On this week’s episode of Tube to Table, Jennifer and Heidi discuss how tricks and treats are used to encourage children to eat or make progress in therapy and why this is detrimental to their relationship with food. This can happen at a family mealtime as well as during structured feeding therapy. Throughout this episode, Jennifer and Heidi will talk through both situations and the length people and therapists will go to “get” their child to eat with tricks or how they use treats to encourage eating.

“What does this therapy look like?” “How do I know if I’m “tricking” my child?” This episode focuses on what behavioral therapy looks like, why it can erode your child’s relationship with food, and what you can do instead. There are basic fundamental reasons why behavioral strategies should not be used to help a child eat, especially those who are tube-fed. If a child is getting a reward for a behavior (praise, toys, shows, etc.), it is behavioral in nature. If a child is getting an external reinforcement for a behavior that should be natural, it is impacting their ability to listen to their own body and learn to self-regulate.  

You can download this episode from Itunes, Stitcher, Spotify, Google Play, or listen to it below:

What are the “tricks”? 

When the overall goal is to build a child’s trust with food, help them understand their bodies, and feel comfortable and safe with the people feeding them, tricks erode that trust very quickly. Any person who has ever been at a table with a child has been tempted to do this, and often parents ask, “What can go wrong?” “How does this interfere with weaning?” 

The most extreme version of “tricking” a child is where someone is distracting them with a toy, song, etc. While sneaking something into their mouth. This could look like a child opening their mouth to sing a happy song, and the food is quickly placed inside that open mouth. This can also look like sneaking food onto a spoon and while your child plays with one spoon, quickly scraping the spoon in their mouth. Every time you trick a child, you are eroding their trust and attempt to build a positive relationship with food. This is especially important for children who ALREADY have a compromised relationship with food.  

What are the “treats”? 

Negotiations with your child such as “If you eat 5 bites then we can watch Elmo”, is teaching your child to eat for an external reason. This type of approach is often used in behavioral therapy where a child takes a bite of food and gets a “treat”, whether that treat is a show, screen time, or loud clapping and celebration, it is teaching the child to eat for an EXTERNAL reward rather than in internal reason.  

Most of the time, children who are in this type of therapy, do not have a positive relationship with food. This means that we are asking children to do something that they do not like doing, for a reason other than listening to their own body. All the celebration, screen time, and negotiations are all different types of “behavioral strategies” that are being used to help a child do something that should be internally driven.  

So what should it look like instead? 

There are fundamental reasons why we do not want to use behavioral strategies to help a child eat. There are natural drives for children to eat including hunger, enjoyment, curiosity, and togetherness. Our previous episodes have discussed these internal drives in more detail. IF we are asking a child to do something for external reasons, then it makes it difficult to discover the internal drives on their own.  

For most tube-fed kids, they are unable to respond to the internal drives of hunger because the nutritional needs are met by the tube. Therefore, they generally do not have an understanding of what food is or have a positive relationship with mealtimes. Hunger is important, but as we have discussed in previous episodes, it is not enough by itself.  

When a child is tricked around food or “forced” to eat through tricks, the trust is broken between the feeder and the child. This impacts their experience around food if they are learning one food that is orange, then you sneak another orange food in there, it can quickly ruin their trust to try something new. By using external rewards or negotiations, children learn that if they DON’T eat then it’s not “good enough” or they didn’t “deserve” that.  As adults, we know that there are natural rewards for most things we do in life, or we wouldn’t keep doing it. The issue is that these rewards need to be natural, or else the reward wears off. 

Make small changes that feel doable for you, you don’t want to try to do everything all at once, especially if you don’t know what else to do. You never want to reward child for eating, if you praise for eating, don’t praise amount or the fact that they put it in their mouth. It is important to praise the effort rather than the outcome. When a child does something really hard, you want to acknowledge it a little but in an appropriate way.  

What about attachment? 

Feeding a child is a crucial part of the parent-child attachment and this attachment starts immediately when a child is born. Parents of children who have been on feeding tubes since birth have shared that it has been difficult to find attachment in other ways when that feeding is disrupted. If attachment is already a concern, why are we engaging in tricks or treats that risk hurting that relationship even more? Attachment is an indicator for wellness later in life, and when that attachment is marked by a lack of trust of negativity, it has the potential to affect attachment outside of mealtimes.  

It is important to remember that children with feeding difficulties or feeding tubes do not have problems INSTEAD of normal childhood, they have these difficulties in ADDITION to normal childhood. All the research and data that applies to all children, also applies to children with feeding tubes. Therefore, it is necessary to keep in mind how attachment for all children is affected through mealtimes.  

What about all the “noise?” 

There is so much in our culture currently about the right way to eat, certain diets to follow, or what children should be eating. This noise is seen both in families and society as well as in the media. Have you ever heard of the “clean plate club”? This involves clearing your plate completely in order to play. It is okay to have certain limits and boundaries at mealtimes, that is important, but make sure your child is always able to listen to their own body. We are all humans, and therefore subject to noise around food, but keep in mind when you or a therapist are working with your child.  

Is what you are doing helping them learn about their body and build a positive relationship and trust with food? If so, keep doing it. Is what you are doing causing them to be fearful of food or getting in the way of their own body’s signals? It is time to stop. 

In the media, we have seen commercials encouraging parents to trick their child into eating something or negotiating to eat 1 french fry for 5 pieces of broccoli. Ad campaigns like these are monetizing food in a way that is extremely problematic. 

A few last tips: 

• Don’t let your child be fed while you are out of the room, this can add to anxiety.  It is ok if a therapist is doing it to show you, but you want to be in room. 
• It can feel scary to let go of some of these things, but this doesn’t mean there can’t be boundaries or limits at mealtimes. There is still a time or place to work on mealtime manners and behaviors, but NOT at the cost of trust. 
• Trust comes first, the skills come later. 
• It’s hard to wait and take a step back, but it really is what tends to make the difference 
• If you need to take a break, it’s okay! 

Next episode we are going to talk with Brianna, a feeding therapist at Thrive, about the time and place for more structure around feeding, there are some kids that time and space isn’t enough for. Where is that line and who needs this structure? Stay tuned!