Listen in as four experienced therapists chat about the challenges that toddlers face with mealtimes. What should we be expecting of 2- and 3-year-olds at mealtimes? What skills do toddlers need to be able to successfully eat? How does their ability to sit up and sit still at the table affect their eating? Are tablets on the table a help or a hindrance? Why do we need to consider family and cultural contexts relating to mealtimes and how do our own sensory preferences affect our children’s mealtime experience? It’s all covered in this episode of Sensory Chat along with some handy tips and reassurance for struggling parents and carers.

TRANSCRIPT

Lelanie: Welcome to Sensory Chat, my name is Lelanie, I'm an Occupational Therapist and an Advanced Practitioner in Sensory Integration, and I'm calling in from Germany.

Amy: Hi, I'm Amy, I'm a Speech and Language Therapist and an Advanced Practitioner in Ayres Sensory Integration, and I'm calling in from Salisbury in Southwest England.

Angela: Good evening everyone, I am Angela and I'm calling from Melbourne Australia. I'm an Occupational Therapist and an Advanced Sensory Integration Practitioner.

Emma: Hello from me, I am Emma, I am a Physiotherapist and also an Advanced Sensory Integration Practitioner. And I'm calling in this morning from Warwickshire.

Lelanie: Our topic today is Toddlers and Eating. And I'm able to hand over to Amy now to set the scene for our next discussion.

Amy: So, what we're thinking about in this episode, is really sort of looking at two year olds heading into three year olds around mealtimes. So that's often a time that parents talk to me as being particularly challenging.

So, because I'm a Speech and Language Therapist, they're often asking me about a child who won't eat or will only eat a certain, you know, restricted range of foods, but also issues about children not wanting to, or not being able to come and sit with the family at the table, not being able to be part of the family experience of being part of a mealtime.

So I think that's what we're going to talk about today. So I suppose to start off with, it would be interesting to have a think about some of the skills that you need in order to sit at the table at two and take part in a meal, have something to eat. So if we think about sort of the motor skills, the social skills, the, the cognitive skills, the language skills that you need to be building in order to take part.

So, what do you think, Angela, would you like to, what kind of, if you were looking at a two year old, two to three year old, where would you be looking at their, their motor skills and development?

Angela: Yeah, while just listening to you introduce that, I'm thinking, wow, like what a complex task. If we think about all the things that you know, we're asking of little ones during meal times and this idea of trying to break it down and really unpick, you know, each element to try and figure out what might be going on is really helpful, I think. But yeah, so motor skills, I guess, you know, this idea of kids needing to be able to sit upright and to sit still, if we can do both of those, then our hands and our arms are going to be more available to feed ourselves whether that's, you know, using our fingers or having a go at, you know, using a spoon. And so I think thinking about, the size of the tables and the chairs and whether or not it's, it's appropriate for your little one to be at the same table as the family. So I guess thinking about the motor skills, you know, this idea of being able to sit upright at the table, but also sit still, are two really important elements. And so it's thinking about how do we help kids to do that. The furniture, you know, the chair and the table that we use is really important. You know, making sure that the table is not too high, and that, you know, their little arms can come over the top and rest comfortably on the table, but also thinking about some support for their feet. You know, if children have that support under their feet, they're going to feel more grounded. So I think, yeah, the seating and the table height is an important thing to think about.

Amy: Yeah. Angela, if I can just pick up on that. So if you think about swallowing, so the back of your throat, the tube that goes down to your lungs for air and the tube that goes down to your stomach for food, in your throat is the same, the same area, the same pipe. And there's a little flap that moves as you swallow to make sure that food doesn't go down into your lungs, you don't choke. Now obviously, as children are learning to coordinate, those are muscles too, they're learning to coordinate that chew and swallow. And that's something that takes some practice and thinking about it sort of in terms of your body's top priority is to keep you safe and keep you alive. That if you're, if you're not stable, if you're not able to sit and feel secure in your sitting or at some level your brain recognizes there's a risk that food's going to go down into your lungs, there's no way your body is going to let you carry on shoveling down peas. There's a kind of a survival response, which could easily...

Yeah and equally we need to make sure our hands and arms are free, you know, so by having that secure base, they're going to be more ready, I guess, for action.

Yeah, absolutely. Absolutely.

Lelanie: I'm so pleased to see - -in here on furniture, but one thing that's made me really happy to see in recent years is that more and more commercial providers, I'm not going to name any here cause we're not advertising anything, actually have chairs that you can adjust the foot rest, that you can adjust the seat. And also some of the providers have actually gone and have a chair that's adaptable from the stage where you can attach a tray, remove the tray, and then actually use the same chair at the dinner table. And I think that's really lovely because your chair grows with your child and from a social point as well, I think it means that your child is with you at the table. And then once they don't need the tray anymore, they can just push their chair to the table and you can adjust the Heights. And I would urge you to check those out,and any good nursery store or most stores, you can find them. Yes. I don't want to be flogging any particular ones.

Amy: I was gonna say you stereotype OT's. that you are talking about chairs straight away.

Angela: Well, I was just thinking about, so how long should we expect little ones to sit for right? And then if they can't sit for very long, how do we, how do we extend that? Or how do we prepare them for sitting?

Amy: But do you want to pick up on that one?

Emma: Yeah, well, actually in - really brings a lot to me cause I get this an awful lot and people say, you know, I sort of say, you know, does your child have difficulty sitting? You know, how long could they sit for? And it's very much the thing I get told a lot about eating and especially restaurants and going out, which is a whole other thing, isn't it doing it outside the home is, is the use of tablets and devices. And that seems to be something I hear an awful lot that yes, they can set as long as they've got a tablet or a device to keep them still. So I was just wondering what people's thoughts were about that really in terms of, how that impacts on the whole, mealtime experience. I don't know what your thoughts are there?

Amy: So I'm very much torn. So in one way, I'm absolutely whatever works, works. So no judgment, if it works and the child is getting the calories, they need to grow and survive, go for it. On the other hand, it's something which might be short-term successful, long-term unhelpful. So short-term successful, but long-term, you're missing all of those cues around how to manage your body, how to manage the chew, manage the swallow. And often we learn those things by watching other people. I know it sounds pretty disgusting, but watching other people, chew and swallow is how we learn to chew and swallow.

So being part of eating with other people and watching other people eat is how we learn, how we're going to manage spaghetti, how are we going to manage banana in our mouths. We learn by watching other people, by eating with other people, how to manage to eat, how to pick up rice and curry together and move it to your mouth. How to use bread, to scoop a bowl. We learn those things by being part of a mealtime where adults or those around us are doing those things as a model.

Angela: And if the function of the iPad is to kind of keep kids sitting for longer than I'd be thinking about what can I do to kind of prep them before meal time, you know? And I think that's where our knowledge of some of our sensory systems in terms of providing some, a little boost of movement or a little bit of heavy work, which is, you know, where kids are using their muscles, through jumping on a trampet or doing some little yoga poses or animal walks or pushing against their parent's hands to create, you know, resistance. It's these types of activities, a little burst of that prior to meal time can actually then support sitting for longer.

Lelanie: The other thing I want to add, Angela, I agree with everything you said is I've actually seen where children can sit longer than with the iPad or any other tablet, but then they're so distracted by the visual material that they're sitting, but they're not eating. I've seen that too.

Angela: Or they slide off their chair.

Amy: Yeah. I think as well that, you know, when we, when we talk about, you know, what's helpful for two year olds, one of the biggest helps for two year olds is predictability. So understanding what's going to happen. And that's what happens, gives you the safety, the security to be able to experiment and explore. So one of the things around meal times is, the more cues you can have about what is going to be happening, the more helpful it is. So eating at the same time, every day, eating in similar places every day, using the same kind of stuff on the table every day. But that can also be, or if, you know, if you do it at a table, I know some families, you know, the, culturally tradition is they eat together on the floor, but again, so the tradition is the same every time.

And so if you can find things that your two year old can have a meaningful role in that sequence, a meaningful part of the steps that are going to bring you to mealtime so much the better. So could it be that your two year old will be pushing the chairs, you know, out from the table or something like that as part of their heavy work?

Angela: Yeah, that's a great idea, integrating it into the routine, rather than thinking about doing something extra.

Amy: You know, not many of us would, would kind of necessarily trust a two year old to carry a bowl of spaghetti to the table, but with support they can take a part. I can tell you, well, I can tell you a tip, a magical tip for helping with two year olds being able to keep stuff, not spill, it doesn't mean they won't spill. Let me tell you a speech therapy secret. So at two, you're really good at processing the big, important words, and it just takes you a beat longer to process some of the other words. So when you say to somebody don't spill it, what your brain hears is SPILL don't. When you say don't drop it, DROP don't. So if you say it as, keep it in the cup, keep it on the plate. Walk slowly. It's more likely that that would give them an a cue help them manage it a little bit better.

Angela: Reinforcing the thing that we want them to do. Right? Yeah. That's great.

Lelanie: Absolutely. Besides the posture and the carrying things around, there's also the issue about different textures and food isn't there? Because it's natural for children to you know, we try and give them a variety of food and their diets, but this is also the age where they say, oh, yeah, I've got control over mum now, if I don't want to eat this, I won't, and it's a fun age to throw things around, spill things, and you know, just exploring with different textures and it's for a two year old, you know, a nice bowl of greens or something goey might you know, they could see a different use for it, like rubbing it over the table.

So, it's the tip, Angela? What is your tip for actually dealing with the texture issues and sitting, and, you know?

Angela: I'm cringing a bit because like I can only tolerate a certain amount of mess and then I'm just like, ah, clean it up. And I'm sure this is the experience of many parents too. But I think, you know, there is this idea of food as play. And so, you know, children may be able to get some of that exploration, messy stuff kind of met outside of meal times. So I'd be encouraging, you know, exploration of, of messy play and, and food picnics, you know, outside of the main meal time, as a way of trying to maybe satisfy some of that need, if that's what the child is seeking, you know, if that's what they're craving, So that's one thing I'd be kind of thinking about.

Amy: Emma, what do you think?

Emma: It's really difficult, isn't it? Because so many things could be going on for that child, you know, it may be the child just isn't hungry, or they don't like that food, or there's other issues in terms of, you know, what's happening in terms of the family. I think in terms of just picking up from what Angela said, I think that there's balance, isn't it it's about balance. And I think if we, as parents are really aware that we are, struggle with mess, then I think that's something that maybe we need to look at a little bit as well, because actually it's normal to make a bit of a mass and it's okay. You know, unfortunately I have seen it lately where children haven't been given those experiences for mess, you know, whether that's at meal time or outside of meal times, and they then don't develop because in the same way, because they haven't had those experiences with different textures and things. So, you know, we often talk about being aware of our own needs as parents and therapists. I think that is an area to just be a little bit conscious about if we do struggle with mess because it will impact how our children are. But yeah, I think, you know, it's just a time for exploration, isn't it? And I think one of the key points that you said Amy, was this whole thing about learning through watching, and copying. And that really takes us back to what have we done previously with children and their meal times and things, because if we suddenly throw children into how to sit as a family, then they're going to struggle more than if they've watched that as they've grown up and they've seen that happening, haven't they? So it needs to be normalized, doesn't it? You know, it is normal. We eat, you know, we do it in different ways and it does need to be normalized to something that we do. So...

Lelanie: Absolutely. And the other thing that is really interesting for me, its a different approach to feeding. So we're not talking about this in this podcast, but there is the whole child-led weaning versus, you know, what you're giving your child's food. And that, you know, that's a different debate for a different time, but if you're going down the child-led weaning route, I think those examples is really important because how are you going to know what to eat if you don't watch anyone else eating?

Amy: I think there's that piece there that we've started to explore around, you know, sort of cultural differences and, and sort of slightly needing different skills for different ways of eating. So, Emma, you mentioned as something that we haven't really talked about here is that when you're eating outside of the home, so sort of what you eat in your kitchen is different than what you eat at Grandma's house. And perhaps the expectations for table manners are different at Grandma's house than they are at your house. But also when you eat out at a burger restaurant or you eat out at a birthday party, or you eat out at a different kind of restaurant or a celebration meal, those challenges, it's huge.

Emma: And those children that go to the nursery and things like that, parents often report that their children will eat things at nursery that they won't eat at home and things like that, or they do things in a different way. And I think that could be quite difficult for parents to understand sometimes.

Amy: That's about that cueing, isn't it? You know, the expectations of what will happen in one location don't necessarily match the cues of what will happen at another location. I'm wedded now to this idea of Grandma's view of table manners, it's certainly been an issue, I'm sorry mum, it's certainly been an issue in my family. So, what advice would you give people where they might, parents who might be encountering that sense of, other family members having very firm ideas about how two year olds should eat and what it should look like?

Emma: You're asking me that Amy crikey. I think I'm a little bit with you and it depends on what the situation is. It depends on whether we've got a child that happily eats most of the time, because if your child's happily eating most of the time, if they're struggling with one particular meal time or they don't want to eat at one particular time, that's not a big deal, is it. But if we're dealing with a child who really struggles to eat and we're becoming quite anxious as parents, that we need to make sure they're getting the right nutrients and the calories. It's a very different situation. Isn't it? So yeah, I think it's, it's about, it's about balance. Isn't it of expectations. We can put extra demands on children short-term but I think we need to be careful about what we do generally as well. Then the last thing we ever want to do is make something an issue when it doesn't need to be an issue. And I'm a bit more of a relaxed kind of parenting person, things have never been too, you know, I I'll let things go quite easily, but then again, I haven't had major issues to deal with. So that's coming from quite a secluded kind of perspective. But yeah. Yes, I think we've all been there where we've got different expectations at different times.

Amy: But one of the things that definitely, when I tell parents, they're sort of slightly surprised to learn that actually, you know, they, they get worried about how much food their child is eating and you don't actually need a massive amount of food, every meal. So kind of what would constitute a good amount of food would be the amount of food you can hold in your two hands. So beyond that, You know, that's, you know, how great, but you don't have to scoff down everything on your plate in order to have enough food to grow and develop. And then the second piece is that, you know, your, your need for different nutrients, different vitamins, different kinds of foods, they happen across a day and across a week. It's not that you have to have in every meal, every different kind of food, every different kind of vitamin, every kind of nutrient. So it can be more, you know, relaxed. The other piece as well, that when we're working with kids who have difficulties tolerating, a large range of foods for sensory reasons, we talk a lot about unhooking from those traditional notions of what you're allowed to eat at any time. So there's no reason why you only have to have toast at breakfast, there's no reason why toast can't be a dinner food. There's no reason why spaghetti bolognaise can't be a breakfast food, if that's what your child will eat. And it's a way to give them the calories that they need to grow and develop.

Lelanie: That's so true Amy, one of the things I remember before the pandemic was I was traveling to Hong Kong and I was amazed that they were serving noodles and prawns for breakfast. Yeah, never thought about it, but actually in different cultures, people can be as well, eating different things at different times, but that was a real opener for me in terms of my stereotype, what breakfast should look like. The other thing that I wanted to add to what you were saying was, is we also have to remember, we don't eat everything. So if a child eats a good selection of fruit, but hates pineapples or hates bananas, but eats a lot of other foods, I think that's okay. I think I've seen a lot of frustration from people that I know are like, oh, he won't be spinach or she won't eat butternut squash, but actually if you're eating other fruits or vegetables or other food with the same nutrients, I think that's okay as well. It could be a reason, it could be the colour or it could be the taste, it could be anything. But if, if the child's eating well, generally I wouldn't, yeah, not to be too worried right now.

Amy: Yeah, I would agree. And I think there's that sense of,almost kind of, it doesn't matter if they're not eating a lot of different kinds of fruit, one kind of fruit or vegetable will do. Though, you know, people get very worried that their children only eat a very small range of foods, but actually when you start to make a list of actually what they will eat, even if they only need it, sometimes it's often wider than you think. And as long as there is something there that is a good source of carbohydrates, a good source of protein, some vitamins and minerals, some vegetables, even if it's, you know, one kind of vegetable in one way, that's fine. That's fine to get going. Okay.

Lelanie: Absolutely. Thank you so much for joining us on Sensory Chat today, we look forward to you joining us on future sessions and we'll carry on talking about toddlers and sensory challenges in life. Thank you.

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