Note: Although Dr. Powers was teaching this technique specific to CF children about 2-4 years old, I think it would work for any child that needs to focus on eating/gaining weight. CFers often have trouble maintaining adequate weight and generally have to eat more than healthy children. You can read more about that here.
Here is the Get-Your-Kid-To-Eat-More technique in a nutshell:
Kids love praise and attention from parents, so use that to your advantage at the table. When they are doing something good, turn that attention on. When they are doing something you don't want, turn the attention off. That's right. No scolding, no prodding, no power struggle (that's attention reinforcing the wrong behavior). By the way, this technique called "Differential Attention."
- First, make sure all the "courses" are there at the start of the meal -- and make them those high-calorie, high-fat choices. Also, check the clock. Your meal time shouldn't run longer than 15-20 minutes.
- Sit with the child for the meal, and get rid of distractions: TV, toys, radio, etc. Hopefully you are eating something too!
- When the child eats or does anything that is good eating behavior--like loading a fork with food, chewing, swallowing, or even reaching for a piece of food--praise them, and be specific. Dr. Powers described this as a "play-by-play" announcing of the meal. It does seem a little contrived at first, but actually, it's lots of fun. Here are some of Peter's favorite phrases:
• That's wonderful. I love how you are eating your . . . . (specific food item).
• Awesome. You are building strong muscles by eating your food. Show me your muscles!
• Wow! That's a big dinosaur bite!
• That's two bites in a row!
• High Five! You are such a great eater.
- Ignore them when they are not eating, like when they complain about the food or delay. And--this is the hard one--when they are talking to you or asking a question while they aren't eating.
Dr. Powers showed us a video clip demonstrating the technique. When his son wasn't eating, Dr. Powers would turn to the side and not look in his direction. Sometimes this lasted a long minute or so, and his son got quite loud saying, "Dad! Dad!" But, as soon as his son started to eat again, Dr. Powers gave a positive, specific, compliment and answered any of the requests that his son had asked him while he wasn't eating.
You can find more about the clinical trials that successfully used this and other behavioral therapy techniques in CF families here:
- Examining clinical trial results with single-subject analysis: an example involving behavioral and nutrition treatment for young children with cystic fibrosis.
- Randomized clinical trial of behavioral intervention and nutrition education to improve caloric intake and weight in children with cystic fibrosis.
Our meal-time routines have become a lot more fun with these ideas.
Medication is an important part of every meal.
Without medicine, Peter would not be able to digest his food.