Most therapists would agree that one of the markers of success in feeding therapy is when a parent or caregiver can successfully feed their child. I would add that it is our job as feeding therapists to not only work with the child but to also work closely with the caregivers. Specifically, to empower caregivers and parents with the skills needed to successfully feed their children and to support and guide them through this often difficult time.
Some caregiver’s tell me their child has been getting therapy but they don’t know what the child is working on because they drop the child off at the door and are never present for the session. In these situations, the parent often does not know what to reinforce at home. I also hear parents say their children will eat for the therapist but not for them. I am sure that is a frustrating situation for a caregiver.
There are strategies that can be put into place early on in treatment that will make the goal of training caregivers to have successful feeding experiences with their child easier to achieve.
- Have caregivers present during therapyI work in an outpatient clinic in a children’s hospital. Parents or caregivers are present for 100% of the therapy sessions. It’s important that parents be present for the entire session. During therapy, parents give me a report of how things are going at home. I ask questions to gather more information and then I ask the caregiver to feed their child and show me how things are going. Having parents present may be difficult if the therapist is treating the child in a daycare or school setting. However, in these situations, every effort should be made to have caregivers present periodically for treatment.
- Have caregivers do the feeding in the therapy sessionI always ask parents to bring foods that we are working on and to do the majority of the feeding during the session. This allows me to assess how well caregivers are able to use strategies recommended to feed their children. For example, I often find parents feeding without putting the whole spoon in the child’s mouth or not full moving the spoon laterally id we are using lateral placement.
During the feeding, I may demonstrate feeding techniques or I may coach the parents on how to feed. If I introduce new techniques then I have the parents practice the feeding strategies. I provide guidance, answer questions and hopefully show them their children can be successful feeders. Sometimes, the session goes badly and the child refuses to eat. We help parents by providing ground rules and structure to the meal to help them trouble shoot difficult meal time behaviors.
- Record Feeding strategies to be practiced at home. Encourage caregivers to record therapeutic techniques on their smart phones to practice at home and to teach other caregivers who will feed the child. Because we serve as a hub for children across our state and surrounding states, I encourage caregivers to video tape recommendations for the local therapists to use.
- Provide a written home program for meal time and practice feedings.We send all of our parents home with a written home program. In the beginning of treatment that might be 1-2 practice sessions per day working on specific skills outside of meals or it may be specific recommendations for meal time.
Here are a few examples:
- practice full acceptance of the dry or dip spoon with spoon pressure to establish proper tongue placement 20 x two sessions per day
- practice lateral placement of puree 2 oz twice per day
- meal time: 75% puree and 25% chewable, 4 oz of liquids via open cup.
- Meal time: puree or mashed foods and 20 bites of chewables placed laterally with jaw support.
What ever the plan, we help parents understand the benefits of daily practice on specified exercises or techniques for overall learning. There are exceptions such as if the child is sick or the family goes on vacation. Overall, in our clinic, we have seen the benefits of parents and caregivers doing the majority of the feeding with therapist support and coaching. The end result is caregivers feel more confident handling the feeding techniques and working through difficult meal time behaviors.