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A common challenge for children and their caregivers
Wednesday, July 20, 2016
Author: Ellen Backman, Speech therapist and doctoral candidate in health and lifestyle at Halmstad University.
From a growth perspective, along with food, meal-times play an important role in cultural learning and social intercourse. Mealtimes provide a context in which the child develops its vocabulary, makes choices and engages in conversations about events in everyday life. Below is a discussion of the common challenges that arise for children and their caregivers along this exciting developmental journey.
0 – 6 months
The eating function develops as early as in the foetal period, and the sucking and swallowing reflexes are already observable in the womb in weeks 10 – 14. The foetus swallows amniotic fluid and stimulates its facial and mouth regions through touching and sucking of its fingers.
For the new-born baby, eating is one of the first functions that it can carry out independently through the rooting and sucking reflex. The anatomy inside the new-born’s mouth and throat is specially adapted to allow the coordination of breathing with sucking and swallowing. A small jaw, a tongue that occupies most of the mouth cavity, and fat pads on the inside of the cheeks all create the conditions for an effective sucking process.
Children also use their mouths to explore their environment at an early age, and they are constantly surrounded by impressions through having their fingers in their mouths, chewing on toys, tasting food or kissing their siblings. The mouth region is the part of their body that takes in the most sensory information, for instance tastes, smells, vibrations, pressure, temperature and two-point discrimination. The way in which the small child uses its mouth as a tool for exploration is an important component in its sensory development. It creates the necessary conditions for its later ability to transition from liquid to solid foods.
However, mealtimes during the baby’s first years are also a platform for creating the emotional and communicative interplay between the child and its caregivers. They learn together to get to know each other, and the main challenge for caregivers during this early time is to help the child to interpret and validate signals originating from the child’s own body. Out of this interplay, the child acquires important knowledge: the child becomes aware of its own body’s signals, learns to communicate its needs and acquires the confidence that the world can provide the child with what it needs.
6 – 12 months
The child’s face has now grown and there is more room in the oral cavity for increased tongue and cheek mobility. Since the age of four months, the child can taste limited amounts of the family’s normal food if it shows interest: perhaps licking sauces from a finger or being given a little mashed potato to try. From the age of approximately six months, the child is ready to be given other foods as a complement to mother’s milk or formula.
Children who are breastfed are often more open to various tastes than those receiving formula because of the slight variations that the mother’s varying food intake causes in the mother’s milk. Taste preferences are also strongly influenced by experiences and events associated with mealtimes. At birth, babies prefer sweet tastes to sour or bitter tastes, and at four months, the baby develops a preference for salty foods.
During the second half of the first year of life, the child gradually learns to eat coarsely mashed foods and soft pieces as it adapts to increased motor control of its jaw, lips, and tongue. However, the child is also developing the improved hand-eye coordination, neck control, thorax stability and manual skills that influence eating development. The ability to regulate its own its nourishment intake by recognising hunger and fullness constitutes a part of eating development. Appetite may be described as a combination of hunger, food-craving and physical circumstances. Feelings of physical hunger caused by a drop in blood sugar and the stomach having shrunk are described as the most important drivers of the appetite regulation system. The appetite is also affected by food-cravings triggered by aromas, for instance, or through inbred social situations and routines. When introducing small children to foods, the appetite may be affected considerably by routines or by a pleasurable and clear presentation. Even by introducing tasting-sized portions, the child can also be encouraged as much as possible to feed itself, as studies show that healthy children who feed themselves cater best to their own nutritional needs and acquire better appetite regulation.
There are clear milestones in development of the eating function in children, and it can be objectively measured using growth curves. The eating function develops primarily during the first three years of a child’s life and it is driven by inborn instincts, curiosity and a desire to learn, in parallel with the caregiver’s ability to recognise the child’s signals and to create a positive and safe mealtime environment.
1 - 2 years
At one year of age, the baby’s tongue and jaw are able to move more freely in relation to each other. This provides the conditions necessary for the child to deal with food textures and to process food in a more advanced manner. The chewing ability develops and can be readily stimulated with the help of soft food in rod-form that the child can hold by itself and where there is no risk of it ending up in its throat in the wrong way, as food in pieces can do.
Important tasks for the caregiver are to offer the child good food, create a safe and pleasurable mealtime situation and challenge the child’s independence. A healthy child will eat, grow, and become independent in the food situation if mealtimes are experienced as a positive time and if the food offered is adapted to the child’s motor and sensory capabilities.
It is important during this period to take advantage of the child’s curiosity and to offer an array of tastes and textures as a preparation for the period of neophobia, or fear of anything new, which appears at the end of this period.
2 - 5 years
Children between the ages of two and five years tend to be most restrictive with regard to new tastes, which is described as having an evolutionary background. The child is now more independent in a motor-related way, and explores its universe at increasing distances from its caregiver. Neophobia is an inherent control function that prevents the child from putting whatever it finds into its mouth and eating only food that is known to it. Family members are important role models in encouraging the child to expand its taste horizons, as well as providing many repetitions of the new taste, verbal assessments regarding the tasting-size portions, and the child’s previous experiences of the meal-time environment.
At age two years, the child will have a well-developed mouth motor function, though it may lack sufficient strength to deal with meat or tough bread, for instance. At three years of age, the child is expected to be able to feed itself, and eating development during the pre-school years consists of a more refined use of gross and fine motor movements, as well as an expansion of various tastes and textures.
Mealtime is seldom a conflict-free zone. For a pre-school child, mealtimes provide a number of opportunities for testing the limits – perhaps with respect to how one eats, and how much or what one wants to eat. A good food situation is based on an adult taking a clear responsibility for what, when, how and where the meal is to take place, while also paying attention to and listening to the child’s signals regarding timing, amount, preferences, and eating ability, thus teaching the child that its own signals play a role.
The customs and rules of each specific family concerning mealtimes provide signals to the child regarding attitudes and expectations in the dining situation, but also regarding the potential for social and emotional development on a larger scale. Eating family meals together has been shown to be associated with good psychosocial health and doing well in school, as well as a lower incidence of alcohol and drug usage and violent behaviour in children and youth. There is therefore every reason to view the child’s eating development and the family’s mealtimes with the utmost seriousness.