Consider feats of endurance; running = marathon, hiking = Everest, cycling = Century ride. Competing in any of the above brings about daunting emotions of inadequacy, In contrast, if asked to do these same activities in tiny comparable amounts, I could confidently participate. Dare I say, thoroughly enjoy it! Yes, we as adults have a variety of skill levels and experience with these activities. However; even if not self-proclaimed runners, we have seen others run as we drive down the street, we listen to stories about our neighbors/friends running endeavors, we may even dream of running; so although “not runners”, we most likely are familiar with the task and various running distances.
In contrast with our littlest of learners, eating may be a completely new task with little to no familiarity, especially if they are tube fed. Additionally, eating may involve a prolonged history of vomiting, pain, or persistent discomfort. Eating may be new, scary, or downright hard. It’s hard to do new and difficult things! Which of us likes jump into something that is new and hard, especially if we are unsure of our success? So as therapists and caregivers where do we begin? I propose: Tiny.
Tiny is a successful strategy that can be implemented in all areas of learning and development. Recall he zone of proximal development by Vygotsky? (Distance between what a learner is capable of doing unsupported and what they can do supported. It s the range where they are capable but only with support from someone with more knowledge or expertise) I find tiny extremely useful especially when engaging in feeding and swallowing therapy. Tiny can take on many forms from tiny changes in taste or texture, tiny bites, tiny sips, tiny utensils, tiny cups, tiny interactions, and tiny mealtime routines; all with the overarching theme of tiny demands. Implementing tiny builds confidence in our tiny eaters, but it even can work with our biggest of learners (Teens).
The concept of tiny allows our patients to start at an area of success move forward. Building each step with confidence acknowledging that, "YES, this is different" or even "This makes me a little nervous" but ending with "I can do it!"
Here are some ways you can start:
·Tiny time periods at the table/highchair: set a timer for a little less than you think they can handle so you can be sure to end on success.
Use a condensed visual schedule (wash, food, drink, play). Building this routine is a foundation for all future success, regardless of age.
Start by offering only tiny amounts of a food or a beverage.
Use small appetizer forks for tiny bites. Here is an example: https://www.amazon.com/Toothpicks-Stainless-Cartoon-Silicone-Supplies/dp/B09F99Y5SF/ref=sr_1_8?crid=2SU743HG982K3&keywords=fun+appetizer+forks&qid=1646108376&sprefix=fun+appetizer+forks%2Caps%2C124&sr=8-8
Use tiny “shot” glasses or medicine cups for tiny tastes. Learning to “finish” a cup is a skill and that is much more easily accomplished with .25 ounce vs a 2 ounce cup.
Tiny interactions: start where the patient is comfortable. (stirring, serving, touching, smelling, and move slowly up the ladder to kissing, licking, tapping on teeth, tiny crumb bites, bird bites, etc.)
Tiny changes in texture. If puree is preferred, add a few highly meltable crumbs to the top of the puree. For example, take a Gerber puff and squeeze it until it becomes a fine dust. This helps to break through possible visual barriers that are inhibiting progress. If crunchy is preferred, use a tiny dip or a tiny lick from a tiny spoon/appetizer fork.
Tiny scheduled volumes. For teens or older children who are more in control of when they eat, try scheduling a small snack or high calorie beverage. These children may be skipping meals meals/snacks due to appetite changes or pain. Skipping meals inadvertently reinforces a decreased appetite.
For our younger children that want to graze, scheduled meals vs. grazing will also improve appetite over time.
Remember, eating is a learned skill. If an child learns that they can be successful, it promotes a perspective that eating is satisfying and fun. If an eater feels defeated because the task at hand is too difficult, or if they feel pain or discomfort; they have reinforced the narrative that eating is hard and bad. As the eating partner and teacher, it is our job to stretch our children/teens slowly from a place of compete comfort to what's next using tiny steps. I liken this process to a rubber band when explaining to caregivers. We want to stretch our eating partners from where they are; however, it is our job not to snap the rubber band by demanding too much.
Not sure where to start? Try tiny Find out what your child/teen can do comfortably and make tiny changes. You will get there!
Disclaimer: Please consult your child's full medical team when making tiny changes.