Teaching a child how to eat when they aren’t experiencing hunger is like teaching that child to swim in a pool without water. What does this mean?
In this week’s episode, Jennifer and Heidi break down this analogy that we use in tube weaning to explain the importance behind the need for a context when learning to eat. We often hear that a child is not eating yet, and therefore not ready to learn how to eat because they don’t know how. This is a confusing topic for families to work through as they are thinking about starting their tube weaning journey. Imagine learning to swim, if you are standing on the dock and flapping your hands, you are not really swimming. If a child is sitting in a highchair with an empty spoon, they are not really learning to eat. As we have discussed in past episodes, hunger is NOT the magic bullet, but it is WHERE the learning needs to take place.
How are these two skills similar?
It may not be obvious at first, but learning to swim and learning to eat do have similarities. Think about how you learned how to swim. If you only stand on the dock and learn how to flap your arms, you won’t learn how to swim. A child who is sitting in their highchair playing with an oral motor tool or an empty spoon is not learning to eat. While swimming, you need the water to really learn, and while learning how to eat, you need to have hunger and intent to eat. Even if you spend 1 hour a day for 5 days standing on the dock, flapping your arms, you can’t learn how to swim. If a child spends 1 hour a day for 5 days learning how to chew on an oral motor tool, we can’t expect them to learn how to eat. Both learning opportunities require a context to truly learn a new skill.
What are the two common misconceptions?
Just because there is water in the pool, doesn’t mean you immediately know how to swim. A person learning to swim still must learn all the foundational skills for swimming, but it’s necessary this happens IN the water. When a child is learning to eat, just because they are experiencing hunger, does not mean they will automatically know how to eat. One of the most common misconceptions is that learning to eat should happen before hunger. Learning to eat needs to happen in the context of hunger, but another misconception is that hunger itself works. In our tube weaning program, we focus on working with children within the context of hunger, while also working with the families to build foundations, skills, and their overall relationship with food.
What if they are scared to jump in?
There are often stories of children at swimming lessons who are afraid to put their feet in or put their face underwater. It is natural and expected for a child learning a new skill to be slightly afraid. In any new environment, children typically need to feel comfortable and trust the situation in order to learn something new. With swimming, the child learns to trust the water and know that they will be safe. While learning to eat, children need to learn to trust the food and know that nobody is going to push them to do something they do not want to do, like the water. Learning to do a new skill can be scary, and it is helpful to learn through experiences. Our bodies have reflexive safety mechanisms for a reason and if you fall in while swimming, your body knows to move your arms and scream/yell. While eating, children gag or push the food out and this is intentional and part of the process for learning to eat. In other areas of life, we encourage children to stay away from fearful or dangerous objects, so why wouldn’t we expect them to stay away from eating if that has only been fearful or dangerous in the past? If a child learns that food is a terrifying thing that they need to overcome, that is the wrong message. We need children to first learn to trust and understand the food.
Are they ready to dive in?
A common concern we hear from parents is that they are wondering if their child is ready to learn how to eat since they don’t have the oral motor skills yet. In typical therapy, the focus is on exercises and working on building the child’s oral motor skills outside of the context of hunger or eating. There is a lot of research on adults who have lost skills from a neurological injury which show that oral motor strengthening skills help with progress. This research has a focus on REHABILITATION and working with patients who are re-learning how to eat. Often, well-meaning therapists see this research and think it applies to all our tube-fed kids, but they are working on HABILITATION and learning a new skill. There is new research that shows that when skills are learned within the actual context where it will be used (walking, eating, crawling, etc.) there is more progress and the therapy is more successful.
There is no research to suggest that for the initial process of learning to eat oral motor skills are effective in the same way as learning about those skills within the context of hunger. Most therapists start with exercises and tools, and therefore parents are told that they must master “tolerance” and “acceptance” of these tools before they can move on. As we know with other life skills, if someone must do something independently, they learn how to do it better and it has a more lasting effect.
How will they learn?
For a child to move ahead with the intensive tube weaning program at Thrive, it is necessary to identify that the child is safe on at least 1 consistency, whether that is thin liquid, puree, or solid foods. This is because every child initially learns how to eat with 1 consistency while the body learns and can have a consistent pattern. In the traditional progression, a child starts with drinking, then transitions to a thin puree, mashed puree, soft table foods, then hard and munchable solids.
Baby Led Weaning is another approach that we often use in our tube weaning program, as well as with children with feeding challenges. This approach focuses on starting with soft pieces of real solid foods and offering your child more independence with foods as they learn how to master the skills necessary. For more information about what baby led weaning is, check out our most recent blog post!
It’s not the Olympics…yet
Back to swimming, when you learn how to swim, you don’t start with learning the butterfly. It is less important on which progression you choose to go with your child, but start out with the foundations and the supports that they need while learning to eat. Parents often have the expectations that their child will start to eat full meals right after hunger sets in, but that is not how ANY child learns how to eat! Children do not start to eat with large quantities, they may take a few bites one meal, a few licks another meal, and that is okay because they are working on building their strengths. When you start swimming, you don’t immediately enter the Olympics. When you run a marathon, you don’t initially start training with 20 miles. Learning to eat is not a straight line, there will be up and downs, and your child will work through their skills.
Our data shows that this can be a fine line to walk on and it is often a balance to keep children challenged, but also making sure they feel good and are not falling apart. If it feels like too much, it looks like too much, it is most likely too much. At Thrive, our therapists are in the room with families to help you make these decisions, like the lifeguard at the pool or the swim teacher.