Ruedo had a muscle condition that left him with very poor muscle control below the neck. He could guide his wheelchair by moving a joystick between his right thumb and forefinger. It was clear he had very limited use of his hands. Above his shoulders, though, everything worked fine. After getting settled and arranged, he and mother sat down by my desk.
Mom said Ruedo barely ate was picky, and refused most foods. It was no surprise he was underweight. Mom began to cry. After a few minutes she wiped her eyes. I waited until she composed herself. We went back to the task at hand. I see he has many challenges, I said, but, tell me, can he get a cookie out of you She began smile so I smiled. Then she laughed. Yes! she said grinning. I knew now we could make some headway. Mom had moved from the world of worry to the world of possibility. She recognized Ruedo s strengths.
Children, delayed or not, know how to manipulate their parents when it comes to treats. It is a sign of mental health and a way into the eating problem. The response to the ploy is up to the parents. Some parents may think, Why not give them what they want The child is already suffering. He hardly eats anything. Certainly, the child will suffer as they grow to understand themselves in relation to others. In the moment of worming cookies out of parents, the child is not suffering. The child is doing what all little children do once they have figured out the weak points of their parents. The fundamental issue that worried mom was the usual concern of parents when they lose control of the daily meals and snacks. Instead of thinking about healthy foods and they focus on the some aspect of the delay.
A Parenting Approach to Nutrition
Once mom and I tacitly agreed that we were talking about a parenting problem, we talked about the feeding relationship, a parenting approach to nutrition. The rule governing feeding relationships is pretty simple: The parent provides; the child decides. In Ruedo s case, no one addressed Ruedo s hard-wired drive to self feed. Mom understood the rule but it would take time to work out a way to solve his particular needs. The better therapists address the parenting process along with remediation. The parenting job includes the basics such as modeling at the table, eliminating the baby bottle, helping the child use a cup to the extent possible, the judicious use of no and yes for treats. When children learn that parents provide, and that they decide, mealtimes go smoother. Pickiness and refusals can abate. Sometimes, sensory delays will weaken. It can be complicated to apply the feeding rule in the presence of delays but not impossible. The reasons to try it are practical and emotional.
Sameroff, a psychologist, finds parents of delayed children need the three R s: Remediation, Redefinition and Reeducation. Remediation refers to optimal remediation of the delay. Redefinition describes the change in thinking that allows parenting strengths to come into play by minimizing any overwhelming aspects of the disability. He finds that parents attitudes can affect the child's ability to overcome. In the case of nutrition, it means minimizing struggles. Otherwise, the emotional fallout of routinely distressing meals grows unchecked. Love gets buried. Lastly, parents have to learn about what s behind the struggles. Learning about hunger, readiness and satiety cues is essential. Parents who see standard emotional behaviors catch their deeper meaning. It becomes easier to apply basic parenting skills. We love our children and calm, mealtimes support that love.
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