A Parent's Guide to Respectful Feeding Therapy - Part 1 - Therapist Neurodiversity Collective

Part 1: What is a feeding disorder?

11/19/2021, by Caroline Braun, M.S., CCC-SLP

If you suspect that your child may be having difficulty eating, it can feel really, really scary and overwhelming. It might feel like everyone else’s child is eating everything so easily while you feel lucky to get a handful of chips into your child’s belly at lunchtime. Other parents and loved ones are quick to give you advice, but you feel like you’ve tried everything. You might be beginning to think that your child’s eating challenges are more than just a phase of “picky eating.”

Maybe your child used to eat a variety of foods, but now they are eating only a handful of foods.

Or they refuse foods unless they are a certain flavor, texture, or color.

Or they scream and cry at mealtimes.

Or they are demonstrating health concerns like weight loss and chronic constipation.

While you can uncover tons of information about feeding on the internet, your loved ones, and the professionals working with your child, it can be hard to make sense of all the information, especially when emotions are running high.

When children have trouble eating, it can be incredibly stressful for parents. But you’re not alone! There are qualified professionals waiting to help you and your child.

That’s why we’ve created A Parent’s Guide to Respectful Feeding Therapy. In this guide, we will define what a feeding disorder is and provide education regarding the types of feeding interventions you may encounter if you choose to pursue therapy for your child.

In this guide, you will find:

A definition and characteristics of pediatric feeding disorder
Characteristics of behavioral based feeding therapies and why they are disrespectful to all children regardless of neurotype
Characteristics of responsive feeding therapies and why this approach is neurodiversity affirming
Resources for help and additional learning

What is a feeding disorder:

Feeding is a highly complex anatomical and physiological process, involving multiple muscle groups and cranial nerves. It is also the only task in your child’s day in which they will use all of their senses. With so much involved, there are many opportunities for challenges to arise in feeding development. If your child is having trouble eating, you may wonder if they have a feeding disorder.

A pediatric feeding disorder is defined as “impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction” (Goday, et. al., 2019). This means that children with feeding disorders may experience the following:

Medical concerns like reflux, abnormal GI motility, or food intolerances/allergies

Nutritional deficiencies

Difficulty with feeding skills like chewing, cup drinking, or sensory processing

Psychosocial challenges such as feeding aversions, challenging mealtime behaviors, and highly selective eating

As a speech-language pathologist specializing in feeding therapy, I often work with clients who need help in several of these areas. For instance, it’s not uncommon for me to work with a child who has a history of reflux or food intolerance, delayed oral motor skills (like chewing), and hyper- or hyposensitivity to a sensory property of food like sight, smell, taste, or texture. These challenges can then lead to nutritional deficiencies, more GI problems like constipation, and challenging behaviors like running from the table, throwing food, and even becoming physically aggressive at mealtimes. The children that I work with frequently come to me eating only a handful of foods, which tends to make their parents very anxious about their health and development.

If your child is Autistic or otherwise neurodivergent, they are at increased likelihood of experiencing feeding challenges. Individual studies vary in percentages, but it’s estimated that between 46%-89% of Autistic children experience feeding challenges (Bandini, et. al., 2019).

This happens for a variety of reasons that are unique to your child.

As an Autistic person who has experienced lifelong challenges with eating, some of the reasons that I, personally, find eating challenging include:

A need for consistency: I have eaten the same breakfast nearly every day for about 5 years and become incredibly disregulated if I can’t have it, particularly if I can’t have it unexpectedly.

Textural aversions: the textures of some foods, like ground meats, are really challenging for me and can make me shiver and wince

Anxiety: I know I like the salmon at Restaurant A, but I’m scared that I won’t like it at Restaurant B because I can’t be sure how they are going to cook it (Will the skin be on or off? Are they going to put an unfamiliar sauce on it? Are they grilling it or baking it?)

Food intolerances and GI concerns that went undiagnosed until adulthood

Stress: I experience frequent nausea when stressed and can gag at even the sight of a food, even foods I know that I like, which can feel really scary. This has led to significant weight loss in the past.

Meanwhile, I’ve worked with children who’ve been really sensitive to the sounds of food inside the mouth, who have oral motor delays causing them to become “stuck” on a certain food texture (like purees), and who dread getting sticky textures on their hands. The challenges that make eating difficult can be varied.

Because every child is so different, it is really helpful for parents to seek a professional to guide them on their journey to happier and healthy mealtimes. While there are wonderful resources and ethical providers out there to help, there are also some interventions that are disrespectful and, in some cases, can make feeding challenges worse.

In Part 2 of this guide, I will describe disrespectful feeding therapy practices so you know what to avoid. At the end, in Part 3, I’ll discuss ethical and respectful alternatives so you can find the right provider for your child.

References:

Bandini, L. G., Curtin, C., Eliasziw, M., Phillips, S., Jay, L., Maslin, M., & Must, A. (2019). Food selectivity in a diverse sample of young children with and without intellectual disabilities. Appetite, 133, 433–440. https://doi.org/10.1016/j.appet.2018.11.016

About the author: Caroline Braun, M.S., CCC-SLP, is an Autistic speech-language pathologist practicing near Baltimore, Maryland. Through her private practice, she provides neurodiversity affirming language and feeding both virtually and in the home environment. Caroline is an aspiring researcher with a particular interest in responsive feeding therapy and affirming parent-mediated interventions. You can find Caroline at: https://www.carolinebraunslp.com/

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A Parent’s Guide to Respectful Feeding Therapy – Part 1

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