When busy parents rush home and the first thing they do is rush to put dinner on the table, they are often perplexed when junior won’t eat. The same child who was cranky from hunger before the parent arrived may be much less concerned about dinner when the parent appears.

What’s going on? Parents are goal oriented, busy and scheduled. Little children are interested in the returning parent, not the schedule of chores that need doing before bedtime. They missed their mommy and daddy. Children show they want some attention and affection. In most cases, bonds restore easily with a little attention. When parents give a little time after returning from work, bonds restore easily. A little playtime before the meal makes dinner easier for everyone.

Sometimes, however, the longing for parents creates more serious eating problems. Longing is part of the picture for 2-year old Amanda, a child I am seeing for food refusals and slow weight gain. Early in the therapy, we examined Amanda’s growth chart. We realized that Amanda’s significant weight increases occurred when mom, a teacher, was home on extended holidays. Part of the problem also lay in with feeding, speech, and movement delays.  A confirming clue appeared. Despite her ability, Amanda refused to hold her own bottle. It was as if she wanted to be babied and did not want to grow up. Her stay-at-home dad helped, too. Amanda’s eating improved when we tightened up the schedule and she fed herself with less assistance. Mysteriously, she began to hold her own bottle. Amanda has been growing taller rapidly. Her rate of weight gain increases more slowly. Mealtimes became less challenging.  Then, a new problem appeared.

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Amanda began to vomit her bedtime milk. She could not afford to lose the nutrients. I guessed that Amanda needed more time with her working mom. I suggested that mom and Amanda go for a little walk after dinner. An after dinner stroll fit the family schedule, improves digestion and creates unhurried time for mother and daughter to hold hands. Sometimes, dad went along. Vomiting ceased within a week.  Amanda’s parents’ attention to the interplay of emotional and eating set everyone on the right path.  We are all looking forward to more progress.

Children grow up in body and mind even when they are affected by some kind of delay or medical conditions. When a medical or developmental problem masks signs of inner maturity, the drive to grow remains. The drive to self feed, for example, exists even when most people miss the child’s cues. In the parents’ mind, the child remains, unconsciously, immured in the NICU, the disease or the technical definition of the delay. Professionals inadvertently contribute to this feeling when they focus in on limitations.

When a growth problem hard to understand, parents and professionals often focus on food instead of the processes related to eating the food. The important adults should the child as a whole person with a desire to grow into increasing mastery.  When the child is kept from mastering of self-feeding within their limitations, feeding struggles and refusals can start because the child does not yet recognize the delay. Children, especially infants and young toddlers, only recognize their desires. When we do not recognize others’ desires, emotional disconnects develop. In the case of feeding, mealtimes can be unsuccessful nutritionally and socially. Here is what happened with Pearl, an underweight toddler with a transplanted liver.

 A long list of drugs suppressed Pearl’s immune system in order for her new liver could make itself welcome in her body. The same drugs, though, irritated her mouth, throat, intestines and suppressed her appetite. The very lifesaving medications were one reason Pearl was underweight. To make things more challenging, Mary, the mother, and, Tom, the dad, were working through a difficult divorce. Dad was out of the house. Loss of a parent and the stress of a divorce can also a make a child want to eat less. And, no one had told Pearl’s parents that keeping her from self-feeding caused Pearl to fight feedings.

Mom, a nurse, understood that drugs can lower the appetite. It was hard, at first, for her to understand that an underweight with medically-induced reasons to a poor appetite should not be force fed, let alone to self feed.  The daily feeding struggles further diminished Pearl’s appetite. Mom was inwardly experiencing the vulnerable baby and not the child strong enough to fight her way back to health and mom during feedings. Mom had to grow past the challenging baby months to become the mother of an increasingly healthy toddler capable of asserting her own desires.

Another area of infantilizing was the little child’s table. Children do better watching grown-ups Infants and young toddlers need adults or at least an older child to model self-feeding in order to eat well. That common piece of furniture had to go.

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The struggles ceased. Pearl began to gain weight. Her need for medicines decreased as her body adapted to the new liver. Sessions decreased from twice a month, to monthly to every other month. I was getting ready to close the case.  A call came. Pearl’s weight plummeted. That nice healthy growth curve that took months to achieve sank like the Titanic. What was the iceberg, I wondered? I rushed up as soon as I could.

By chance, I arrived as mom was taking Pearl to the school bus in a stroller. Pearl and her mom lived in a high rise whose set-back entrance felt like a mile to the bus to mom who had to be at work on time. Pearl could do the walk, albeit at toddler pace.  At the same time, a working, single mom definitely is busy. Those few extra morning minutes provided by the stroller could make a big difference in terms of getting to work on time. Looking at the stroller, then, looking at Mary, I said, “Are you babying her again?” I saw an abashed face with an acknowledging smile. Mom had backtracked on Pearl’s self-feeding and other parenting strategies we had worked on. We all got back on track. Pearl’s weight climbed back into the healthy range.