Wait…For…It..- Feeding Therapy: The Power of Waiting
By: Melanie Potock, MA, CCC-SLP
As a speech language pathologist who specializes in feeding, one of the most important strategies that I teach to parents and caregivers is the power of waiting. Children need time to organize their thoughts and their bodies before gathering up their courage to interact with a new food. Well-intentioned parents who cheer enthusiastically for their kids in order to “encourage them to do it” are accidently reinforcing NOT eating. If a child isn’t eating, the best thing to do is to give that behavior no attention by simply waiting. Feeding therapists can provide strategies on how to negotiate each step to eating, when to praise, and just as importantly, how to praise. Whether today’s lesson was how to smell steamed broccoli without gagging or how to bite into a crunchy cucumber, each step is celebrated! By waiting for children to take the next step while we provide the framework for success, we instill in them a sense of autonomy and affirm their own feelings of “Wow, I did that on my own!”
Therapists observe parents and/or caregivers rewarding “not eating” with the infamous airplane game at mealtimes. While a flying spoon loaded with applesauce cargo may be thrilling for the eager toddler – you know, the one who loves to have spoons careening into his mouth on the pink landing strip known as a tongue…well, it can backfire with the hesitant eater: “Here comes the airplane…zooom…open up…opennnn uuuuup….open up for the airplane…now it’s flying higher…here it comes!” The more the hesitant eater refuses to open, the more exciting the airshow becomes! Help parents understand that they need to be aware of rewarding their child with attention for not opening up. Think about it: If the child opens up, the air show ends immediately–and what fun is that?
Remember the basic principles of how we develop behaviors. The antecedent is essentially what cues the behavior to occur. The behavior may be desired or undesired. The consequence reinforces or helps fade the behavior. Keep in mind that a consequence can be “no attention or minimal attention”. For example, think of the toddler who stumbles and falls on the way to the park with no other impact but a bit of surprise and a dirty pair of pants. That’s the antecedent: falling. The behavior might be a getting back up and continuing on, or on the other end of the spectrum, crying – loud, piercing wails – it all depends on the particular personality or sensory system of the kiddo who is doing the falling! But, if the consequence after every dramatic sob is his mom rushing to scoop him up, smothering him with kisses and carrying him to the park…well, that consequence reinforces the dramatics and if continued, he will quickly learn the behavior of sobbing after every little fall. What would happen if that parent gave it very little attention except to quietly, pleasantly say, “Ooops. You’re okay”, and just waited for him to stand back up? What would happen is now we have an opportunity to reward the desired behavior: standing up and walking! Once he is back on his feet, the creative parent will reinforce his independence, perhaps by singing “the ants go marching one by one” and thus engaging their child in something fun, like marching off to the park.
The same principles can be applied to learning to eat new foods. First, what is the goal of today’s session? What is the desired behavior? Let’s consider one of my feeding clients, 3 year old Ellie. While working with little Ellie at her preschool, the goal on that day was to eat thick-crust, cheese pizza while seated at a community table with her friends. She had the oral mechanics and a nicely balanced oral sensory system to be capable of this goal and had eaten the same pizza a few times at home – but she became overwhelmed in the presence of her peers. Let me tell you, Ellie could hold that piece of pizza better than any kid I know. She could hold it, and hold it and hold it. Her sweet and caring teachers repeatedly told her “Take a bite…it’s good! You will like it”. She got a lot of attention for not taking a bite. When I held one finger up to my lips to signal them to stop talking at her, they kindly stopped and turned their attention elsewhere. Ellie kept holding that pizza. But, she began to relax. You could see the wheels turning in her adorable head. About every 20 seconds or so, I would comment about pizza to keep her focused on that task at hand. Silly comments – such as “Woah Benjamin! You look like a dinosaur when you eat pizza with those GREAT BIG DINO teeth” About 20 seconds later – “Pizza makes my lips pop – puh – puh – puh- PIZZA! Or – “I like eating with you guys – you’re fun!” As Ellie became more centered and confident, she casually took a small bite. Once she was chewing, I reinforced the desired behavior by turning to her and saying, “You look like a dinosaur too, Ellie! Dinosaurs love pizza!” and she smiled and chewed. I waited. On her own, she took another bite. There is immense power in waiting for a child to take the next step. Even if the step is learning to pick up a pea, be willing to wait, cue only about every 20 to 30 seconds and reward the desired behavior with attention or praise. Try to avoid comments such as “Good job” or “There, you did it!” Zero in on something fun and silly that takes the pressure off the task at hand, such as “Hmmm – did you pick up that pea with your trunk, Mr. Elephant? Or “Did you pick up that pea with your tiara, little princess?” I love it when my little clients giggle at silly sentences about food. They are proud of themselves! They did it on their own!
Try rewarding each step of eating with positive comments, such as:
- “Wow, that rolly-poly Brussels sprout almost fell off your spoon, but you made it land on the plate! Good balancing!” This would be appropriate for a child who won’t touch the Brussels sprouts, but you suggested he spoon one out of the serving bowl and onto his plate.
- “You can roll those peas across your tray…zoom!” Touching peas leads to picking up peas, which leads to smelling peas, kissing peas, licking peas, and eventually, eating peas.
- “You are a master cruncher! That was loud!” This therapy session may be only focusing on crunching crackers between two fingers until she is ready to crunch a cracker with her teeth.
- “My roll smell yummy just like Grandma’s house…what does your roll smell like?” That’s the perfect amount of attention for a child who decides to finally pick up a roll and give it a whiff.
- “That orange slice looked like a big happy smile when you bit into it!”
- “Hey, where did that asparagus go? In your happy tummy? You’re the best at asparagus!”
When we keep each step positive and praise our clients for trying, they see themselves as “good eaters” and have the confidence to try again. One of the best phrases I learned from a fantastic mom was “You are such a big-girl eater!” I love that phrase, because you can use it for every stage of learning about food. “You are such a big-girl rolly-poly Brussels sprout spoon balancer!” Kids love silly sentences like that!
With a new family in therapy, one of the first things we discuss is waiting. I tell parents that “It will look like I am doing nothing, or, that your child is doing nothing. But, it’s purposeful. I’m quietly waiting for your little one to do what I am cuing her to do. Watch – you will be so proud of her!” Set them up for success and wait – then praise. It’s one of my favorite tricks and works like magic.
Questions for Discussion
- How can we apply the concept of waiting to helping children learn to talk?
- Why do parents have trouble waiting? Provide some scenarios that would demonstrate the benefit of waiting for a desired behavior that you might discuss with parents.
- What do we need to do as therapists to facilitate success during our feeding therapy sessions?
- Provide a hierarchy of steps to learning to eat green beans if a child has never encountered a green bean in his life.
- If the child in the article had not encountered the pizza at home, what would have been your goal for the preschool setting that day?
- Explain why an eager eater – one who is eager to try a puree – would not be impacted by the airplane game. What is the antecedent in that scenario? What is the behavior? What is the consequence that is reinforcing the behavior?
This Months Featured Author:Melanie Potock, MA, CCC-SLP
Melanie Potock, MA, CCC-SLP is the author of Happy Mealtimes with Happy Kids: How to Teach Your Child About the Joy of Food! With over 12 years’ experience treating children with feeding difficulties, Mel’s approach to developing feeding skills includes the fundamentals of parenting in the kitchen, such as how to avoid mealtime debates and creating more joyful mealtimes, even with a picky eater. Mel wrote this book in the same manner that she works with families; with an open heart and a touch of humor. She has also produced the popular children’s CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food. Both products are available on her website at www.mymunchbug.com, on Amazon.com and in the Mayer-Johnson catalogue.
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