Nursing newborns, picky toddlers, four-year-olds with bizarre food preferences — at every age, parents are concerned with what their children eat. In his latest guide for parents, “Feeding Your Child: The Brazelton Way,” Dr. T. Berry Brazelton applies his “Touchpoints” philosophy to feeding (watch for the setbacks that often come before a leap of progress) and follows feeding progress age by age. Brazelton discusses the new book and how mealtimes can be fun and healthy times with family, on “Today.” Read an excerpt here:
A Parent's First Job
Feeding a child is a sacred mission for a parent. From the first stirring of the baby in the womb, a parent-to-be feels: "This will be my new life. It will be up to me to assure that my baby grows and thrives. Feeding her well will be my job — one part of all that responsibility." This new role may begin to feel like a challenge even before the child is born. After birth, although feeding may lead to more worries, it is more likely to be a source of great pleasure — from the very first feeding — for parents and baby.
Touchpoints — A Predictable Path for Development
The steps along the path taken by dedicated, responsible parents and their child are predictable ones. There are times when the child will be difficult to feed. These predictable hurdles, which I call "touchpoints," often precede a new burst of independence in the child.
When a strong-willed child is eager for more participation in feeding — holding the bottle, sippie cup, or spoon or flinging hunks of food from the high chair — parents can feel challenged. These touchpoints occur as a child is ready to take on a larger role in caring for herself. Parents sense the child's pulling away. They may try to regain control, lest they lose the child they have learned to understand. But parents can also learn to let go and feel proud of their child's new resourcefulness. When they do, feeding will again become a source of pleasure and a special time for being together.
I call these times of change touchpoints because I have found that passionate parents can reevaluate their role if I can reach out to them at the right time with the information they need — revealing the child's struggle as an important one for her future development. We hope you can use Chapter Two, "The Touchpoints of Feeding," to help you watch for the conflict between your child's goals for independence and yours for "getting her fed properly." As you learn to prepare yourself for these times, you'll find it easier to plan your child's meals, and encourage her participation in them.
Chapter Three, "Feeding Challenges and Opportunities," addresses common problems that arise as children learn to eat, and parents learn to feed them, in the first years. As you can see, this book is not meant to be an exhaustive guide to pediatric nutrition or gastrointestinal illness. While pointing out some basics, it focuses on the behavior and psychological issues that accompany feeding, from the beginning of life through the early years. Specialized questions, for example, about food additives, allergies, or digestive disorders can be pursued through the books and resources in the bibliography.
"Ghosts from the Nursery"
As a baby grows, a parent's responsibility to nurture can seem even greater. No wonder a parent can find it difficult to turn feeding over to the child as the child fights for independence in making her own choices. My own mother, a sensitive and worthy lady, could not let my younger brother learn to feed himself on his own. My memories of meals when we were little are of her cajoling, singing, and poking bits of food at him for two hours at each meal. He, in turn, was in control. His jaw muscles bulged as they held his mouth shut. His eyes were rather merry as he led my mother through the two-hour battle. "Please, just one bite!" she would plead, over and over, to no avail.
This experience became a "ghost" in my own nursery, an expression that child expert Selma Fraiberg coined to describe the effects of certain childhood memories on adult behavior. It helped set my future. I eventually determined to become a physician who could turn parents' passion toward positive approaches to child rearing, especially in the area of feeding. Many parents discover their own "ghosts," childhood memories about being fed, as they accompany their own child through the touchpoints of feeding.
By the end of the first year, for example, control over choice and quantity of food must become the child's. Many parents find it hard to turn that job over to the child. However, no parent can successfully force a child to eat: a battle over food is one the parent is sure to lose. Parents can only present the child with healthy choices.
Feeding oneself and making one's own choices is a necessary goal for any young child. Parents will have to learn to give up the delicious sensation of the baby nursing in their arms and to enjoy instead the mealtime company of a 1-year-old who is more interested in testing out gravity with her food than she is in putting it in her mouth. Ultimately, though, enjoying the pleasure of being together that goes along with mealtimes will be the most effective way for parents to support the child's development of healthy eating habits.
When parents struggle with a child over food — what to eat and how much — the child's hunger seems to lose its importance. Hunger is a basic instinct, controlled by a fairly primitive part of the brain. However, more complex parts of a child's brain are set in motion and can override hunger. This occurs, for example, when a child begins to wonder, "Do I have to eat this because my mother says I do? Can she make me?" When there's a chance for a struggle, a child's hunger may not be enough to push a child to eat. If there is turmoil over food between parent and child, food loses its primary meaning — as a necessity for health and a source of comfort and pleasure.
Sometimes such struggles arise from a parents' "ghosts," sometimes from limitations in the baby or young child's ability to suck, swallow, coordinate chewing movements, keep food down, and so on. Often these factors work together. Struggles over food are always passionate. Parents everywhere know that food is as necessary to survival as air, and they care deeply about their child's survival and growth. Children, for their part, have strong preferences from an early age. Cultural traditions are also an important part of a parent's passion.
A Parent's Passion
Parents' commitment to feed their children and to protect them from malnutrition is powerful. This became clear to me in a study we did of a malnourished group of Mayan Indians in Guatemala in 1978. Pregnant women were subsisting on 1,200-1,400 calories a day, even though more than 2,000 calories per day (exact amounts vary depending on height, activity level, and other factors) would be necessary for adequate nourishment of the developing fetus's brain.
We tried to increase their diet to an adequate level. We offered these women a daily 1,000-calorie liquid supplement. They came into our local center each day to get the supplement, take it home, and then — use it to feed the rest of the family! Our special liquid supplement for these pregnant women never reached their fetuses. The mothers felt they must first feed their already born children. The sad result was a lower than expected IQ by the time these unborn babies reached school age.
When we finally recognized the obvious, that of course a mother would feed her children before feeding herself, we changed our tactics. We began to urge these well-meaning women to drink the supplement "in order to have smart babies." When they understood that they were not just taking this additional food for their own benefit, but instead for their unborn babies' well-being, they were willing to drink it themselves. How powerful is the maternal instinct to protect her offspring!
Brain Development Begins Before Birth
The Guatemalan study also showed us the strong influences of poor nutrition on children's development. We learned that lower intelligence was all too likely if children were undernourished in the womb or in early infancy. At birth, babies who have been undernourished during pregnancy are already less responsive to nurturing. Mothers may then feed them "when they want it," often only three times a day for a lethargic baby, rather than the 6 to 8 feedings a day that well-fed newborns usually demand.
Even in a land of plenty, parents are just as passionate about their responsibility to ensure that their child is well nourished. In fact, our increased understanding about the effects of nutrition on health and early brain development can lead parents to put pressure on their children. This can interfere with pleasure in eating-the second most important motivator for children after hunger.
There is still much to be learned about nutrition. In the meantime, a child who learns to enjoy eating a wide variety of foods will receive the balance of nutrients that, as far as we know now, will best help her grow up healthy and strong. For a child to develop this kind of curiosity and flexibility about food, mealtimes need to be fun, relaxing, and a time for a family to enjoy being together. In this book we suggest ways to keep them that way.
Pressure from others, along with a parent's sense of duty, can get in the way. So can a child's struggles to eat independently. Parents need to be prepared for the touchpoints in which struggles are likely to arise. The goal must, of course, be for a child to feed herself independently and to enjoy eating enough of the right kinds of foods to help her grow and be healthy. Parents will want to take into account the child's temperament as well as the developmental challenges of each touchpoint, which we will explain in Chapter Two.
Temperament
Feeding a Quiet Child
A quiet, sensitive child may be on a different track from her peers. She may comply with being fed and continue to be compliant even during the usual times of conflict. For example, unlike other children her age, she may allow herself to be fed into the second year, apparently content to be a passive recipient. Then, all of a sudden, refusal! No longer will she put up with being fed. Passive resistance may be her response.
Her refusal to be fed is a warning to her parents to pull back and let her try feeding herself. Since she has not had experience with finger feeding or with utensils, her first attempts to feed herself may be clumsy. A big mess at every meal — food on her face, her clothes, the table, the floor, everywhere — will be the inescapable price for her earlier compliance.
Parents may even be thankful for the slobbery mess when it comes — a welcome relief from the initial food refusal of this phase of self-assertion! Patience with such a child will be the saving grace. Let her learn how to take over the job of feeding. Offer her only two bits at a time of an attractive finger food for each meal. Then ignore her struggle and leave it to her. Keep her company, but don't cajole during meals. If and when she downs the two bits, offer her two more at a time, until she starts smooshing them or launching them over the edge of her high chair. This means it's time to stop-until the next meal. Don't let her "graze" between meals. And for now, don't worry about a well-rounded diet. Remember that this previously compliant child is quickly learning the skills of self-feeding. It might have taken her several months longer to learn had she been less passive and started in with her attempts to take over her own feeding earlier. Be patient and follow her lead.
Feeding an Active Child
At the other end of the temperament spectrum is the active, constantly moving, curious-about-everything child. She is far more interested in sights, sounds, and rushing around than in food. A parent whose motive is to see that the child is well fed is bound to feel frustrated, even desperate. "Sit down in your seat," a worried parent will beg as the child climbs out of her high chair to hang teetering on the edge. The child looks up coyly, holding out one hand for a "cookie." Anything she can eat will do as long as at the same time she can clamber around the house, up and over furniture and into drawers to pull out clean clothes with grubby fingers.
Many parents of active children have asked me: "Should I feed her on the run? She'll never eat enough sitting down. She barely sits before she's gone. I wait until she's hungry, but she never is. I feel like I need to give her bits of food all through the day so that she'll get enough. What should I do?"
My advice has been:
1. Keep mealtimes a sacred time for the family to be together. Don't let the phone or other interruptions interfere.
2. When your child loses interest in sitting at the table — that's it. Put her down and let her know her meal is over. No grazing between meals. No more food until the next meal.
3. Make meals a fun time to be together — at least as much as is possible with a squirming, food-throwing toddler. Make meals as companionable as possible — you eat when she does. But if she doesn't, eat your own meal and let her know that you can chat and be together if she stays at the table. If she squirms to leave, put her down. But she'll have to wait for your attention until you're done. Eventually she'll learn to model on you.
4. No television at the table or promises of special sweet desserts to get her to sit and eat.
5. Be sure you let her feed herself. Never say, "Just one more bite." If you do, you'll be setting yourself up for testing.
6. Don't go to special trouble to cook her a special or exciting meal — your disappointment is likely to outweigh the benefits. Instead, let your child know that "this is what we're having for dinner tonight." If she doesn't want it, she'll have to see if she likes the next meal any better.
7. Let her help with meals as soon as she is old enough to do even the smallest task, such as setting the table (start with the napkins only!), cleaning it with a sponge, and so on.
8. Have your child's pediatrician check her weight and growth, and ask her for supplements if necessary.
9. Above all, don't set meals up as a struggle or her high chair as a prison to keep her in.
Beyond Nutrition
Right from the first, feeding is an opportunity for intimacy. Parents find such satisfaction in being able to provide a child with what she needs and to enjoy with her the pleasure of eating. Mealtimes are opportunities for parents and child to relax and enjoy each other. If parents can manage their own feelings about their child's independence in this area, the child will look forward to meals, to eating the way the rest of the family do.
Table manners and attitudes toward mealtimes are learned in the fourth and fifth years as children model on their elders. Keep mealtimes pleasant. Use them as times for communication with each other. Save other times for difficult topics that need to be discussed. More than ever today, families under stress need the rituals of mealtimes to bring them together. Children need to share meals with the rest of the family, not with the television.
More Ghosts from the Nursery
Parents bring many kinds of childhood experiences with food to the table. As a young pediatrician, I would never have admitted it, but while I was recommending that parents eat with their children, I began to get a stomach ulcer from eating with my own. My stomach hurt after each meal. I found myself making comments that I'd never recommend to other parents: "Just eat one taste of that — you'll like it." My children would look up at me as if to say, "Why should I like it?" When they lagged behind at table, I would steal a bit off their plates, as if to spur them on to eat, "before Daddy stole their food."
They have never forgotten my foolish antics, and they have never understood why I cared so much about how much and what they ate. Fortunately, my stomach pains began to disappear when I became aware of the reason for my behavior — a ghost from my own nursery, the memory of my mother pushing my brother to eat. Although I escaped her pressure myself, it was in the air at our mealtimes.
As a result, I would advise parents to reevaluate their own experience when they find that they are getting uptight about what and how much their child is eating. "Ghosts" interfere with common sense and are more likely to affect your behavior if you're not aware of them. If you are aware of them, you can make choices. My grandchildren have given me a second chance. I do not steal food from my grandchildren's plates. Nor do I press their parents any longer to eat "a rounded diet." They do anyway.
Excerpted from "Feeding Your Child: The Brazelton Way," by T. Berry Brazelton, M.D. Copyright 2003. All rights reserved. Reprinted by permission of DaCapo press.