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By Eva Kerschischnik and Dr. Peter J. Scheer, MD
The therapists need to know several things at the start of an LTE-Program.
We ask the parent for an exact description of the motor skills and the behavior of the child with their toys in everyday situations. This is needed to be able to assess what the child can and can’t do. Then we are able to assess whether the child can get to the food itself. This is important, because we know what can expect from the child. The expectations of the parents are sometimes biased by their wishes. On the one hand they compare their child to other children, but on the other hand they know that their child was ill for a long time. All these recollections and memories influence their perceptions. Psychoanalysts even hypothesize that the inner pictures or representations of the child have a strong influence on the perceptions of the child. You could say: I don’t see my child, rather I see the child the way “I” see it. To overcome the subjective perception that can sometimes occur, we perform a detailed investigation with the parents. Parents shouldn’t believe that we do not believe them. In fact, the opposite is true and we take every observation that the parents make very seriously. They help us to understand the child’s abilities.
When a child lacks certain motor functions, for example sitting or walking, then it may be that the child also lacks oral motor functions. This is because motor functions usually develop simultaneously. When a child cannot sit or stand up alone, then they often have no idea what they should do with food. This is called “motor planning“. When a child only has partial or no motor planning, they are dependent on the plans of their care-providers. As this person is often willing to help the child, they may not see the child’s weaknesses, simply because they are used to them. That is why it is important for us to assess what the child can do by itself and where they need help. This knowledge and the child’s development are of particular importance: when a child shows very little motor development then it may be that the child does not know how to handle food. Transitions, like from sitting to standing alone, are a critical factor in motor development. They show if a person can plan their next action.
Within the context of the child’s history and their capabilities, we ask the parents for descriptions of the feeding situation. Which rules do the parents have about eating: does the child have to eat healthily? Must the child sit at the table? Who has which problems? Does the child eat better or differently when specific individuals (like in day-care, or when a babysitter feeds the child) are present? Does the child want to sit at the table? Are meals taken together at home every day or only on weekends? Who in the family likes to eat? Who is a role model for the child? Does the child always eat together with the same caretaker? Are good manners important during meals or may the child behave as it pleases? Is the child praised when eating? These questions serve to identify the problem and at the same time, to also create an awareness for parents of the possible underlying problems. Answering these questions are already the start of the therapy.
When a child receives therapy (speech and language (speech-pathology) therapy, ergotherapy, physiotherapy, and/or other complementary therapies), we want to know the reasons why and what is done during these therapies? We like to know all the details. Evidentially the therapies influence the process of learning to eat. It may be that our staff would like to comment on a specific therapy: they say what could or should be done with your child in order to learn to eat. Sometimes we propose that therapies are paused, simply to give the child the possibility to concentrate on eating and dealing with the challenges associated with it.
During this second stage we start building up trust with parents. Afterwards it’s about learning what the three most important goals are for parents and to agree with them on goals. This could be changing the eating situation, the quality or quantity of food,learning to chew and swallow, or the consistency of food. Now we will work towards the first goal, whereby we take the easiest one first, in order to achieve a first change. We would like to experience a first success together. Later on we work on the other goals. It may be that new goals appear during the process, or that some goals have to be redefined. It may also be that the parents voice their worries and distress, uncertainties, or unhappiness with the child’s eating. We take all these concerns into account and use them to redefine the goals and the underlying process. The Learn to Eat program is sold on a monthly basis. Parents themselves choose if and how long they need our help. The idea is that the parents and children reach their goals themselves, we support and accompany. Nobody knows beforehand which path the child will take or what is “right”. Together with the family, we find the right way for the child.
New questions continually arise: does the child suffer from an Autistic Spectrum Disorder (ASD)? Does the child suffer from a sensory perception disorder? These concerns may help us to understand certain behaviors. Thus we can target our counselling even better to your child. For example, we will ask if your child can pick grass, or if they play with sand. Children with a sensory perception disorder do this differently than other children. Indications of an ASD might be that the child always wants the same things, additionally it may be resistant to changes.
Sometimes when the parent complains that the child won’t sit still for longer than 3 minutes, it is because the child can’t sit. We are often just as surprised as the parents by this observation.
Goals can always be changed. This depends on the interaction with us, the child’s development and on the observations that the parents share with us. Subsequently goals may be changed accordingly and new goals are defined.
Changes evolve around all kinds of things, it could be the consistency of food, or its taste. We never propose more than one change at a time. Sometimes more calories per meal are added. Often we will work on the child’s behavior, mealtimes, circumstances under which meals takes place, and other things.
On the whole, you could say that our Learn to Eat team is a counselor right in the comfort of your home. We will work on the problems in preparing food, mealtime situations, and find mutual solution. We are starting with the evaluation of your child’s personality and developmental possibilities and focus on what your child is able to do – this is the point where we start from. Daily availability guarantees new and good solutions for you and your child.