As a childcare provider, you know that feeding young children can be challenging. In your career, you have probably managed a wide variety of mealtime behaviors of young children, ranging from only wanting one food to being picky eaters.
Children with special needs often face more challenges and pose more challenges for caregivers at mealtimes and snack times than a typically developing child. With 10-15 percent of U.S. children having some type of special health need, it is highly likely that you will find yourself caring for children with special needs at some time.
When helping special needs children with feeding and nutrition issues, recognize that you will function as one member of a team. Other members of this team include the child’s family, the child’s health care providers, the person who prepares food in the childcare environment, and the child. Each member of the team has specific responsibilities. Some of your responsibilities as a caregiver include:
- Sharing information with the child’s family.
- Being supportive, reassuring, and understanding of the child’s family.
- Coordinating activities (and communication) with the child’s family.
- Understanding the child’s individual food and nutrition goals.
- Supporting the person at the childcare facility who prepares meals (in childcare homes and some centers, this may be you).
- Offering and serving food in a positive environment.
- Serving as a role model in regards to food and eating practices.
- Promoting and helping establish positive food and nutrition attitudes in children.
Childcare providers often become the link between the child’s family and health care providers. Community health nurses, therapists, dieticians, and other specialists may visit your childcare facility and ask that you observe the child’s behaviors and progress in many areas, including feeding. Becoming a close observer of the child at mealtimes is an important role that you have in helping children develop the skills they need to get adequate nutrition and have pleasant mealtimes.
Developing Eating Skills
Often, children with special needs require more time to eat than other children. They may struggle to feed themselves and make bigger-than-usual messes at the table, all of which can be frustrating to a caregiver attending to several children at once. Here are several suggestions that can help reduce the frustration while promoting the child’s development of eating skills:
- Allow the child to eat increasingly challenging textures as he is able.
- Help develop self-feeding skills by making sure the child is positioned comfortably and using adaptive equipment as needed. Avoid feeding the child if he can do it himself.
- Respect the child’s food preferences, eating pace, and whether or not he chooses to eat.
- Set appropriate limits on snacking and sweets.
Some children may require modifications to their diets and mealtime routines. Three common areas of nutrition-related concerns for special needs children are texture modifications, appropriate weight gain (too much or too little), and food allergies.
Depending on their abilities, children may struggle with different food textures. Some children have problems with thin liquids (which can be thickened for easier swallowing); other children may not be able to swallow dry or lumpy foods easily. Foods that do not dissolve and foods that contain multiple textures (like soup) also can cause difficulty for some children. Sometimes a food’s texture can be changed to make it easier for the child to swallow (such as pureeing) or it can be chopped or softened.
Some health conditions may increase a child’s tendency to be overweight (such as spina bifida and Down syndrome) and other conditions may lead to underweight (such as Fetal Alcohol Syndrome and cystic fibrosis). Conditions like cleft palate or cleft lip may affect children’s weight by make eating difficult. Some children may gag, choke, or struggle with chewing or sucking. Children with autism may have an altered sense of taste or smell that affects their acceptance of foods. Medications also can affect appetite and eating habits.
Food allergies or intolerance should be carefully managed for children, especially those with other special needs. For example, diarrhea caused by milk (lactose) could lead to severe dehydration in a special needs child who is lactose intolerant. Foods most likely to cause allergic or other reactions include milk, soy, eggs, wheat, and corn. When a child is allergic or sensitive to a food or ingredient, it should be eliminated from the diet. This can be fairly simple if the food is normally eaten by itself, but it becomes more difficult if the food is used as one of multiple ingredients. Reading food labels helps to identify ingredients that may cause allergic reactions.
Depending on the child’s condition, extra fats, limited fluids, special formula, or other dietary changes may be needed. For example, a child with diabetes mellitus requires a diet to control the child’s blood sugar level through restriction of simple sugars and concentrated sweets. A child with PKU (phenylketonuria) must have a special diet that severely limits the amount of protein the child consumes and also must avoid foods containing aspartame (the ingredient found in some sugar-free foods and in Equal®). A severe peanut allergy may require that peanuts and peanut products be totally removed from the child’s environment.
Sometimes, specific equipment is needed to feed a child with special needs.
A specially designed nipple may be used for feeding children with cleft lip or cleft palate. Other children may be fed through a feeding tube. Using adaptive feeding equipment may seem awkward at first, but appropriate training and experience using the equipment, along with support from the child’s family and health care providers, can increase your comfort level.
Whatever the child’s condition, it is important to closely follow the diet modifications prescribed by the child’s health care provider, to communicate regularly with the child’s family, to keep accurate records, and to ask questions if the specifics of the diet and feeding instructions are unclear.
Feeding a child with special needs may be challenging at first, but as you work with families and health care providers and gather information about managing the child’s condition, you can develop skills and confidence that make for a rewarding experience.