Exposure and practice with foods and feeding
Feeding difficulties in infancy can mean being fussy or difficult to feed eg. pushing food away or clamping the mouth shut! It may also mean refusal to eat solids or over reliance on milk feeding – whether at the breast or the bottle. Sometimes it means only eating a few mouthfuls, with feeling full up very early. For some children this means a compete refusal to eat specific foods and not others. Food refusal may also have become a battleground within the family. Forcing a child to take milk or solids is never a good idea. For sensitive infants, force feeding will often cause feeding or bottle aversion. This may take some time to work through. Feeding your child may be one of the most difficult things for you, and food refusal is frequently an emotional trigger. So, it is a worry, and not least because infants are growing so quickly and need lots of nutrition. Infants often don’t eat well when over-tired, distressed or unwell. Over-hungry infants can also get stressed and refuse to eat, preferring the comfort and ease of milk. However, it does becomes important to address, when food refusal is ongoing or chronic and feeding times have become a battleground. Importantly if weight gain slows or growth faltering is present. Limited practice or experience in eating solid foods impacts the early learning of physical feeding skills, those which help infants to eat, accept and enjoy a wide range of foods and textures. The time of greatest impact of feeding difficulties is during the “sensitive window” at 6-12 months – the time when infants are primed and ready to learn how to eat. Infants are more likely to experince growth faltering and nutrient deficiencies eg. iron deficiency anaemia at this age, due to the especially high needs for calories and nutrients during late infancy.
Repeated illness during the first year
Feeding difficulties in infancy are most often linked to viral illness, eg. episodes of prolonged or severe vomiting bugs like rotavirus, bronchiolitis or other respiratory infections, when breathing and eating together are difficult. Conditions such as painful reflux or cow’s milk allergy can limit the desire to eat; infants learning very quickly when eating is followed by pain or unpleasant body sensations. For infants who have been repeatedly unwell or hospitalised during this sensitive window, solid feeding may have been difficult to establish. There are many factors that can impact on an infants willingness to eat solids, and those infants who have been difficult to feed from birth are often those most sensitive. Very often feeding skills may need to be re-established and so returning to an earlier step in the weaning process is needed: A few immediate tips:
- Reassurance is helpful – either directly or by seeing other family members eating is helpful in itself
- Continuing to expose infants – the sights, smells and observations of other family members eating, without pressure to eat, is a good way to maintain sensory stimulus
- Gentle and consistent encouragement, without pressure
- Try not to stress over this – you will already know how super-smart infants are and how they pick up on those “invisible” cues
- Relax with familiar songs, games, smiles, praise and lightness
- Keep to a routine of mealtimes; this helps to reset expectations, stimulate the hunger hormone ghrelin, and maintains regular exposure to foods and eating
Growth Faltering and Nutrient deficiencies
The first nutritional need for all infants is sufficient calories (energy); 3 times the amount of an average adult woman. Addressing any growth faltering at the earliest point is helpful to support early brain and cognitive development as well as growth going into childhood. An infant feeding assessment is the first step in identifying how your child’s particular feeding difficulties have arisen, before addressing how best to support the (re)learning of key feeding-skills and meeting needs for energy and nutrients.