When children are adopted, they often have had trauma in their lives that can affect many aspects of their lives, with eating being one of them. In fact, nearly 80% of children with developmental issues also have feeding issues. So it is no wonder that our children who are adopted, who are often developmentally delayed and have experienced many issues, such as bottle propping as infants and then given mushy and limited number of foods often have eating problems.
These issues do not just apply to internationally adopted children but can be seen in children who have been in foster-care. If your child was adopted from foster care, she may be normal weight, but she may have been deprived of certain foods, given lots of snack foods, and may not have been provided any structure around meal time. On the other hand, if your child is from an orphanage, he may have had overly structured meal times and had to consume limited amounts of food very quickly.
In the book Love Me Feed Me: The Adoptive Parent’s Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More , Katja Rowell, a medical doctor, does not so much provide nutritional goals for the adopted child but she explains the best ways to establish a positive relationship between you and your child. Food and dietary habits can become an integral part of what Dr. Rowell call the Trust Model for establishing attachment with your child. This Trust Model helps to provide nurture as well as means of establishing healthy eating habits in your child. You may be asking, “But what about my other kids who have not had difficult starts in life? How am I going to make meal time different for all my children? As with any positive attachment and trust model, this model can be used with all children.
This Trust Model promotes shared power: you the parent determine when, where and what your child will eat, and your child gets to determine if and how much to eat based on what foods are there. This allows you to decide on what nutritional foods your child can select from and where and when your child will eat, but the child gets to decide on what food to select from and how much to eat. Now, of course, an infant, who has nearly all the power when it comes to feeding, decides the when, where and how much to eat; you, the parent, just decide on what milk to give her.
The Trust Model gives children the structure that they need as they know what to expect. And as with feeding a baby, sometimes you must take your cues from your child. For example, younger children need to be fed more often, so they will ask for snacks more often in-between meals. If your child is malnourished, you may need to offer your child food more often until you get to know your child’s signals as to when he is hungry.
Feeding your child with the family helps your child see others eating, sets a model of portions, and to be able to know when he is hungry and full. At meal time, it is best to have different types of foods at the table—especially those that your child likes based on taste and texture—so that your child can have familiar foods as well as try new foods in a non-coercive setting.
Giving your child a snack—in the afternoon—or perhaps two snacks—can help a child who gets cranky in the afternoon waiting for dinner to feel more relaxed and content Do not be concerned with a “ruined appetite” before dinner. Your child may eat less at meal time, but as long as the snacks provide healthful foods, your child will get the nutrients he needs.
Simple but practical solutions for children who come from difficult pasts can help solve food and meal time problems. However, some children, especially those with medical and sensory problems, may require more therapeutic assistance. Often an occupational therapist (OT) is the first professional who may become involved, as the OT usually assesses sensory and gross and fine motor skills and the child’s ability to feed herself. A registered dietitian (RD) may assess the child’s nutritional intake and growth patterns and if more serious steps must be taken, such as tube feedings, are necessary. As with any type of professional who is going to provide advice and some counseling, certain factors must be taken into consideration. A mental health counselor would be involved to assess the parents’ and child’s interactions surrounding food and may also assess attachment issues. The counselor would also work closely with the other professionals such as an OT and RD.
If you, as a parent, are having major food issues with your child, your child’s pediatrician may not give the advice you need, unless your pediatrician is very familiar with adopted children’s needs. Instead, you may need to consult with a pediatrician at an international clinic for a referral to a feeding clinic or OT.
If you feel that your child is growing steadily but there are still major issues surrounding eating issues, then you may want to consult with a counselor who has experience with adoption and attachment issues and can help you use trust based approaches in helping you and your child with behavioral issues surrounding food. If your child is having eating issues and may also have sensory and other issues related to motor skills, then the counselor and OT need to be working together. The approach needs to be parent focused as adopted children need to be attaching to their parents—not separated from them.
Rowell has a list of questions you may need to ask before working with a professional:
- How do you help the parents integrate the skills at home?
- Am going to be involved in the treatment plan, or am I going to be separated from my child? (Parents are the ones who ultimately work with the child.)
- Do you use negative/positive reinforcement? (Either type of reinforcement can feel like coercion to a child and can result in a power struggle.)
- Do you require the child to eat food she does not want or hold food in front of the child until she eats it? (This leads to a power a struggle.)
- What resources do you suggest?
Children who have had difficult starts in life had little control in their lives and often feel shame. So any approach that takes away power from a child (instead of offering shared power with the parent) or shames a child into eating often leads to more problems.
Bad formal therapy is worse than no therapy. But good therapy need not be formal–it can be done by the parents if the parents can take cues from the child. The parent can trust the child to do the eating while the child trusts the parent to be “there” for him and builds upon the relationship.
To learn more about your child’s nutritional and feeding needs, these websites provide very valuable information, tools, and even equipment:
- http://adoptionnutrition.org/ This website provides information related to the nutritional needs of adopted children—even by country—as well as addresses some feeding issues such as hoarding and children who will not eat.
- http://mealtimenotions.com/ This site offers stories, articles and information regarding the feeding and nutritional needs of children with special physical and sensory issues.
- Snack-play-love https://www.adoptionlearningpartners.org/catalog/downloads/snack-play-love-presentation.cfm Karyn Purvis, a developmental psychologist who is an expert on attachment in adoptive families, covers in this PowerPoint behavioral issues related to nutrition and eating habits among adopted children.