Weaning and Whining: What to Expect from a Weaning Toddler

Weaning is a long, hard, and exciting journey for everyone, but is possibly truest for families working to wean their toddlers: children gaining newfound independence in all ways, but especially with food. This independence likely comes with behaviors such as refusal, pickiness, short attention spans at the table, tantrums for no apparent reason, and possible plate throwing. They may like a specific food one week and claim to hate it the next week. And as frustrating as this news might be, it’s important to remember that all of these are expected behaviors: they are toddlers, “terribly two”, testing boundaries, and as they wean, food is now something they can exert control over.

So often, caregivers ask us about what they might expect from their weaning toddler, and to answer this, we are best served by mirroring the eating progression of typically eating infants.

By the time a typical eating toddler is about 2 years old, we expect them to safely and efficiently manage all textures, tastes, and complexities of foods. In other words, they are eating meals that are similar to what their adult counterparts are. Most of these toddlers began eating at around 6 months old, starting with purees off a spoon, tastes of mom and dad’s food, teething biscuits, etc. These tastes bring new flavors and help to build foundational skills for solid foods, but of course, there is no pressure for infants to take high volumes of purees because they continue to receive most of their nutrition from formula or breast milk.

Weaning toddlers follow a similar pattern when learning to eat more than breast milk or formula. So, in the beginning stages of a wean, for example, we expect volume to be low, new flavors to be accepted or rejected, and interests to change and expand around food. Similar to an infant, our weaning toddlers are getting the majority of their nutrition from a formula or a blended diet, so we do not expect solid food volumes to be large in the beginning.

Following this learning pattern, many typically eating infants begin to branch off purees around 8-12 months and start to try pieces of soft, fork mashable table foods, and thicker purees such as small pieces of fruit, yogurt, guacamole, mashed banana, etc. Gagging is typical when new sizes and textures are added, but this becomes desensitized as the infant gains more experience with foods. We expect similar behaviors for our weaning toddlers as they begin to explore new textures. Many may gag on new foods, and this physiological response will typically go away with more eating practice.

Between 12 and 24 months typical eating children continue to explore different foods in an adult schedule (three meals and 2-3 snacks) and continue to build the oral motor skills to manage almost all foods. Food becomes primary at this age and a child typically switches from formula or breast milk as their main source of nutrition to a balanced diet of solid food, water, and milk or milk alternatives. And, by 2 to 2.5 years old, a typical eating toddler has had about 18 months to 2 years of experience with food and drinks, every day, multiple times a day.

We can expect this same progression in oral motor development for our weaning toddlers. If a toddler begins weaning at 18 months, for example, we expect their “eating age” and oral motor skills to be closer to a 6-12 month old. Thus, we don’t expect them to wean to foods their peers are eating; rather, we expect them to wean to purees and soft table foods because this is the stage where their skills are most efficient. And as caregivers, we can be at peace, knowing that their oral motor skills will continue to develop as they learn to eat – by eating.

Probably the most important thing to keep in mind is this: Rome wasn’t built in a day. And neither are oral motor skills. In fact, we expect the same amount of time (18 months to 2 years) for oral motor skills to develop to eating all foods for weaning toddlers as we do for infants.

So if you’re working through a wean with your toddler, and finding yourself concerned or curious about how eating skills progress, take heart: while it might take time, happy, trusting and independent eating is within your grasp!

Kathryn Stewart, MS, CF-SLP, Feeding Therapist

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When Your Weaning Kiddo Gets Sick…

Nothing rings worse in a mother’s ear than the distant whimper of her small child. Tiny moans, followed by the little cry of “mama!” is often followed by swiftly running feet and the clinking of the big bowl that hopes to catch the inevitable nastiness projectile-ing from that precious baby.

Stomach bugs, strep, colds, coughs, pneumonia, and flu season – every childhood illness can prove to be quite intense for many families, but perhaps most for those whose children have recently weaned (or are in the process of weaning) from their feeding tubes. So if you fall into that category, and you're navigating the world of sick kids who are mid- or post-wean, we have a few tips that might be helpful. 

1. Keep in mind that it is very common -- if not expected -- for a child's appetite to decrease when sick, so don’t be alarmed if your child whose appetite just picked up suddenly says no to food. When that happens try as best as you can to not let your anxiety get the better of you. Offer foods that are appropriate for the illness, but don't worry if your child doesn't eat much. As you would with any oral child, focus on hydration and offer comfort alongside plenty of rest. 

2. There's no need to rush immediately to tube feeds at the first sign of decreased appetite. This is especially true if your child is already weaned. So, keeping tip number 1 in mind, only consider re-tubing your child if you are seeing signs of dehydration that would lead to hospitalization. Otherwise, trust your child to listen to his or her body and to eat as much or as little.

And no matter where you are in the process of recovering from illness, keep this last tip in mind: restful cuddles are likely the best medicine you can offer, so hand them out in droves! The time together will likely give both of you a lot of relief!

Elisabeth Kraus, MIT, Parent and Family Coordinator

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How to Foster a Safe Eating Dynamic for Your Weaning Child

A safe eating dynamic is one in which no one feels pressured, neither caregivers nor kids. There is room to explore food, to enjoy it, to be heard and respected when you say "no thanks" and when you say "yes, please." In a safe dynamic, your eating is not the focus of people’s attention, and no one is trying to impose any agenda beyond having a relaxed meal.

For tube-fed and weaning kids, the world of food is brand new and everything can feel foreign, needing to be approached with caution -- especially when there has been a history of oral trauma (nausea, vomiting, suctioning, intubation, surgery, unsafe swallow, etc.). Making the feeding experience SAFE is what allows kids to build trust and confidence, and with trust and confidence eating skills can develop and grow! Conversely, when eating does not feel safe, kids go into fight or flight mode, experience stress, and cannot learn about food.

What to do, though, when you are a parent or caregiver and all of that stress and pressure is in your head? When every meal feels like both a chance at progress and a shattered hope? When you have been told there are minimums or foods that "must" be taken? 

In my mind, there are two approaches available for those of us seeking to create joyful, pressure- free, and trusting mealtimes for our kiddos – for those of us who can ignore our children’s eating and for those of us who have a tough time doing so.

I call the first approach"Cheers! We're just hanging out!" If you are able to look at your child as an eating companion, free to make his or her own decisions about eating, you can create mealtimes as a space in your busy day to just be together. Tell stories, sing songs, talk about the meal, how you made it. Describe the smells and tastes that YOU notice. Invite your young person to share in your experience: have them on your lap, offer a lick of food on your fingertip or silverware, have them help with serving, or let them feed you. 

Invitation means that you open the door, but do nothing afterwards. We don’t talk about their food, suggest bites, clap or cheer or use technology to distract from eating. Safety is created by companionship and zero pressure. If your child says "yes" to a food interaction, you assist only to where absolutely needed (handing a food, supporting a cup, etc.). If a child says "no" or is not interested, you react by acknowledging that you understand, it’s no problem, and you continue your own meal.

This environment fosters wonderful relational opportunities – the freedom to talk with and enjoy one another. But for some of us, "not caring" about whether our child eats or drinks is just an impossible task. For that reason, I call Safe Space Option #2, "I'll be over here now, doing my own thing!"

As parents or caregivers, we have all been through traumatic experiences with our kiddos. Or, we have medical team members that are highly numbers focused. We pay a lot of attention to each bite, looking at whether they are swallowing safely. We intervene and help and ask and offer. But all of those behaviors get in the way of a new eater’s sense of trust and control, with the result of typically zero progress or even setbacks. Not to mention, tons of stress!

In these cases, creating a safe feeding dynamic can mean removing ourselves from the mealtime experience. We can become that warm and respectful server at a fancy restaurant: "Madam/sir, here is the chef’s choice for today. If you need anything, simply let us know." And then, we disappear! And it’s just you and the dish. 

The same goes for kids who have a hard time eating around other people, and for adults who have a hard time letting go and ignoring our kiddos: Present the food, give them a kiss, and take yourself somewhere else. Whether that’s the kitchen (because there are always dishes to be done…), or the couch with a cup of coffee or tea. Going away means that your child has been invited to a mealtime, but there is no agenda and no interference. And if you were to take a secret peek at how these children react to being alone, you would find that they typically start to experiment. They will cautiously touch or taste, taking things as slowly as they need to, guided just by their own sense of safety and curiosity.

So whichever method you choose – the "Cheers!" or the "See ya later!" – we hope that mealtimes become warm and safe spaces for your whole family!

Olga Owens, JD, Lead Parent Coach

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Food Families: How to Connect Preferred Foods to New Ones

There is little that is more frustrating than when your child only accepts 5-6 foods – especially when most of those foods don’t contain enough nutrition to function as pillars of a caloric, nutrient-dense diet. But there are ways to help your child to expand his or her repertoire, and one way to do that is to identify foods that are related to the preferred food, and to offer them together. This mimics taste testing, and provides your child with opportunities to explore and sample new things in a pressure-free way.

Let’s say, for example, that your child loves French fries (who doesn’t, right?)! One way to use this love of fries to move beyond that food item is to think of other foods that are “related to” or “in the same family” as French fries, and to offer the preferred food alongside the relative food.

There are closely related “sibling” foods, like baked fries, homemade fries, or larger/smaller fries (shoestring vs. steak). Or perhaps you might offer a more “distant relative” like a seasoned fry, curly fry or a sweet potato fry. Then, you might think about visiting with some of the fry’s “second cousins,” “nieces,” or “nephews” – things like tater tots, hash browns, roasted potatoes, or mashed potatoes.

Another progression example could relate to mac n cheese! Perhaps you may want to move from Kraft, to Velveeta, to homemade, to Alfredo, to elbow pasta with tomato sauce, to spaghetti and so on and so forth. As you progress, take the time to provide lots of education about the food item as you are presenting it: “Look how they are all elbow noodles!” “Noodles feel like ‘this’ when you put them in your hand.” etc.

With the exposure to each member of the family, close or distant, your child has the chance to explore and try a food item that feels safely connected to what he or she already enjoys. So offer these relatives with no pressure to accept – truly, that is the key!

Becky Keifer, MA, CCC-SLP, Lead Feeding Therapist

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Staging Your Meal

Mealtime staging is an intentional method of food presentation that takes into account 1)
nutrition, 2) efficiency, and 3) skill development in order to optimize each meal to meet the needs of the child in that moment. So, as we wean, we pay good attention to a child’s eating age (calculated based on the time the child became an oral eater), while remembering that oral motor skills develop over time: kids learn to eat by eating. This means that most newly weaning
toddlers, for example, will be most skilled with purees, wet casseroles/ground textures, and fork mashable soft foods.

When presenting a meal for a kiddo, it’s important to present foods with the most nutrition at the easiest skill-level first. For some kids, that means that we start every meal with yogurt, pudding, mashed potatoes, hummus, guacamole, or some other food that offers the most calories, while requiring the least amount of skill. If the child is willing to be fed, we feed them, and if not, we offer loaded spoons or self-feeding opportunities.

The second part of the meal is when we’d offer the next level of nutrition at the next level of skill difficulty. This is where you might bring out soft-chopped foods like cooked veggies, grated cheese, soft pastas, canned or crock-potted meats, hash browns, etc. – all good calories, but requiring the child to use slightly more advanced skills. Then, the third part of the meal would include strips: toast, french-fry- size soft items that not only require chewing, but biting as well. These foods require the next level of skill advancement. These 3 stages can be offered separately (one, and then the other), or they can overlap (putting soft food on the tray while feeding purees, for example).

In this way, your child gets “the biggest bang for her buck” out of what you offer first. Then, at
stage two, your child might get a minimum to moderate amount, and at the final stage, your child gets to focus on skill development, with no pressure to consume more calories (because she got those good nutrients at the beginning).

Now here, I want to highlight the minimal place for crunchy or meltable crunchy food items.
These items often do not contain enough nutrition to be a prominent part of the wean, and should only be offered as a dessert or special treat. Of course, if your child is only willing to accept crunchy food items, then you’ll want to begin working on connecting those foods to new, softer foods.

In all, this process of staging your meal offers your child some great advantages: your child gets high calorie, nutrient dense foods right off the bat, AND your child gets pressure-free opportunities to try new things. What more could you ask for?

Becky Keifer, MA, CCC-SLP, Lead Feeding Therapist

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Grazing is for Sheep…

When children who have been tube fed for a majority of their lives begin the process of weaning off of the tube, it becomes really easy to feed them all day long – because we’re so invested in them eating, and we don’t ever want to tell them that it’s not time to eat. But in order to utilize appetite as a motivator for eating, it’s important to foster a normal physiological GI cycle, giving the stomach the opportunity to fill all the way up (signaling the brain that the body is full), and then giving the stomach the chance to empty (signaling the brain that the body is hungry, and ready to eat!)

Snacking all day long (grazing) prohibits the brain from sending those signals because your body is never full or hungry. And if neither of those signals – fullness and hunger – is ever triggered, your appetite doesn’t have a chance to kick in and motivate eating. And in my practice, I have seen fully tube fed children wean successfully simply by eliminating grazing, and instead by providing structured meals and snacks with clear beginnings and ends. I have watched this establishment of routine aid in skill development because appetite is an intrinsic motivator for intentional eating – and intrinsic motivation! There’s nothing more powerful!

So to foster a good, healthy appetite, caregivers should consider having their child’s tube feeds resemble as normal an eating schedule as possible. Mirror your oral feeds to the same pattern, remembering that infants can eat anywhere from 6-8 times per day, toddlers eat 5-6 times per day, and school-aged children eat 4-6 times per day. Anything within that spectrum is normal. For example, when weaning an infant, we may encourage parents to eliminate continuous night feeds, letting the baby wake to eat because as tired as we may become, that is what babies do!

When it comes to toddlers and older children, however, our expectations change: we expect these kiddos to only eat during the day. But regardless of age, every mealtime should have a noticeable beginning and a noticeable ending. (Notice that I am not referencing “feeds,” but mealtimes – because it’s important to begin thinking of tube feeds as mealtimes.)

For all children – infants on up – we like mealtimes to last for about a half an hour. This includes bottle feeds or toddler meals: a half an hour maximum is a good goal. More so, we encourage parents to plan for there to be at least 1 hour before the beginning a meal where no food or drink is offered. This is so the body has time to signal the brain that it’s hungry. If meals and snacks are too close together or are small and consistent all day long, the brain doesn’t receive the necessary hunger cues from the body.

So if your child is stuck in a grazing pattern and stalled in their progress, consider changing your routine to establish clear meal and snack times. You may just find that appetite is just the ticket!

Becky Keifer, MA, CCC-SLP, Lead Feeding Therapist

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