forced feeding. 

Positioning is very important for feeding. Flexion and Extension is important. We follow a 90/90/90 posture which is the ideal one. You can refer to google for the image.

Active feeding is very important. When feeding food with a spoon, do not put the spoon inside the mouth all the way, take the spoon with food closer to the lips, encourage the child to come closer and eat if off the spoon. Provide the chance at every stage possible. It encourages lips and tongue movements.

Avoid all fancy bottles, strawed ones, use a basic tumbler/glass at home to encourage sucking in lips and tongue.

Also avoid fancy cutlery that comes with different grips, velcro strips. We can use simple adaptations at home to get the same. You can use a clay or squishy ball, where a spoon can be inserted in it for the child to hold it properly. We need to think about why we need an item i.e. what skill are we focussing to develop through buying that item, if we do that most purchases can be avoided.

She mentioned a scenario as to how they fixed chewing for a child who eats with mouth open and does not chewing properly, as a result lot of foods come out of the mouth. They worked on cueing, lot of behavioral intervention, reinforcement by giving star for every correct attempt, taught him how to open the spoon, close his mouth while eating, etc. Our objective was that they should eat by themselves using their hands, and eat like other children when going outdoors.

Communication during feeding is very important, if the position is correct, where the eye level of mother and child meets, a lot of communication happens during feeding. Distraction should NOT be there.

You should engage the child, communicate with the child, teach a lot of things, etc.. but do not make it a distraction. Make use of the opportunities that happen naturally.

Conclusion

If you want a skill to be developed, only if you introduce that skill it will be developed. Most parents would not have exposed different foods to the children at an earlier stage. Only if we give a chance to the children we know what is possible and what is not. The kid will explore the food, make their body and place messy, lot of cleaning would be required, but the important point is that he is given a chance to explore, which is very very important. The objective of feeding time is not to empty the bowl. 

Personal Feedback

She gave a lot of detailed information with many demonstration videos displayed on the projector. She gave justification of the suggestions as to why they work and what are the wrongdoings which we are doing at present. She spoke at a nice pace, articulated the message well. The slides had so many points, which I could not note down, due to the time frame and my inefficiency.

Regards,

Saranya and Karthikeyan