Eating Meals

Mealtimes are an important aspect of family life. Children begin to develop self-feeding skills from birth. Self-feeding is a very complex task and it is common for children to have difficulty using cutlery to feed themselves. It usually takes until a child is 7 years old before they can successfully use cutlery to feed themselves without being too messy.

Your child may require other medical support depending on their difficulty if unsure please contact your GP.

Some information for this webpage has been drafted using resources from Greater Glasgow and Clyde Children’s Services

General Hints and Tips

Mealtimes are important, family mealtimes are when children can copy the grown-ups using cutlery, learn social skills and promotes sensible eating habits. Below are some ideas and activities to promote the development of meal time skills.

> Involve your child in the self-feeding process as early as possible.
> Whenever possible, ensure that your child is sitting at a table, well supported and at the right height. It is important that their feet are supported so that they can use their hands freely. Chairs with adjustable height seats and footrests are widely available.
> The first thing for parents and carers to consider is try not to worry about mess. When a child is learning this skill, it will be messy. This is an important stage in their development.
> Practice feeding with cutlery when time is not so pressured.
> Using cutlery is a three stage process introduce the spoon, then the fork and finally the knife
> Consider the size and shape of cutlery. Try and make it fun with a favourite character or brightly coloured cutlery.
> Lead by example. Try to eat with your child when you can so they have the opportunity to copy you
> Practice during playtime is a great opportunity to integrate this skill. An imaginary tea party or by pretending they are feeding dolls or teddies for example.
> A good way to teach your child how to eat meals is to break the task down into small steps and teach them the last step first. This technique is called backward Chaining. Once they can do the last step of the task, teach them the second-last step, then the third-last step and so on.

Pre-eating Activities and Games

The following activities require coordinated use of both hands and are similar skills required for using cutlery effectively. They can be practiced in a playful way to develop hand skills. This should also support more successful use of cutlery during self-feeding.

> Hammering activities e.g. Tap-a-Shape, toy worktools
> Scooping non-food items such as sand or small stones into a bucket.
> Colouring – steady the paper with one hand whilst the other colours.
> Construction games – E.g. Lego, bead threading, K’nex.
> Cooking / Baking – any two handed task, e.g. mixing bowl and spoon
> Using play dough / modelling material – use cutlery to cut.

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Using an Open Cup

The following activities and ideas may help your child develop their ability to hold an open cup.

> Start by using a cup with two handles to help your child gain stability and hold the cup steadily.
> Initially only half fill the cup to reduce spills
> Progress to a one handled cup and then on to the child holding a beaker using both hands.
> To help your child make a good lip seal around the cup, practise using thickened liquids like smoothies, milkshakes or yoghurt drinks to give them more time to get organised
> Gradually lessen the support you offer and allow them to hold and bring the cup to their mouth and then tip it to drink from it
> As with feeding, encourage them to sit in a good position so that they have the best control of their arms and their body to make a slow and graded movement when tipping the cup to drink from it
> Some children like cups they can see into or cups that are tilted to reduce how far they have to tip their heads back e.g. Flexi cups or Doidy cups.

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Utensils

Using a spoon

> Introduce the spoon as early as possible, immediately after weaning or between 9 and 12 months as a play object.
> Initially, your child will play with it but eventually they will make an association between the spoon, their mouth and eating.
> When you child shows they can hold the spoon and place it in their mouth, help to guide them in holding the loaded spoon. Assist them by supporting either at the elbow if they can hold the spoon, or by using your hand over theirs to feel the movements they need to make. Gradually aim to give less and less help. They may need you to place the spoon in their hand to make the correct grip at this stage.
> Allow your child to finish off what’s left in the bowl to practise self feeding if you do not want all the food spilled. This will provide them with the success of finishing the task
> Give sticky foods that will readily stick to the spoon like porridge, mashed potato, sticky rice, puddings etc.

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“Give sticky foods that will readily stick to the spoon like porridge, mashed potato, sticky rice, puddings etc.”

Using a Fork

> Once your child can use a spoon, you can introduce a fork
> Offer you child a child size, easy grip fork at first
> Work on one aspect at a time for using a fork, e.g. scooping or stabbing.
> When your child is learning to scoop with a fork, use foods that stick to the fork (e.g. porridge, mashed potato). These are less likely to spill, so the child has more chance of succeeding.
> When your child is learning to stab with a fork, use soft foods that don’t disintegrate. Begin by loading the fork for your child, then move on to foods that are easy for them to stab, like fruit or cooked vegetables
> Take your time and be consistent. Learning a new skill takes time, so persevere with giving support until you feel that the child is making progress.
> Finally, progress to offering the spoon and fork together, let them practise holding two pieces of cutlery at the same time.

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Using a Knife

> Always set the dishes and utensils out in the same way to develop a routine and help your child locate items at each meal.
> Think about the utensils you are using. Knives with thick and/or textured handles are easier to hold. A knife with a short handle is easier to control. Use a plate with a raised edge to prevent the food from sliding off the plate. Place a non-slip mat underneath the plate to prevent it sliding when your child is learning to spread or cut.
> Encourage a good cutlery grasp right from the start; your child’s index finger should point down the back of the knife towards the blade.
> Encourage your child to hold the item being spread or cut with their non-dominant hand to keep it still.
> Work on one aspect of using a knife at a time, e.g. spreading or chopping.
> Start off with soft spreads and firm foods when spreading. Spreading very soft butter or jam onto toast and spreading runny icing onto fairy cakes etc. As they become more proficient at this, start to use spreads with firmer consistencies such as peanut butter or Nutella.
> Start off with chopping soft foods and move to firmer foods. For example practice chopping mushrooms and bananas before moving onto apples and potatoes.
> Take your time and be consistent. Learning a new skill takes time, so persevere with giving support until you feel that the child is making progress.

Children learn in different ways so you might need to vary your approach. There are a number of ways in which you can help:

>Physically assist your child (see below for more details).
>Show your child – do the task alongside your child.
>Tell your child – talk your child through each step of the process. You can use each of these ways individually or any combination depending on what suits your child. Please be aware that some children cannot look and listen at the same time, so limit the amount of information you giving.

Ways to physically assist your child using a knife:

>The child can hold onto the helper’s hand as the knife is used to saw the food.
>Hand-over-hand – the child grasps the knife while the helper puts their hand over the top of the child’s.
>The child grasps the knife and the helper holds the end to guide the movement.
>The child grasps the knife while the helper helps the child by supporting and guiding from the elbow.
>You can also practice using a knife during other activities e.g. when playing with play dough or during craft activities.

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Using a Knife and Fork Together

> It is important that your child is well supported when they are learning any new skill. Whenever possible, ensure that your child is sitting at a table.
> It is important that their feet and back are supported so that they can use their hands freely. You could use a sturdy box under their feet and cushions on the chair to make sure they are well supported.
> Always set the dishes and utensils out in the same way to develop a routine and help your child locate items at each meal.
> Think about the utensils you are using. Knives and forks with thick and/or textured handles are easier to hold. Knives and forks with short handles are easier to control. Use a plate with a raised edge to prevent the food from sliding off the plate. Place a non-slip mat underneath the plate to prevent it sliding when your child is learning to cut
> Encourage a good cutlery grasp right from the start; your child’s index finger should point down the back of the knife and fork towards the blade and prongs.
> It is usually easier to use the fork in your non-dominant hand and your knife in your dominant hand but allow your child to experiment and find out what works best for them.
> Start off with cutting soft foods and move to firmer foods. For example, practice cutting mushrooms and bananas before moving onto meat.
> Take your time and be consistent. Learning a new skill takes time so persevere with giving support until you feel that the child is making progress.

Practice, practice, practice! Give your child opportunities to practice every day. A motivating game to use when practicing outside of meal times could be the ‘Mars bar games (or banana) Throw a dice, each time you get a six, cut off a piece of mars bar. Carry on cutting pieces until the next person throws a six. You may also want to vary the time of day when you practice, so practice at snack time. If your child is exceptionally hungry, you may want to cut up some of their food so they can practice once they have satisfied their initial hunger. A good way to teach your child a new skills, is to break down each task into small steps and teach them one step at a time (chaining). Teach them the first step and then teach the second step and so on until your child has mastered all of the steps. For cutting with a knife and fork the following steps may be appropriate. Use these steps along with the different helping techniques below:

>Get your child to stab the food and keep it still while you cut with the knife.
>Get your child to stab the food and saw with the knife.

Children learn in different ways so you might need to vary your approach. There are a number of ways in which you can help:

Ways to physically assist your child using a knife and fork:

>The child can hold onto the helper’s hands as they cut the food using the knife and fork.
>Hand-over-hand. – The child grasps the knife and fork while the helper puts their hand over the top of the child’s.
>The child grasps the knife and fork and the helper holds the end to guide the movement.
>The child grasps the knife and fork while the helper helps the child by supporting and guiding from the elbow.
>You can also practice using a knife and fork during other activities e.g. when playing with play dough or during craft activities.

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Eating Meals and Sensory Difference

It is important any underlying medical issues or health concerns, including behavioural and emotional challenges are fully explored before suggesting it is a sensory-based difficulty. If the child is known to still regularly choke, gag or present with any other swallow or breathing related difficulty, then it is advised that a medical professional should be involved to rule out any mechanical feeding issues.

“Parent and professionals working with children are responsible for preparing and providing a balanced meal at an appropriate scheduled time. The child is solely responsible for whether they eat and how much they eat.”

(Satter, 1987 as cited in Just Take a Bite, pg.38).

Environment

> The child should be seated with feet supported, at a stable table in a comfortable, upright position.
> A calm environment will be beneficial. Consider other strong smells such as pets, bathrooms, and smoke or air fresheners. Low scent environment across your home may better prepare the child for eating.
> Ensure the mealtimes are fairly consistent in timings, with a clear routine.
> Turn all distractions off e.g. TV or radio.
> Model behaviour by eating together as a family as and when possible. Children learn from watching others; watching you eat and use cutlery can have a positive impact.
> Consider your own eating habits and those of others that may care for your child.

Other Hints & Tips

> If appropriate, give children a chance to handle food whenever possible; at the shops, in the home, garden and any educational settings.
> Give the child an opportunity to have an important job at mealtimes, to give a sense of purpose and control e.g. dishing food out to all.
> Do not comment on your child’s eating during mealtimes.
> Discuss how to eat, such as biting an apple with front teeth, using tongue to move the apple around mouth.
> When possible cook one meal for all the family that everyone can eat.
> Offer subtle (but reasonable) changes to rigid eaters, even slight placement changes will be considered a change.
> Consider presentation; a fun plate or arranging food as a smiling face can make mealtimes fun.
> Incorporate the desired ‘treat’ as a standard part of the meal. Having pudding as a reward may identify the pudding as “good” and other foods as “bad”.
> Consider how much an appropriate amount is for a child.
> Allow the child to lead the pace, children are good at knowing how much to eat and when to stop, but need their natural pace to do this.
> Explore various textures, dry to wet/messy with hands and feet to help develop the sensory system.
> Consider the temperature of food that children appear to enjoy or tolerate the best.
> Consider using ice cubes to desensitise the mouth from tactile and taste input.
> Do not force a food that is not enjoyed.
> Use straws with yoghurts or puddings to suck hard. This can be calming and organising and prepare the mouth for food.
> Encourage blowing activities to prepare and strengthen the mouth.
> Try food in different sizes; small, large, pureed to determine which is easiest (only if appropriate for age and feeding ability of child).

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Fussy Eaters

Many children go through a stage of refusing to try new foods. In fact it’s a part of normal childhood development and can peak between 2-6 yrs. Some children who were previously thought to be “good eaters” can start rejecting any new food and even reject food they previously ate. As a result of this reaction to new foods, parents can begin to only offer foods that the child prefers and so the child’s diet can become limited.

Children often like things to be the same and are not keen on new things. Later on, some children with additional challenges rely on the routine and predictability of mealtimes to be able to function more easily which makes them even more resistant to change.

Eating a limited diet, especially if important food groups like fruit and vegetables are missing, can lead to nutritional deficiencies or health problems.

If a child is struggling to try new foods it can cause mealtimes to become a stressful event for the whole family.

Strategies

>Try to stick to regular mealtimes. This allows your child to become hungry before the meal so they are more ready to eat
> Try to eat at a table with your child in a good sitting position
> Encourage, but don’t pressurise. Give them plenty of praise but try to avoid getting into a battle. This can have an adverse effect and make the problem worse
> Lead by example , Eat at the same time as them, trying the new food and showing enjoyment
> Use cutlery and crockery that they find interesting at each meal, possibly with favourite cartoon characters
> Offer very small servings of the new food alongside food they like on the plate. If this causes difficulty, then offer a very small amount of a new food on a different plate on the table
> Offer the new food regularly at intervals so that your child remembers what it is
> Try having two spoons ,one of the new food and the other their favourite food. Offering the favourite food right after they have the new food in their mouth. They will be less likely to spit it out if they have a mouthful of their favourite food!

It can take children up to 10 – 15 attempts to finally get to like a food. Be relaxed and look for fun times to try foods where the emphasis is not on the mealtime, for example at a party, picnic or snack time. Don’t stop offering foods that have been refused. Just keep offering the food and wait for the fad to pass and for your child to start eating it again

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Eating Meals

General Hints and Tips

Pre-eating Activities and Games

Using an Open Cup

Utensils

Using a spoon

“Give sticky foods that will readily stick to the spoon like porridge, mashed potato, sticky rice, puddings etc.”

Using a Fork

Using a Knife

Using a Knife and Fork Together

Eating Meals and Sensory Difference

“Parent and professionals working with children are responsible for preparing and providing a balanced meal at an appropriate scheduled time. The child is solely responsible for whether they eat and how much they eat.”

(Satter, 1987 as cited in Just Take a Bite, pg.38).

Environment

Other Hints & Tips

Fussy Eaters

Strategies

Useful Links & Resources

Speech and Language Therapy

Learning Disabilities Team

Making Sense of Sensory Behaviour

Life Skills for Little Ones