How To Measure ‘Success’ in Responsive Feeding Therapy
Whether your child is a part of a tube weaning program, identifies as a “picky eater,” or you are struggling to navigate that wonderful (yet also stressful) time of a child’s independent eating journey, you are not alone! In fact, it is normal to find this time of parenting to be challenging - it can be hard see the “small wins” as children of any age learn to feed themselves. As a dietitian working with numerous families over the years, one thing is for certain: letting go of the pressures around measuring specific numbers – such as weigh graphs, food logs, hydration milliliters, ounces gained per feeding or volume consumed at a meal – is VERY hard to let go of, especially if your child has been deemed “failure to thrive” or “underweight” by a medical provider. While many of these numbers are valuable to measure (and at times life-saving) issues can arise if parents and caregivers are using these as the ONLY means of success in feeding therapy.
As said above, It can be easy to feel “stuck” in navigating your child’s intuitive eating journey – or that progress is limited - if the only measure of success is quantitative data. But by shifting focusing towards qualitative markers (such as environment, enjoyment, and other ‘small’ wins) this can greatly improve the feeding experience for all…and result in long term positive outcomes in growth and development.
According to feeding therapists from Thrive Pediatrics (Jennifer Berry OT, and Heidi Leifer Moreland ST) true measures of success in responsive feeding therapy are the following:
Child initiation, Enjoyment during mealtime, Attention, and Satiation (or feel better) after eating.
Let’s dive into each of these topics a bit more:
· Child Initiation: Starting the process towards food – it can be subtle! This could be in relation to initiation of actual eating, such as pointing, leaning, reaching, talking about food or making noises, looking at parent, food or both; crying, mouthing towards things, lack of interest in other activities/acting unsettled. This could also be initiating feeding within the meal or snack (doing so by self or someone else to do so). Parents may ask themselves: “Do they (the child) need a need met?”
· Enjoyment during mealtime; Attention: possibly talking, smiling, engaged - with food or other members of the family. This is an area that can be difficult for parents/caregivers if they are worried about a child’s intake (or lack thereof). Parents may ask themselves: “Are they enjoying the experience? Is it stressful? Can they sit at the table? Has attention gotten better? Endurance of meal? Do meals ‘look’ better objectively?” Focusing on interactions during the meals may feel small – but can make all the difference long-term.
· Satiation/Feeling better after eating: This is most often observed by parents; lessening of actions as noted above. Parents may ask themselves: “Are they doing well? Engaging in activities, progressing through milestones, growth across the board (not just weight)?” A useful quote can also be: “Look at a child’s state, not just their weight.”
If letting go of tracking all numbers feels impossible, start slow! Discussing safety parameters or boundaries with your child’s pediatrician and/or dietitian is a good place to start. Some examples could be: Are they peeing, pooping, and sleeping enough for their age/growth/level of development? Or are they acting lethargic? Monitoring weight can in fact be an important data point, but I would discourage daily weights (as it is normal for weight at any age to fluctuate day-to-day). At most, working to decrease weighing a child to one time per week can help to monitor any trends the providers might need.
Remember: a child’s ability to learn & regulate intake - as well as parents’ ability to trust they are getting enough nutrition - takes time. The process is not immediate, and can understandably be overwhelming. While the long-term goals might be to have natural mealtimes (as defined by the family unit), parents trusting their intuition & instincts for responsive feeding, or overall thriving as a family….in my opinion, more emphasis should also be placed on the eating experience as a whole. Each meal and snack is simply an experiment and opportunity to learn more about yourself, your child, and what is helpful or might need to be shifted next time. Looking at each eating episode with curiosity, compassion and non-judgement, might just be the answer you were searching for.
“By focusing on quality and connection, it leads to quantity and growth later.”
Sources: thrive spectrum pediatrics https://thrivewithspectrum.com/
Podcast: Tube to Table https://thrivewithspectrum.com/category/tube-to-table-podcast/