This blog is based on a talk I was asked to give to a group of parents who attend Happy Little Eaters run by the team at Nutripaeds.
I’m going introduce a few different concepts to you and then try tie them all together at the end.
“Don’t Slouch at the dinner table!”
How many of you heard that as a kid? “Sit properly!” “Straighten up!” “Take your elbows off the table?” And who of you now tell your own kids to do that?
Why? Why did your parents ask you to do that? Why do you tell your kids the same thing?
Probably because it looks nicer if a child sits up straight? Its more aesthetically pleasing to an observers eye? It has to do with manners?
But did you know, that eating is actually EASIER if you sit up straight? Or that swallowing is more effortful if you slouch.
Try it for yourself. Go on. Slouch forward. Right forward so your back is rounded and you head is poking out in front like a tortoise. Have a little swallow.
Now to exagerate that posture, sit up but look up at the ceiling. And swallow.
Now sit up straight, head over shoulders, shoulders over hips, look forward and swallow.
Which of the three is easier?
The last one. Am I right?
Sitting posture helps with the ease and coordination of eating. If we sit up straight the area that our stomach has to expand is more. Our lungs have space to move, because the diaphragm has space to move down allowing for the easy flow of air. If we can breathe easier, then coordinating breathing while chewing and swallowing becomes easier.
In addition, bio-mechanically, gravity can assist with taking the food from the back of the throat to the stomach if we sit upright, as your esophagus travels from top to bottom.
When you slough forward, you create a kink in this system. It requires more effort and coordination from a brain and muscle perspective to get the food around the kink, than if gravity was assisting it in a straight line from top down.
Because of this bio-mechanical design, some advise that you need to sit you child at 90/90… 90 deg at the knees, 90deg at the hips, feet supported on a surface, support the head in midline and then the food must come from the front….
But… to throw a spanner in the works…do we always eat or even swallow in this position?
Or as typical, grown people, are we able to eat an ice cream, walk and talk?
We are able to gulp the last piece of toast in the morning while tying a shoe lace without choking. We can lounge back and sip a cocktail or cup of tea at the end of a long day. We can ly on our stomachs at a picnic and enjoy a beer or some food. And it’s a pretty good thing I can swallow my saliva while lying on my side or I’d end up with a wet pillow every morning or probably worse my hubby would get drooled on all night.
What this means is that, for typical development, to be safe in swallowing, we need to learn to coordinate our bodies in a multitude of ways and be able to swallow safely with our bodies in all different positions.
Any parents knows this; how many of you have kids that as babies and toddlers will put everything in their mouth in all sorts of weird and wonderful positions. It’s part of the developmental process that allows them to swallow safely, so that one day, they too can bend down, swallow their last piece of breakfast and tie a shoelace before dashing out the door.
But, in addition to the importance of us being able to coordinate our bodies in all different ways, what is more important is that the person is able to multi-task. Eating requires us to multi-task incoming sensory information and well as multi-task the outgoing motor plan.
Before you even take a mouthful, your brain needs to;
- Know where your body is in space
- Know where your body is, in relationship to the food, the table, the plate, the spoon etc.
- Know where your head is in relation to the rest of your body.
- Know where your tongue is, in your mouth and where it is in relation to your head and body.
- You need to know where your tongue is, in relationship to your teeth.
Then you put something in your mouth;
- How does your brain pay attention to the taste and smell and size and texture and temperature, without losing the sense of where your tongue is, in relation to the teeth and the head and the body?
- How does your brain tell your jaw, how hard or soft to bite? And chewing the first bite of a crusty baguette is going to be very different to the pressure you use for the last chew, as the consistency of the food changes in your mouth…
And it goes on… the amount of multi-tasking your brain needs to do on a continuous basis, in terms of registration of the sense, process it, give it meaning and feed-forward into creating an action as a result of this information is immense. And that is with only one bite of food!
AND, in addition to that, it needs coordinate the timing of chewing and swallowing with breathing, so you don’t swallow and breath in at the same time.
So, is there a lot going on in the brain! And you know this. If you really want to taste something, why do you close their eyes to focus on the taste?
We have the fact that bio-mechanically swallowing is easier if head is on shoulders, facing forwards in a sort of static position.
And we have the fact the swallowing and eating in a typically developed person need to be able to be coordinated in a number of ways and that to be typical we need variability in the way and position we are able to eat and swallow.
Lastly, eating is not just about swallowing, it’s about the multi-tasking of a multitude of sensory inputs and then multi-tasking a multitude of motor outputs, and this is a continuous feedback, feed-forward loop.
Where can it go wrong?
- A child with poor core coordination is not going to be able to physically hold their body upright. Or if the demands of sitting upright and not falling over are too much on the body, eating and swallowing will be difficult.
- A child who has missed out on opportunity to mouth toys in all different positions, sit and eat in different position, will don’t have developed adequate safe swallowing skills.
- A child with difficulties in sensory processing, specifically the multi-tasking of sensory information will struggle to focus on sitting upright, as well as the eating process.
So as parents, what can you do to help?
1) You can keep telling them to sit up straight… but did that ever work for you? I didn’t think so.
2) Understand which area your child may be struggling.
If you can understand where the difficulty lies you can target intervention more specifically.
3) Create a space where bio-mechanically sitting and eating is easy.
a) Some advise, 90/90 with head and trunk supported with cushions and feet resting gently… But I feel that no toddler is actually going to stay like that and your cushions will be a mess.
b) From sitting point of view, make sure your child is not working hard to be in sitting. Balancing on a stack of cushions, perched at the end of a dining chair with your feet dangling, make it very difficult to sit. Make sure your child has adequate foot support, and if need be a back rest.
– Use high chairs but make sure there is a foot support
– Toddler chairs are great. make sure the child feels safe and that they don’t feel they will fall off the sides. Ensure foot support.
4) Allow opportunity for oral sensory and oral motor experience in different positions, that isn’t necessarily nutritional. (i.e. not at the dinner table). Allow babies and toddlers opportunity to mouth toys and have sensory play that involves the mouth where they don’t have to be sitting upright, but exploring all different possibilities of body positions.
5) Realise that from a sensory processing point of view eating may be difficult.
a) Prepare for eating. Some people find that some big sensory input, just before dinner can help the brain maintain a sense of where the body is in space. Time spent on the trampoline or jumping on a bed, or swinging back and forth, or sitting in a laundry basket and being dragged around the house can help give “Loud” info to the brain about the body so that it can maintain a better posture for food.
b) However some people find that too much excitement before dinner, stimulates the sympathetic nervous system which means the child itsn’t going to feel hungry, even if they are. Then some down time with a book or craft before dinner may help them realise that they are hungry.
c) Allow for time between mouthfuls for them to readjust body, and become aware of their body again. Between mouthfuls, if they are sagging, you can give their backs a firm little rub, or a tap on the shoulders as a sense reminder to the brain of where the body is in space.
d) Minimise other sensory distractions during eating times, such as loud noise, TV etc. For children that find sensory processing very difficult, even a loud clock can be distracting.
e) Be aware of what food textures may be less or more difficult for you child to manage. And this will have an effect of posture and vice versa
6) To me, this point is most important. Create opportunity away from the dinner-table for children to have activities that develop a better sense of their body in space, that helps with improving core coordination and strength and assists with improving skills of multi-tasking sensory information. The principle for these kind of activities is to use the 3D environment that we have and that our bodies have the capacity to exploring and play in a 3D environment at different levels, on different types of surfaces and different ways to use the body. Principles of up, down, over under, in, out, backwards, forwards, sideways, turning, twisting etc. Some ideas include;
- Climbing: Jungle gyms, rocks, trees, tree trunks
- Obstacle courses in the passage, by crawling over pillows, climbing on and off couches and beds. What are all the different ways you can get off? Climb off, slide down on your bottom, on your tummy, hands first, head first etc.
- Rough and tumble with mom or dad… using people as jungle gyms.
- Activities where you move forwards, backwards, sideways, turning etc.
- Wheelbarrow walking, cartwheels, handstands (head down activities).
- Swimming, playing in the pool with mom/dad. Moving different ways in the pool.
So Learn to play with your kids, get out, get up, get down, get in, get messy, have fun!