One of the biggest lessons I've learned as a Feeding Specialist, is that I mustn't assume everyone will know what I'm talking about. I've had lots of training and built up my knowledge over this past decade. While I attempt to impart this knowledge as clearly as I can, everyone comes from different backgrounds and has different life experience which means we don't all start from the same point of understanding.
There are so many different aspects involved in a child's journey to the table that I feel are useful to know before trying to work through challenges that set that journey on a different course.
Like with any skill, eating and drinking is something a baby / child needs to learn and master - yet another developmental milestone. Remember we talked about the amount of mealtimes they'll have over the course of their lives, they'll get a lot of practice but if it's too tricky to start they might shy away from this daunting endeavour.
Where it all begins:
Your baby, however they reach you, starts their eating and drinking journey before they are born. Yes they receive all their nutrients via the umbilical cord but from week 11 they are already learning to swallow! The foetus will do this to circulate amniotic fluid and to practice that all important skill for life outside the womb. Ref.
By week 18-20 gestation your forming baby will be sucking their fingers and thumbs learning how to coordinate all the skills of eating and drinking. There is also some research to suggest your foetus will already have taste preferences too, crazy!
By birth, most babies will have a mature enough swallow pattern to latch to a breast or bottle and start their feeding journey outside the womb. *We'll talk about breast Vs bottle in another post.
Some babies will follow a different course, if they find swallowing too challenging or there are other complications to make their first feeds difficult to do orally they will likely have some feeding support from a tube to make sure they are getting the nutrients they need. These babies will likely receive some support to develop their oral feeding skills in a more cautious way to try and prevent longer term difficulties *more on this in another post.
Your baby has established itself on the bottle or breast and you've entered a whole new season of your life - round the clock feeding of a newborn. You might be pumping milk, navigating formula measures and cleaning and sterilising equipment until your hands are raw. Your baby is building stamina and mastering those skills with every feed. Stamina is a major component to feeding, as the days and weeks progress your infant needs to take increasing amounts of milk in one go. Breathing effort is the key thing. Your baby needs strong lungs and muscles to support their feeding because it's not possible to swallow and breathe at the same time - meaning they need to hold their breath briefly every time they swallow. We talk about the suck:swallow:breathe pattern. Then there's mastering the difference between a non-nutritive suck and a nutritive suck i.e. one for comfort and one to fill their tummy.
As they grow they will be learning new physical skills, all of which have a role in Mealtime.
Head holding
Communicative cues
Sitting
Hand to mouth all play their parts.
Learning their senses, hunger / thirst
Then there's the start of the weaning journey, when to start, what to give, when to give it, how to prepare it. You look online and listen to advice and EVERYONE says something different 🤯.
When you start, theirs the development of advanced oro-motor patterns that needs to happen. Babies will start with a forward-backward tongue pattern much like they do with milk. They might lap at the spoon too. They are simply moving the food from the front to the back to swallow it fairly instantly.
Then they start to move their tongue side to side or laterally. This pushes the food between their gums where they later will learn to chew. They might squash the food with their tongue and the roof of their mouth and then move it back to swallow.
A little further down the line and you'll start to notice you babys chin move round and round. This is the start of their adult 'rotary' chewing pattern. They might not always get this right which is when you'll notice them gag, a lot, while they practice. They may also push the food out of their mouth - this isn't a rejection this is simply saying that's too big, I can't handle it. Gagging and removing is completely normal and safe but it can be very frightening to watch. I get it. It's been interesting weaning our babe together, I with knowledge am a little more relaxed about a gag but seeing this play out through my partner's eyes I really get how scary and off putting this can be for care givers.
Chewing development - which we will talk about in another post, has a small 'window of opportunity' to develop naturally. This means that between certain ages is the key time for this skill to develop and if it doesn't or isn't given the opportunity in that timeframe is likely a missed opportunity and will require waiting until your child is older to get to grips with the skill. Generally between 7-9 months.
Then gradually over time, your baby transitions to 3 meals and 2 snacks eating mostly what you eat at the table. Then they hit 2 and neophobia kicks in. Neophobia is another typical part of development it means 'the fear of new things' which happens a lot in eating and drinking. It also coincides with your baby's language development and learning about boundaries - they can say no now and will push the boundaries and your buttons. Food is a great way to do that because it's such a frequent and necessary part of the day that it draws a lot of attention.
But you overcome this with strategies, or you don't (and I can help with this) and your child moves on to a more settled and predictable table time.
Remember any developmental process isn't linear.
Moving onto Weaning:..
Have you found weaning your child challenging? Is your child finding it challenging? Do they throw food, spit it out or only play with their food? Did they like puree but struggled to transition to anything that needs chewing? Then read on..
In my years working with children 0 up with eating and drinking difficulties I've met lots of caregivers of babies (and some older children) who report that weaning started quite well but they struggled to move on with textures or they moved on but their child only plays with the food and spits it all out.
Some causes of difficulties with eating development
There can be a whole range of causes for this but more often than not it's a missed opportunity to develop the important chewing skills needed for more challenging textures. This in turn creates underlying issues such as lack of motivation, frustration and avoidance for an activity that seems to tough and only creates an unhappy environment as their caregivers become more worried. Let's have a look at some in more detail:
The milk - food vicious cycle.
When littles ones experience the above, understandably milk becomes a greater feature in their diet again. This also creates an over reliance on milk and for older babies they can wait out a meal knowing milk is coming. They fill up on milk and are then not motivated to eat. It's a tough cycle to be in and to break, particularly due to worries that their child will no longer be taking on enough calories.
Baby-led weaning or BLW
BLW can be a fantastic way to introduce foods and help those chewing skills along in a time sensitive way. The caveat - if done correctly. There is so much information out there about BLW but in my experience many caregivers aren't clear on how to manage this well. Even those who do, it doesn't suit all babies. Websites such as 'Solid Starts' or 'Ella's Kitchen' (not an ads or affiliated partners) are incredibly useful for knowing how to prepare and introduce foods at certain ages and stages. However, if opportunities are missed, usually between 7-9 months, to introduce soft finger foods for chewing practice then babies find themselves spitting foods out instead of swallowing them.
Building positive relationships with food
If this isn't built in, babies will also struggle to develop their eating and drinking skills effectively. If meal times are any of the following:
Stressful
Boring
Passive (e.g. using a tablet or the TV as distraction)
Too difficult
Babies will switch off from the experience.
Getting messy with food, enjoying preparing food together and eating together can all help improve your child's relationship with food.
What have I found to be helpful?
Controversially, starting again, or as I like to call it, take a 'weaning reset'. Many caregivers and care providers find this challenging because it feels they are taking steps back. But actually a reset allows for a fresh start and a chance to really work on your child's skills in a positive way.
Building back up using smooth puree, then a little texture and a little more with bite and dissolve finger foods moving to soft finger foods can be really beneficial for children like this.
It's important to put these foods on their tray or on the table so they can explore them with their hands first. This helps to build trust and tolerance before the all important mouthful.
If chewing skill development has been missed then purees provide an opportunity to learn to coordinate a swallow again - see my Dysphagia post for more info. Once they start to associate food goes in and fills up my tummy then you are on the right track.
It's a brave step to start with purees again but if your baby isn't eating much then this can be a great option to work back up to age appropriate texture intake. Use pouches for ages or see my texture guide for more information.
Good luck!
Any questions please do get in touch!
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