Behavioral Problems in a Child with a Feeding & Swallowing Disorder

We have a child that was diagnosed with pediatric feeding problems. His behavior is very difficult at feeding time. Is there anything we can do to help him?

Having a child with feeding and swallowing disorders can feel like a tornado hit. There is constant chaos and you may feel overwhelmed and exhausted. Your child is “strong willed” which makes behavioral management even more challenging. Ensuring that you are handling situations appropriately and not accidently reinforcing negative behaviors is vitally important to survival. This educational paper will help empower parents to maintain appropriate structure and control to ensure progress towards happy healthy family mealtimes.

Consistency. All family members and caregivers must be consistent. If even one family member or caregiver does not follow the feeding program, gives in, doesn’t follow guidelines set by your therapist or doesn’t agree on behavior management, your child will be given conflicting messages and your efforts will fail. Consistency is vital to the success of any program especially feeding. Success requires that all family members and caregivers must be on the same page with regards to feeding behavioral management and discipline.

Behavior management is the actions or reactions of a person in response to external or internal stimuli. In feeding therapy, we are manipulating stimuli to enable positive reactions (tolerance of a variety of food tastes and textures) and actions (oral sensori-motor feeding skills) as we progress towards the child’s feeding goals.

Discipline is training. Training is the tool that produces a specific pattern of behavior. Our job as parents is to train the patterns of behavior that will enable safe healthy feeding skills. This includes not only the therapeutic activities your therapist designs specifically for your child, but also by only reinforcing positive patterns of behavior. Training healthy feeding behaviors is very similar to the techniques for training any other type of behavior. Positive discipline works most effectively in reinforcing and training successful patterns of behavior.

Only reinforce positive behaviors. Children want attention. They are constantly seeking attention and would rather have negative attention than none at all. Make sure that you are reinforcing only positive behaviors. If you offer your child something and they choose not to accept it and then throw a temper tantrum that you give in to, you have taught them that the way to show disproval and to get what they want is to have a temper tantrum. By giving in, you have taught them to throw a temper tantrum in order to get what they want. They have the time and energy to have that temper tantrum. You don’t. That is often why you give in. Unfortunately, if you give in, you have just reinforced a behavior (temper tantrum) and taught them that is how to get what they want.

Give them choices: Everyone including all children regardless of age like to be in charge. By providing choices, you allow them to have control and independence. Manipulating the choices (only ones that you approve of and provide for them) creates a win win situation. Don’t ever give your child the opportunity to choose something that they can’t have or give them the choice to say no. Good choice making makes a child feel proud. Teaching good choice making skills empowers children to make appropriate food choices. That is one of our goals as parents.

What if they choose not to choose? What if you offer your child a choice of two food items that are acceptable to you and appropriate for your child (discuss with your therapist to make sure) and they don’t want either? First give them the choice of either “you choose or I choose which one”. If they still don’t choose, you need to figure out what went wrong. First of all, make sure that the choices will enable success. Don’t offer two foods that your child hates or is too new and then become upset that they didn’t make a choice. If the choices are reasonable and they don’t choose, remove the choices and the attention and try again in a few minutes. Now, if you have given two choices and the one they really want but can’t have is sitting within sight that is not fair. You will lose every time. If junk food is not a choice, do not have it in the house (or anywhere in sight). If your child has a temper tantrum, just ignore the behavior (as you would if they want a toy they can’t have while you are shopping). Be very careful not to reinforce this negative behavior or it will escalate. Do NOT give in. Allow the child to calm down and offer again. If they refuse, they are finished. End of story. You can try to offer choices in 30 minutes to an hour. Carefully manipulating the choices will give you the edge and your child a win. This strategy should be discussed thoroughly with your therapist before trying on your own.

Ignore inappropriate behaviors by pretending that the behavior is not occurring. To ignore the unacceptable behavior (temper tantrum); do not look at, talk to, respond to or acknowledge the child in any way until your child discontinues the inappropriate behavior. Expect that the behaviors that you are trying to extinguish will intensify before they decrease so stay strong and be consistent. Expect that ignoring the undesired behaviors will be difficult. The second that you are not consistent and give in is the exact moment that you reinforce the behavior. If other caregivers and family members allow the behaviors, your success is significantly jeopardized. Give your child a lot of attention once the unacceptable behavior stops.

Power struggles occur when there is a battle over control. Power struggles result in resistance and defiance. It takes two to engage in a power struggle. You can choose to engage or not to engage. When you choose not to engage in a power struggle, you take all of the power. The more you engage in a power struggle the more power you give to your child. The more power they have, the more powerful they think they are, the more defiant they will be come. Engaging in power struggles teaches children that defiance is the way to deal with challenges. Always help your child understand what is expected of them and be consistent about these expectations. Providing choices that delineate expectations that are age and skill appropriate, teach children that they have a choice and have some of the control. Manipulating the situation to reinforce positive behaviors and independence is the best way to avoid a power struggle.

Model the eating behaviors that you want your child to learn. If you don’t eat vegetables, then how can you expect your child to eat vegetables? Like all behaviors, your child learns to be just like you. Show by example the how and what to eat for nutritious choices.

Encourage. Even if your child has had a bad day, speak positively to others about your child’s eating skills when your child is in listening range. Say “Sarah really tried hard in feeding therapy today” or “Sarah is really working hard towards her feeding goals”. Try to encourage and stay positive.