A really interesting chat broke out on Twitter earlier this week between several adopters. It was one of those chats where you realise that all your children do something that hitherto you didn’t really identify as being an ‘adoption thing’ but actually, now everyone is doing it, it must be. The thing we were talking about was eating. We have quite a few behavioural issues around food here but this chat was more about the mechanical side of things: disruptions to the process of taking a bite of food, chewing it and swallowing it. The chat really began around children holding food in their mouths for much longer than average, something which seems to be common in many adoptive households. We also noticed that many of our children overstuff their mouths and choke more often than you’d expect.
The big question was why? We had a healthy debate and several of us stuck our oar in. As with most complex issues my first reaction was to blog it out so here is my summary of the main factors:
The reason for holding food in their mouth could be a sensory one. It could be that a child is under-sensitive to sensory information in their mouth and can’t ‘feel’ the food there very easily. If this is the case it is likely they would be better at eating/chewing/swallowing food which has a more extreme taste or texture or temperature. Spicy foods or those with a lot of crunch or those which are sharp or bitter will provide the mouth with more sensory information than bland foods, helping a child to ‘know’ it’s in their mouth. The difficulty here of course, is that you child will have their own taste preferences and these will influence the range of food they will eat. I think this category could apply to Little Bear but he really doesn’t like spicy foods. He does like a good crunch though, especially from a crisp, but won’t tolerate it from a raw carrot. He has no difficulty dispensing with cold ice cream!
The converse of this point could also be true: some children are over-sensitive to sensory information in their mouth. These children are often sensitive to different textures finding some pretty disgusting. It’s possible that these children hold food in their mouths because it is preferable to them than swallowing it. Other signs of this could be spitting food out or an active gag reflex.
Often children need to get used to a bigger range of textures before being asked to eat the consistencies of food that bother them. Because of how the sensory system is wired, the next best place after the mouth to explore texture is with the hands (and if they can’t manage this, then with the feet). In typical development, young infants naturally put their hands in their food and explore it. This is an essential developmental step and some older children need support to revisit it to help with eating issues. Sometimes the foods they struggle to tolerate can be played with and explored manually before them being brought close to the lips then perhaps just touching them with their tongue tip. This should be a gradual process (weeks not hours) and needs to be managed sensitively. It should be done with a child, not to them. You can also lessen sensitivity through general tactile work – exploring different materials etc. It doesn’t necessarily have to be done with food though that does work well.
I suspect there is a third sensory category when it comes to eating which would be ‘sensory seeking’. I don’t think you would see food being held in the mouth with this aetiology but you might see over-stuffing as a child tries to get the most sensory input they can. I think you would see a constant need to eat and perhaps wanting to eat stronger flavours/ more extreme textures/ more extreme temperatures. It wouldn’t be a huge leap to think that children who seek oral sensory input would also chew/suck non-food items, though I think it is possible to seek oral stimulation without the food side of things.
However, there are other possible issues at play. What about experience? As most of our children were not with us when they were babies, we have very little information about their weaning. We don’t know if they were allowed to experience the getting messy-putting-their-hands-in-their-food stage. We don’t know what range of tastes they were given or even if the types of food they were weaned on were appropriate for an infant. We don’t know whether that may have led to sensitivities and a greater likelihood of gagging. We don’t know whether they went hungry or whether they were force-fed. All these options could cause potential eating issues now.
We do know though that tastes develop based on experience – the more times you try a food, the more likely you are to like it. We also know that there are ‘windows of opportunity’ within the weaning phase and if children are not exposed to tastes at these points, the window can close.
I strongly suspect that Little Bear hadn’t tried a wide range of foods before he came home. He certainly wasn’t too familiar with vegetables. If children haven’t been exposed to many different tastes and textures, they won’t eat a wide range. Things that are new to them will seem alien and it is likely their first reaction will be of dislike. They are likely to pass these foods around their mouth/ spit them out etc.
Research suggests that rather than assuming they definitely don’t like that food, we should keep offering it to them. Obviously you have to be extremely careful with making children eat foods they don’t want so this is pretty tricky. We used to do a lot of hiding vegetables – in sauces or soups and Little Bear happily took them that way. I also used a bit of good old bribery (some of you won’t like this) e.g. you can have pudding when you’ve tried one bite of x/y/z vegetable. We’ve had good success with this and I’m really proud of the range of vegetables Little Bear will choose to eat now.
The other aspect of experience that is important is that our muscles develop alongside the foods we eat. If we just eat sloppy or dissolvable textures all the time, our chewing muscles won’t develop. Many children who have experienced neglect have low muscle tone in general. Some have such low tone that their face can appear droopy and they need specific stimulation of those muscles to improve the tone, often completely altering their appearance.
I suspect that Little Bear was mainly given a mushy diet in foster care and didn’t experience a range of textures like fish or meat. I have noticed that he is more likely to hold chewier items in his mouth and this could be because his muscles are underdeveloped and chewing is actually really hard work for him. I chatted this through with a friend who is experienced in children’s eating and drinking difficulties a while ago and she suggested building texture up gradually. You can’t expect a child to go from eating Weetabix one week to steak the next. There needs to be a gradual build-up of chewiness. I think this has led to an improvement here. Little Bear will now happily polish off a range of fish, sausages, bacon or chicken (if it’s soft enough). He will eat beef but it is still noticeably effortful for him, it stays in his mouth a long time and can result in it being spat out.
My friend also pointed out that if you aren’t experienced in chewing (or sometimes this just happens randomly) you don’t develop the side to side movements of your tongue that you need to push food from one side to the other as part of the chewing process. She said you can develop this outside of eating by playing games that involve trying to touch a specific item in a specific place with your tongue or just the teeth on one side. I used to add a little game onto the end of tooth-brushing involving Little Bear playing ‘tag’ with his tongue and the brush.
Although I don’t want to get into the behavioural side of things too much, it is also pertinent to consider a child’s general presentation. Do they have difficulties with attention control and concentration in general? Little Bear does. Could it be that he gets distracted mid-chew and forgets he has food in his mouth? I do tend to give him frequent prompts and reminders to keep chewing. I also need to remind him that his mouth is full so he shouldn’t put the next mouthful in yet.
So far, that is quite a lot of possible factors that could be affecting our children’s eating. However, I haven’t really mentioned swallowing/choking and the factors above don’t really explain why some children who were removed from neglectful situations very early or even at birth still go on to have these types of difficulties. Could something be going on in utero?
It’s certainly possible because the bit of the brain that is most developed when a baby is born is the brainstem. This is also the bit that controls basic functions such as eating and drinking. The cortex and higher brain regions mostly develop after birth and are consequently very susceptible to environmental damage such as lack of stimulation. Because the brainstem develops during pregnancy, one assumes it is more susceptible to damage from things that happen in utero than any other bit of the brain. We know that recreational drugs, including nicotine and caffeine, as well as alcohol and stress hormones such as cortisol cross the placenta and impact an un-born baby. I have struggled to find specific research about particular pollutants affecting the eating and drinking areas of the brain but it isn’t a huge leap to imagine it’s possible. Is there something different about the structure or connections in our children’s brains that lead to the types of mechanical eating difficulties we are seeing? Perhaps.
At these points I like to reassure myself with the concept of brain plasticity – the ability the brain has to build new connections and new pathways; to learn to do things it couldn’t do before. I read that the brainstem is less plastic than the cortex but it is still capable of plasticity. Maybe change in the areas it controls is more difficult to achieve and may take longer but I like to think it’s possible.
It seems our random Twitter chat has led us unwittingly into a fairly complex area. My feeling is that this little corner of behaviour is under-researched and I suspect I have raised more questions than answers. If anybody knows of any articles that could tell us more, please send them my way. In the meantime this one was sent to me and I think it’s well worth a read: Article about the impact of trauma on the developing brain
*I probably need to point out that all children are different and will all have been impacted in different ways and to greater or lesser extents by their experiences to date. The reasons given here are just some of the possible reasons and may or may not apply to your child. They are also my personal thoughts and based on my reading only.