In this post, you will find an explanation of attention and behavior concerns that interfere with independence in self feeding and resulting meal time problems with kids.
Attention and behavior during meal time functional skills are a vital importance to independence with independence in self-feeding. The child with cognitive impairments or unsatisfied sensory needs can impact attention and focus leading to safety concerns, decreased independence, or limited coordination and functional ability to self-feed. Behaviors can result in intentional or unintentional feeding difficulties.
The child who is limited in sustained attention or the child who is distracted by sensory needs or interference may be overwhelmingly unable to attend to feeding tasks. Likewise, children with behavioral tendencies may be seeing a satisfaction of other needs that therefore interferes with independence in self-feeding.
When attention of behaviors are impaired, there are many resulting problems that interfere with safety and independence during meals:
- Decreased concentration
- Impaired memory
- Poor judgement
- Impaired direction following
- Decreased initiation
- Poor self-monitoring
- Impaired problem solving
- Slow or inefficient processing
When a child presents with these problem areas, they have an impact on meal time. Development of self-feeding is often times delayed and parents seek answers to help their child feed them selves independently. The peaceful meal time is a sought after experience given that meal times are a time for conversation, reflection, and satisfaction. When behaviors or attention limit a child’s ability to self- feed, the meal time can then become focused on safety or become a stressful situation.
Other times, meals are a quick operation that needs to be completed in a timely manner in order to allow families to move on to the day’s activities. In these situations, meals need to be efficient and energizing.
In both scenarios, a child with meal time problems secondary to attention and behavior can effect the family dynamic.
Consider the areas of meal time that are dependent on appropriate attention and behavior:
- Tool use to hold utensils effectively or appropriately
- Eye-hand coordination to scoop, poke, and cut food
- Eye-hand coordination to bring utensils to the mouth without getting distracted
- Bilateral coordination to hold and use a knife and fork at the same time
- Lip closure to maintain mouth closure on a straw while sucking and while chewing
- Swallow control to initiate food propulsion
- Rhythm of swallow and breath
- Rate of eating/drinking
- Ability to keep food in the mouth
- Ability to tongue sweep to clear the mouth between bites
- Visual attention (may be a concern for clients with a strong preference to one side)
- Sensory needs that interfere with seating, including wiggling or fidgeting during meals
- Food refusal
- Playing in food, moving food around on plate, hiding food, throwing food
- Eating only certain foods
- Standing up to eat
- Dropping utensils/spilling food or drink
- Fidgeting and wiggling at the table
- Talking with mouth full of food
Each of the above problem areas are concerns that may be a result of attention and behavioral issues. these patterns assume a typical oral motor and pharyngeal motor development.
The sensory variances related to attention provide distractors that interfere with attention and behavior during meal time. In many of the examples listed above, the sensory needs or preferences of the child may impact meal time attention and behavior. Strategies to address sensory-based attention and behavior concerns should address the child’s sensory needs prior to and during meal time.
There are suggested interventions that can help children with attention and behavior problems during meal time:
- Orientation to time/place/person
- Structured environment (such as a quiet room)
- Redirection to the task
- Allow for extra time during meals
- Provide visual, verbal, and physical cues: These might include modeling, gestures, imitation, and cue cards.
- Elimination of distractions
- Limited number of choices
- Offer one food at a time
- Use simple and concise language
- Consider meal times and medication times
- Provide respect for food preferences
- Bright colors or high visual contrast for place settings
- Shiny utensils/dull colored utensils
- Provide the biggest meal at various times- Typically dinner is the largest meal of the day in the US. Try providing more at breakfast or lunch and a smaller meal for dinner.
- Clearly established mealtime rules and expectations
- Expect that food will spill, messes will happen, and kids will not always be hungry.
- Request school lunches have accommodations added to the IEP if needed.
Sometimes a simple visual or physical cue can help with strategies intended to help kids hold the spoon or fork correctly. These are a few different visual and physical cues that can help kids boost attention while eating. There are many adapted utensils out there (Read more on Your Kids OT’s post today) that can help with attention during meals. Try these DIY versions:
Help Kids Hold a Spoon, Fork, or Knife with a Visual or Physical Cue:
For these ideas, I added a few different prompts right onto the spoons: a sticker, a pipe cleaner wrapped around the spoon, a bit of modelling clay, or a couple of rubber bands are inexpensive ways to bring the child’s attention to help with just one concern that attention may impact during self-feeding.
It is important to remember that this list of suggested strategies does not include all interventions that may help kids with attention and behavior problems and resulting difficulties during meal times. Knowing that every child is drastically different with temperament, environment, likes/dislikes, sensory needs, cognitive level, and motor skill, there are myriad interventions that can work to address needs. What works for one child may not work for another. The trick with attention and behavior needs to to try one strategy and then another, sometimes in combination, to meet the needs of the child. Consult an Occupational Therapist for best intervention strategies and plan of action for your child.