Feeding disorders affect 25 to 45 percent of typically developing children and up to 80 percent of children with special needs and/or chronic health issues. A “feeding disorder” diagnosis applies to a child who can’t consume a balanced diet of age-appropriate food or liquid to support steady growth and development. When speech-language pathologists and other health care professionals treat a child with a feeding disorder, they work toward improving the child’s ability to eat a variety of foods.
Food insecurity, on the other hand, means a child experiences limited or uncertain availability of nutritionally adequate and safe foods, or has a limited or uncertain ability to acquire acceptable foods in socially acceptable ways. Nearly 50 million people in the United States struggle with food insecurity and 16 million of those are children.
Now consider a family seeking help for a child’s feeding disorder while they struggle with food insecurity. What strategies can SLPs put in place to achieve goals in feeding treatment when food is scarce or clients have limited funds for expanding the variety of foods?
Whether treating the child in a clinic, hospital, school, or the home, I recommend using these six steps to develop a plan of action:
- Screen for food insecurity frequently. Situations change and appearances can deceive. The sudden loss of a job or mounting medical bills can change the way a family shops for food. You might suspect food insecurity upon first meeting a family, but some families might conceal this condition.
The American Academy of Pediatrics (AAP) issued a policy statement in 2015 recommending all pediatricians inquire about food security at health maintenance visits or sooner if indicated. The Hunger Vital Sign tool offers two simple questions to ask families in determining food insecurity. The AAP suggests pediatricians begin the discussion by saying, “Many patients tell me they have trouble getting enough food for their families.”
Finding the right words to start the discussion is delicate, with or without scripted questions. Clancy Cash Harrison, TEDx Speaker, Food Justice advocate and author, offers this advice for health professionals:
- Lead with empathy. Discuss how you understand fresh food can be expensive for many families, which is why you recommend—and even buy yourself—frozen fruit and vegetables without added sugar or salt.
- Start a conversation with how feeding children can cause worry on a variety of levels. People may feel confused about types of foods to buy or if they can afford appropriate food. Ask parents what they find stressful about shopping at the grocery store, leading with the examples mentioned.
- Ask your client if they want to learn how to feed their family the most affordable foods with the most nutritional value. Download affordable food charts for them. Harrison also creates free meal plans focused on cost as well as nutrition.
- Determine how to acquire more food for the family. Should concerns arise via the screening tool, you can refer families to resources in their area, including Special Supplemental Nutrition Program for Women, Infants and Children, Supplemental Nutrition Assistance Program, National School Lunch and Breakfast programs, and local food banks.
- Develop a treatment plan, listing the foods they need to implement treatment strategies. After you help families get support for acquiring more food, outline the treatment plan with the child’s caregivers. Keep in mind the number-one priority is the health and nutrition of the entire family. Try to select foods for treatment that other family members enjoy. If family meals are too challenging for the child’s eating level, discuss ways to adapt meals for the child. Ways to adapt food include blending, chopping, or separating out ingredients before making a soup or casserole.
- Discuss how to use foods. Many adults aren’t familiar with feeding treatment. As we discuss expectations with caregivers, communicate different scenarios that might occur in sessions. For example: “In our first session, we’ll just play in new foods, so your child experiences new textures. I’ll ask you to repeat this food play throughout the week, so what foods can we use repeatedly? Leftovers are ideal and I only need a few tablespoons to get started.”
- Implement practical strategies that respect the family’s need for food.
- Use a plastic ice cube tray, pieces of foil or small empty jars to store a few tablespoons of leftovers intended for feeding therapy. Parents can bring these foods to sessions and you can warm them slightly in a microwave. Although packaged foods provided by a feeding clinic provide an important tool, the essence of feeding treatment is to help the child eat what his family provides.
- Encourage parents to include a teaspoon of whatever they serve—unless it’s a choking risk—on their child’s plate. If the child won’t eat the food, save it for later or try to serve it in another part of the meal. For example, add peas and carrots to a rice or pasta dish.
- If the child experiences difficulties tolerating messy food play, implement inexpensive tactile play first. Parents can make reusable homemade playdough, offer fruit peels, or let the child play with dry beans, which can later get washed and cooked. Instruct caregivers to watch for choking risks and monitor kids closely.
- Help alleviate mealtime stress. Families are often overwhelmed, even after feeding strategies are in place. They may have little energy left for following a home treatment program. To ensure follow-through at home, begin by offering simple, doable strategies that help the parent feel successful. Build gradually from there, gently asking the parent to do a bit more. This steady progression builds confidence and trust between the family and the clinician, which in turn facilitates steady progress for the child in feeding treatment.
Melanie Potock, MA, CCC-SLP, treats children birth to teens who experience difficulty eating. She co-authored “Raising a Healthy Happy Eater: A Stage-by-Stage Guide to Setting Your Child on the Path to Adventurous Eating” (2015), “Baby Self-Feeding: Solid Food Solutions to Create Lifelong Healthy Eating Habits” and “Happy Mealtimes with Happy Kids,” and produced the kids’ CD “Dancing in the Kitchen: Songs that Celebrate the Joy of Food!” Potock’s two-day course on pediatric feeding is offered for ASHA CEUs. She is an affiliate of ASHA Special Interest Group 13, Swallowing and Swallowing Disorders (Dysphagia). mymunchbug.com/contact-us/