Saturday 16 December 2017

Ask the expert: How can I get my two-year-old to give up being spoon-fed?

Illustration by Maisie McNeice
Illustration by Maisie McNeice
It's worth including lots of finger food for a toddler at mealtimes.
David Coleman

David Coleman

Q: I would love your advice on a situation I've been having with my 30-month-old. He will not feed himself in any shape or form. I'm at my wits' end and have tried everything.

He does eat, but only what he is fed. We, literally, spoon-feed him his three main meals and then have to place snacks into his mouth to get him to eat. He is so stubborn I don't know what to do.He is also having three bottles a day, which we also have to feed him as he won't hold the bottle himself. How can we get him to feed himself?

David replies: I think if you stop feeding him, he will quickly choose to feed himself, assuming he has no developmental or sensory issues.

It may seem like a quick and flippant answer, but think about the context. Any child who has the luxury of a parent doing a task for them is likely to continue to let the parent do the task because it is easier, and often nicer.

Your son may feel very nurtured by the way that you feed him. It may be a warm and comforting experience to have his food prepared, served and fed to him. He may feel that this level of attention from you represents your 'minding' of him.

Mealtimes, while your son is being fed, might also be the only time that he gets one-to-one attention in an otherwise busy household. Your son might be motivated to insist on being fed to keep that small window of time when you are focused only on him.

Think also about your motivation to have continued feeding him up to now. Perhaps you worried, or still worry, that he won't be able to eat enough, or won't choose to eat enough, if you don't feed him.

Perhaps the closeness of feeding him also fulfilled some of your own nurturing needs, or need, to be needed.

So, if you are thinking about changing the feeding habits of your son, be aware that both you and he may be quite emotionally attached to the old habits.

As I mentioned at the start, do check whether a developmental delay, or a sensory issue may be part of his reluctance, or inability, to eat independently. If they are present, they will influence how you try to encourage him to eat by himself.

For now, though, I am going to assume that he has developed within normal limits.

Be clear in your own head about the rationale for why you want him to eat independently. This is not so that you can explain it to him, but rather that you can bolster your own resolve if he protests a lot when you stop feeding him.

When you do stop, ensure you are warm and understanding of the fact that he may be cross or upset at not being fed. Acknowledge that he may be missing the closeness of being fed. But, also reassure him that you know he will, and can, eat what he wants from what he is offered.

Then, make sure you offer all the same variety of food as normal. Include lots of finger food that doesn't need any implement (like a spoon) to get the food to his mouth. This means that any lack of skill with a fork or spoon won't be an impediment to his eating.

Also, ensure that you include him at the table with yourself and the rest of the family for mealtimes. Let him see that other people feed themselves, and let him see how they achieve that, by using cutlery or their fingers.

Incorporate other ways of nurturing him, like hugs, cuddles, bathing him, reading to him and so on, such that he learns that food is not his only way to get special time with you.

Most importantly, though, he has to know that you are not fussed, at all, by how much or how little he actually eats at any meal.

Do give him ample choice and variety, but don't worry if he eats it or not.

It may be difficult to not worry about what he eats, since you were previously so invested in his eating that you continued to feed him. But he needs to realise that what he eats is his business, not yours.

He needs to learn that he is welcome to eat whatever he wants from what is offered to him and that it is entirely his choice. Then, he will learn to respond to his hunger signals and seek food, rather than passively waiting to be fed.

My three-year-old daughter is terrified of doing her poos in the toilet. How can we get her to use the loo?

Q. My daughter will be four in September and she is absolutely terrified of doing her poos in the toilet. She was in an awful way for months with constipation and I think the problem has stemmed from this. She has been prescribed a laxative, but she can still hold her poo for days. She is fully trained for her wees, night and day, but will not entertain doing her poos.

The whole thing is mentally and physically draining on us all - especially my daughter. She has an excellent diet; drinks plenty of water and is a very active child. Have you any advice?

David replies: I could imagine that the constipation was quite significant in the struggle she now has with pooing in the toilet. One of the unfortunate outcomes of constipation can be that children end up, eventually, passing a quite painful stool.

Prior to the poo itself, your daughter may have experienced a lot of discomfort and cramping.

If even one experience of a painful poo coincides with an early attempt to use the potty or the toilet, it can be enough to deter children from wanting to poo in the toilet again as they could associate the pain with the place and not the poo.

The other real difficulty with constipation is that children sometimes end up with some very impacted and hard stool, blocking up their bowel.

We rely on the feeling of distension in the lower bowel as our warning signal that a poo is coming. It is this feeling of needing to go to the toilet that we encourage children to respond to.

When they have been constipated, however, their lower bowel can be constantly distended and so they lose the sensitivity of the stretching of the bowel and may not even be aware that there is a poo there.

A final complication of the constipation is that, sometimes, when a child is constipated for a number of days, the stool gets compacted and hard in the bowel, and a smaller amount of liquid poo can still escape around the edges and leak.

That leakage is almost impossible for a child to notice, and so, they often get staining or 'leaky' poo in their pants without even realising.

I could imagine that any, or all, of these experiences may be relevant for your daughter. In addition to the discomfort, distension, soiled pants and reluctance to poo, your daughter may have met a lot of cajoling, persuading and then frustration and anger from you and her dad.

Because many of us don't realise what our child is going through, we will try to treat them as if this is just a 'regular' situation. When they don't seem to respond 'regularly', it can be very frustrating.

Add in the hassle of dirty pants and the seeming waste of time trying to get them to the toilet and it is easy to see how a very negative pattern of interaction can build up between our child and us.

It is good that your child is on a laxative now. That should ease the likelihood of compaction of her poo and keep her stool soft and easier to pass.

For a while, you may want to consider allowing her to poo in a nappy. If her poo becomes more frequent and softer, she should regain the sensitivity in her bowel to know when a poo is coming. If she knows a poo is coming, she will have time to tell you she needs a nappy.

This allows her to get back into a more regular habit of pooing. You may begin, again, to see a rhythm or habit to her toileting, such that she poos at a similar time every day or so, without pain, discomfort or the distress of a row about whether she uses the toilet or not.

With the pooing back on track, you can then address her potential fears of using the toilet. Talk with her about how unpleasant, or painful pooing in the toilet used to be, and then reassure her that her poo won't hurt any more.

After that, you need to take the pressure off the toileting, and give her back responsibility for the pooing, such that she chooses a nappy or the toilet when she needs to go. I think that, in time, she will opt for the toilet more than the nappy as it is quicker, more efficient and easier.


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