Last year, a colleague and friend Occupational Therapist Gillian Griffiths (co-writer of SENSATIONAL mealtimes) introduced me to someone new. She suggested that we would completely get along based on our interests and similar passions about paediatric feeding. Enter…. Kyla Smith, a passionate and dedicated Dietitian who runs a private practice called Mealtime Building Blocks in Perth; I only wish she lived in Newcastle so we could work together!
So of course when we met, our entire conversation focused on paediatric feeding. It was so lovely to meet my professional soul mate! During this conference, we spoke about blogging for each other, because although we were like minded, we both were qualified in different degrees, hence what we brought to feeding was entirely different.
So drum roll, Kyla’s suggested topic for me was chewing… how does a parent know when their child is just fussy or if they have underlying chewing or oral motor difficulties?
Excellent question Kyla! Feeding is multifactorial, it can involve different health professionals from different backgrounds like:
Medical - reflux, diagnoses like Down syndrome, Cerebral Palsy, Autism Spectrum Disorders etc and how these factors influence feeding
Dietitians – not only growth and general nutritional intake but also constipation, allergies and intolerances
Occupational Therapy– the role of our senses around food, mealtimes and general sensory modulation through the day as well as self feeding and overall muscle tone.
Clinical Psychologists- the role of behaviour/anxiety/past food experiences on food as well as parent and child interaction
And of course, my area as a Speech Pathologist – chewing and swallowing. And specific to chewing – the movement of our lips, tongue, jaw and mouth as a dynamic process to helping a child get through a range of different foods like yoghurt (puree), milk arrowroot biscuits (bite-dissolve), banana (soft), carrot (hard) and finally foods that require complex and advanced chewing skills like steak.
So what is running through my head when a parent calls about their fussy eater?
Case 1: The foods they report that their child eats e.g. biscuits, banana and yoghurt – common theme here? All fairly easy to chew – in fact, these foods can often be just sucked and swallowed. Let’s try something a bit harder? What about chicken nuggets, chips and toast – again fairly easy to chew – you only have to bite down and often a bit of tongue “mashing” can make the food soft enough to swallow.
Case 2: How their child eats? Do they chew… chew and then finally spit the food out? Okay so what’s going on here? What types of foods are they chewing and spitting. Don’t get me wrong, I’m okay with spitting; it helps a child explore a new flavour and spit it out if they are not sure about swallowing it (which is all part of learning about new foods). But what if they were chewing and chewing on a piece of apple and then their parents found “chewed up” bits of apple throughout the house? BINGO – depending on their age, they should be able to manage this texture.
Case 3: And the kids that put one piece, two pieces and then the entire food into their mouths and then like little stuffed chipmunks then spit the food out. Then that requires more analysis – is this underlying sensory issues or is this difficulty chewing certain foods? Could it be that the little ones that actually can’t “bite and pull” pieces of sandwiches and end up stuffing the entire piece of food in their mouth; this “bite and pull” action is an important oral motor developmental skill.
Case 4: Lastly, what about our slow chewers? That can still be chomping on a piece of food for an entire mealtime? And an hour after meal, still have the food in their mouths – what are they doing??
What am I looking at when I see them?
I explain to all parents, that during the assessment, I want them to bring foods that their child manages well and also foods that they struggle with. Why?
Firstly, I want a baseline of what they can do with a preferred food and then I want to see how they struggle with certain foods…
Is there a trend in textures with both preferred and non-preferred foods?
What do they do with their tongue, lips and jaw with these foods? For example, do they push the food out with their tongue? (“tongue thrusting”)
How about the types of chewing actions – is it up-down, diagonal or rotary? These developmental chewing actions help a toddler go from soft dissolvable foods like rice stixs to more textured foods like strawberries, flaked fish and then finally pieces of red meat.
What do I discuss with the parents?
We talk about stages of chewing and stages of food chewing levels in my sessions. I even get the parents to chew a piece of food and we break down what we “normally” do when this food is in our mouths and then observe how their child manages it. This is not fussy eating - this is a child with physiological difficulties chewing and swallowing specific foods based on texture.
And while these kids who sit at tables may “look” fussy by dawdling with their meals, they are actually struggling to chew and swallow.
So what about the kids that refuse to eat more than chicken nuggets? They might be refusing anything more textured meat-wise because it’s harder for them to chew and swallow. They are not being fussy, they can’t work out how to manage this food orally and understandably are staying with what they know they can do – makes sense to me!
So yes Kyla, you hit the nail on the head when you said, often it may not be “just fussy eating” it could be something more and it’s our job as paediatric feeding therapists to help analyse and problem solve with you as parents as to what the underlying causes might be and then help work out the best individualised feeding program for your child. I absolutely hate the “one size” fits all feeding approaches. You wouldn’t expect one set of prescriptive glasses to suit everyone; you would expect a GP to give the same script to everyone so why should we just adhere to one feeding approach to work with all feeding kids. The key to a good clinician is one who can problem solve with you and continually review the process to ensure it is working. Children are complex and we love them for being their little individual souls.
So if you’re in Perth, call wonderful Kyla at Mealtime Building Blocks a call and if you’re in Newcastle, then give me (Val) a call at Let’s Eat! Paediatric Speech Pathology, we are passionate and experienced… and yes… enjoy spending social dinners talking about the job that we just love doing!
It was so lovely to meet you Kyla and I am humbled that you wanted me on your amazing blog, hope your readers find it useful!
This website and information on this blog post is provided for educational purposes. It is not meant or intended to replace Speech Pathology assessment and management nor medical or nutritional care for a child. It is recommended that you discuss any concerns or questions you might have with your Speech Pathologist and managing Doctor and develop an individualised team plan specifically for your child.
About the author of this blog post
Valerie Gent is an Australian based Speech Pathologist with 13 years experience in Paediatric Feeding. She has recently opened a private practice called 'Let's Eat! Paediatric Speech Pathology' that caters for Newcastle based babies and children with feeding difficulties. Valerie is passionate about working in the area of paediatric feeding and special needs and has been involved in the teaching and training of Australian Speech Pathology University students and allied health professionals. You can find out more about Valerie Gent and 'Let's Eat! Paediatric Speech Pathology' via her website www.letseatspeech.com.au and Facebook page www.facebook.com/LetsEatPaediatric SpeechPathology or email her on firstname.lastname@example.org