As we talked about last week, we look at 4 domains of feeding during our initial assessment. When children have difficulty with feeding, there are many different factors that might be underlying this. Even when children don’t have a diagnosis, or difficulties are more mild, it is helpful to look at all these areas. This visual from the Feeding Matters’ Coordinated Care Model (Feeding Matters, 2023) shows the 4 domains of feeding. There is currenlty a lot of research happening around these domains and the relatively new diagnosis “PFD”.
Figure 1 – Feeding Matters’ Coordinated Care Model from “What is a PFD?” by Feeding matters, 2023. (https://www.feedingmatters.org/what-is-pfd/)
One of the domains of the Coordinated Care Model is ‘Psychosocial’. This is about the interactions between child, caregiver/s, and the environment. Concerns in this domain are often the first to be expressed by families, usually as;
“Mealtimes are so stressful!”
Difficulties in the Psychosocial domain may present as challenging mealtime behaviours as children are anxious around food and/or at mealtimes.
For children, fear around food and eating is real and can be all consuming. For example previous negative experiences with food (such as coughing, gagging, vomiting, or choking) may make eating and drinking scary. As a result, kids may start to avoid certain foods.
This can lead to food restrictions for example, only accepting a limited number of foods, only accepting a certain brand, or eliminating whole texture groups (e.g. no crunchy food or no soft foods), or whole nutrition groups (e.g. no vegetables or no meats). As caregiver/s this can lead to us feeling lost, frustrated, and stressed. In trying to make things better, however, we as caregiver/s may be inadvertently reinforcing these behaviours. For example, encouraging kids to ‘just take a bite’ or forcing kids to stay at the dinner table until they are finished, may exacerbate their anxiety, resulting in more avoidant behaviours at mealtimes. This constant stress can then impact the relationship between you and your child.
This domain of feeding can be particularly complex as it is unique to every family and their situation.
During our feeding assessment, we will talk to you about all the behaviours before, during and after a meal. We then work with you and your family to establish how you can begin to reduce your child’s anxiety around food and provide you with the tools and the language to make mealtimes less stressful.
During therapy sessions we love our new emotion magnets - they’re great for ‘checking in’ and can help start conversations.
