When children enjoy their food and eat well, mealtimes can be pleasurable, sociable occasions for everyone. However, for many families with children aged under five, the experience is quite different. Mealtimes can be more like battlegrounds, and parents become distressed and demoralised by the constant challenge to ensure the healthy growth and development of their child.
This is much more than 'faddy' eating, and if the difficulties are not resolved it is possible that a child's centile chart will show that their weight is beginning to be affected and their growth is faltering. If the weight drops through two centile spaces then it is time for professional help to assess the situation.
Despite the prevalence of faltering growth (previously known as failure to thrive) in children, the services available to families vary considerably. Professional responses to the situation have not always been particularly helpful. Many parents report that they have felt 'fobbed off' or that people thought they were being 'over-anxious' or 'neurotic' when they expressed concerns about their child's eating.
Parents are the experts about their children, so their concerns and anxieties should be listened to carefully. In such cases they are likely to have tried the generalised standard advice about children's eating, to no avail, so you need a clear understanding of what actually takes place with food and feeding before offering advice.
The Feeding Matters National Development Centre, based in Bristol and run by the Children's Society, offers training and consultancy to health and social care professionals keen to develop their responses to families struggling with this difficulty. Nursery nurses working with health visitors, or those working in family centres, may be particularly interested in this training.
The Children's Society ran a programme to develop a model of working with parents whose children are experiencing faltering growth that has been found to work for the majority of families. Staff from the Society videoed mealtimes in family homes where parents had asked for help and then carefully studied the tapes. A member of staff would run through what was happening with the parents and then jointly put together a plan of action with them.
Some of the videos are now used to train other professionals and, along with other experts in the field of faltering growth, the Society is working to produce guidelines for responding to parents with this problem. It is hoped that the guidelines will be included in the Department of Health's National Service Framework for Children's Health.
Parents should always be involved in discussions about how to respond to their child's feeding problems, and their lifestyles, culture and values taken into account. Early suggestions should be readily achievable, because success early on gives the impetus to persevere. It is also likely that there will be a stage when things get worse before they get better, so it is essential that parents are prepared for this and are supported to continue with the changes they have begun.
Di Hampton is manager of the Feeding Matters National Development Centre, Brook House, Pennywell Road, Bristol BS5 0TX (0117 941 5432).
