Before choosing strategies involve Jack’s parents in prioritising goals for his feeding.

This may involve discussions aimed at increasing the parents understanding of:

• Jack’s food needs – too much milk is reducing appetite for other foods and limiting opportunity to develop skills to manage lumpier foods. Bottles are not appropriate for Jack at this stage.
• Typical child growth. Unrealistic expectations for Jack’s growth are contributing to Jack’s feeding difficulties.

Once goals have been prioritised choose one or two strategies that will assist in achieving goals. Choose strategies that parents feel confident they can achieve and that build on Jack’s strengths. As these are implemented further strategies can be added.

Suggested strategies may include:

• Reduce milk intake and cease use of bottles. 

Possible steps to achieve this might include:

• No bottles during the day – offer drinks of water in a cup.  May use bottle on waking and before bed in the evening.
• Once Jack is managing this, then eliminate morning bottle followed by bed time bottle.
• Aim to reduce milk to a total 500-600 mls/day.
• Establish sharing of feeding tasks with Jack and his parents.

Parents:

• Provide regular meals and snacks – include new foods and textures with familiar foods.
• Provide opportunity to explore new foods and textures even if messy and food is not eaten. 
• Allow Jack to feed himself – perhaps negotiate turn taking with feeding.   
• Meal and snack times have a clear beginning and end. Only water is provided in between.
• Mealtimes are limited to 20-30 minutes.

Jack:

• Determines when he has had enough.  Coercion and force feeding are not used.
• Focus on social interactions and enjoyment of the mealtime rather than the amount of food eaten.
• Build on Jack’s strengths e.g. Jack has shown at child care that he is more interested in food and self-feeding when milk is not available.

Resources

• Healthy eating and play for toddlers (1-2 years)
• “Try it – you’ll like it” Vegetables and fruit for children
• Why no sweet drinks for children
• Managing toddler mealtimes
• Raising Children Network
• Ellyn Satter Institute
• Mealtimes - Relaxed and Social video
• Feeding Independence video

Follow-up

Regular follow up is recommended to:

• Evaluate progress and effectiveness of strategies. Progress may be measured in terms of changes in both Jack’s eating and parental anxiety.
• Build on initial strategies and ensure continued progress in Jack’s feeding development.

With reduction in milk intake and consistent implementation of agreed strategies Jack should show significant improvement in his eating over the next few months. The variety of foods and textures will gradually increase as he progresses towards becoming an independent feeder.

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