Facilitating Child Feeding as a Neurodevelopmental Skill and a Relational and Responsive Process

To facilitate child feeding through the relational and responsive process:

• nurture the primary caregivers’ role as the most important co-regulators for their infant
• promote both recognition and prompt response to the child’s signs of hunger and satiety in emotionally supportive, and developmentally appropriate ways (Black & Aboud, 2011)
• provide feeding guidance that supports the caregiver’s ability to read the child’s cues in order to make the eating or feeding opportunity manageable, enjoyable, and successful, while retaining developmentally appropriate structure and expectations (Rowell & McGlothlin, 2015)
• intervene to prevent distress, physiological instability and disengagement of the child
• encourage parents to provide positive experiences around the mouth as tolerated by the child, e.g. sustained touch, kisses, toys, hands 
• respond to sensory preferences, pace, and temperament

Collaborative goal setting between child, parent and healthcare providers enables a shared understanding of child and parent goals, interventions, and feeding progression. Progression is dependent on skill development. It may take time for skills to develop, so it is important to celebrate achievements as they occur. 

Children with PFD, including those with sensory preferences, may find changes to food textures, temperature, taste, and mealtimes a source of discomfort and distress (Evans Morris & Dunn Klein, 2000). It is important to assist the child to explore at a level that is comfortable and safe for them. Small steps need to be taken to assist a child’s transition through the new texture experience. Gradual changes to texture, e.g. thickness, lumpiness, and grainy properties of food in small amounts, may be necessary for children who have sensory aversions or strong preferences.

Alternatively, if the child has no difficulty at their current level with their oral skills, they may be eating ‘easy’ foods that are not challenging enough for them. They may stay at a certain developmental level longer than is clinically required. This decreases the child’s ability to develop new oral sensorimotor function.