father trying to feed baby

Successful Mealtimes – It’s Not About the Food

If you are trying to feed a young child who is refusing to eat what you have made, won’t sit down at the table or will only eat a few foods, it sure feels like it is all about the food! The good news is there are often many other variables at play that can be addressed. 

The concept of “mealtime” has changed over the years, resulting from changes in our cultural, economic and social structures; and for children who have been adopted, mealtime experiences might differ greatly. Mealtime is when two or more people in a shared relationship come together to eat food in the same place at the same time. Successful mealtimes can help develop family identity, provide structure, support family cohesion, encourage a sense of belonging and positively influence the health and well-being of family members. 

Some of our children have experienced adverse childhood experiences at various points in their lives. Adverse childhood experiences (or ACEs) can influence children’s behavior and have an impact on mealtime participation. We want all of our children to be engaged and participate in mealtimes to support their overall growth and development.

Here are 11 areas where you can help to support your child and create successful mealtimes.

1. Safety  

Safety is the condition of being secure from undergoing or causing hurt, injury or loss. When it comes to shared meals, caregivers should ensure the environment and food they are presenting are “safe” for the child. Aim for consistent, relaxed, engaged meals where everyone is facing the table and the environment feels calm.  

 2. Food texture 

Food texture can also be thought of as the “density” of the food. Your child’s food needs to be a good match for his skill level (not his age). Matching the texture of food with a child’s skill level is the best way to avoid choking, or blocking the airway. Typically, the progression goes like this: bottle-feed only until 6 months, then offer smooth purees, textured purees, “mashable” soft foods, “meltable” soft foods and finally soft foods. For example, if I have a 3-year-old who still uses a bottle for primary nutrition, they may not be ready for a typical child’s diet of chicken nuggets and fries. 

 3. Your child’s anatomy

Assess the anatomy of your child. Consider how children’s physical structures and abilities may make them more successful or have more challenges with different types of eating, chewing or swallowing. Consider the structure of their chewing surfaces — the lips, tongue, cheeks and back of the throat. All these need to be in good repair for a child to eat and swallow. A young toddler or child will not eat if it hurts. What is the condition of their teeth? Do they have cavities? Thrush? Big tonsils? Look for clues in a child’s behavior, such as refusing foods that are cold or hot, swallowing food whole or only wanting liquids. 

 4. Positioning 

The ideal positioning for eating is 90/90/90. This means we are looking for a 90-degree angle at your child’s hips, knees and ankles, with their feet resting on a solid surface to ensure they feel secure. Avoid putting feeding seats on the table. Make sure your child cannot slip off their chair, that the chair cannot tip over and that your child has good support to the back and sides. Proper positioning will allow a child to use their arms to feed themselves freely. It will also ensure that their airway won’t be compromised, their jaw will be able to chew food normally, and they will feel more safe, secure and available to participate in the meal.  

illustration of child sitting on chair

 5. Utensils 

Always aim to use utensils that are the right size for the child. Allow your child opportunities to practice or play with them. If you have a smaller child try and use silverware that the child can easily pick up, hold and manipulate with tiny hands, and that has small surfaces that will fit easily into their mouth. Conversely, make sure the utensil is big enough for older children. A baby spoon with a metal handle and a plastic-covered bowl is typically not big enough for a 4-year-old to use efficiently. Using utensils or certain types of utensils could be a new experience for some children. Starting with “finger foods” presented with a fork or spoon may be a great way to help your child learn without the pressure of having to get it right every time. 

Mealtimes can help develop family identity, provide structure, support family cohesion, encourage a sense of belonging and positively influence the health and well-being of family members. 

 6. Cup drinking 

Drinking from an open cup is more complex than you would think. There are many steps to drinking successfully from a cup. Let’s help children learn skills without the embarrassment or shame of spilling on themselves, swallowing the wrong way or “not being allowed” to drink at the table (when everyone else is). Sippy cups, bite-and-sip cups, juice pouches, straws, and little “dosing” cups are all great ways to introduce the skill of cup drinking. 

 7. Safe learning 

We want to allow children the opportunity to learn, play, try new things and participate with the whole family. To do so, we want to create an environment that promotes safe learning — an environment where spilling, dropping and making messes are OK and part of learning how to develop eating skills. Be conscious of saying things that may hurt a vulnerable heart, or of using sarcasm, teasing or pointing out an error in a disparaging way. Sometimes things said in jest can undermine your relationship: for example, “Are you going to eat all of that?” or “What are you crazy? All kids your age like this!”.

Research shows that sometimes the things that are said to us can leave behind a long-term injury. The focus of shared meals needs to be about creating a shared experience between family members, not about a power differential that can cause children to feel unsafe. 

8. Predictability 

Creating predictable habits and schedules can be very helpful for children. Children can develop feelings of safety by having predictable mealtimes and predictable rituals for shared meals. Unpredictability can keep your child’s nervous system on high alert. It can often take very little to trigger a fight-or-flight response in many of our children who have experienced ACEs or have some type of disability or special health care need.

When a fight-or-flight response kicks in, blood and energy move away from digestion, limiting appetite and impeding adequate nutritional intake. It may be helpful to create a visual schedule of the day for your child. (This could be sticky notes stuck on the refrigerator — it doesn’t have to be fancy.) On that schedule, include at least three meals and two snacks.    

little girl with Down syndrome laughing with parents

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 9. Routines 

Create predictable routines and expectations around food and meals. Work together as a family unit to come up with some mealtime expectations: for example, food is only eaten at the table or in the kitchen. Set up simple and functional routines, such as starting with everyone washing their hands and then sitting down together.

Other routines can be about how food is shared around the table and how everyone is expected to clean up after the meal together. Come up with achievable plans, such as everyone sitting at the table for 10 minutes. Set a timer to help. Timers can help with the complicated concept of time by making it concrete. It may take time to establish a mealtime routine that everyone can stick to. It can be helpful to plan ahead of time what is going to happen if things don’t go as planned.      

10. Food security 

Food security is the physical and economic access to sufficient food to meet dietary needs for a productive and healthy life. Some children who have experienced ACEs or have certain types of disabilities may struggle with stress around food security. Many of these children may need to know that they have consistent and secure access to food.  They may also need help in understanding how this consistent and secure access can help them develop a better relationship with food. 

If your child is feeling food insecure, let them know that there is enough food in the house.  Locking cupboards and policing food can be destructive to a child’s mental health in this situation. Typically, it leads to hoarding-type behavior. To avoid this, have certain foods always available to your child. You can set up certain drawers in the fridge, space in the pantry, or a low cabinet with foods for your child to access. 

11. Food rewards and punishments 

Hunger is a survival cue. It is our biological need to eat. It can be very stressful for a child when food, which satiates hunger, is used as a reward or punishment. Our culture makes it very hard not to refer to food as “good” or “bad.” For example, stating “If you eat your vegetables, you can have ice cream after dinner” implies that you can only eat the “bad” foods if you have the “good” foods first. It can lead to overeating, misunderstanding natural hunger cues and problems with the ability to regulate eating. Don’t force your child to eat or be disappointed when they refuse food. Consider using other, non-food-related rewards, such as an extra book at bedtime or a special toy for bath time.  

For more details on feeding best practices, download Holt International’s Feeding & Positioning Manual: Guidelines for Working With Babies and Children.   

adoptive parents receiving parent counseling with their adopted child

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All parents encounter challenges as their children grow up. And sometimes, issues may arise that leave you uncertain as to how best to respond. But not every issue requires therapy or counseling. The PACE program is here to help during those times.

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