EARLY DAYS
Feeding is one of the first ways that babies get to know their mother and the outside world. From their first moments, babies learn how their mother responds to their hunger. Before they even know their mother as a mother or recognise feeds, they learn that they cannot always get what they want. Through feeds they discover that there is a world outside their body over which they have little control.
In the early days, feeding is often the only way a mother can soothe her baby's cries. She gives characteristics to her baby based on how they feed. One mother might see a baby who latches on easily and suckles quickly as good natured, while another might regard a similar baby as greedy. A slow feeder could be seen as lazy or, conversely, peaceful.
The mother's own relationship to food is important. If she is sensitive to feeding and being fed, to giving and being given to, to control and being controlled, then these feelings in her will determine how she understands her baby's behaviour. For example, a mother who feels deprived may feel her baby's cries are of hunger rather than from overfeeding. Another mother who feels vulnerable might feel that her baby's cries are manipulative or controlling and she might withhold a feed.
In this way the physical characteristics of mother and baby - the mother's supply of milk, the size of the teat, the shape of the breast, the baby's oral muscle tone or metabolic rate, combine with mother's own wishes and anxieties during the feeds. With such a potent mix, it is small wonder that feeding difficulties develop and that they can easily get out of hand.
ANXIOUS TIMES
Six weeks after Jack was born his maternal grandmother died of cancer. His mother had been very close to her and had nursed her during her illness. Although it was a normal pregnancy Jack was a small baby, and when he was two months old he was hospitalised for a severe tummy bug. When he was discharged after a couple of days he had lost some weight, although the doctors were not overly concerned.
Despite her health visitor's reassurances and advice to relax about Jack's feeds, his mother became extremely anxious that he was not eating enough. She spent hours trying to persuade him to take his milk - there was barely a minute between the end of one feed and start of the next. But Jack did not gain weight fast and appeared uninterested in feeds. He remained a slight, delicate-looking and clingy child.
At around two years old he developed another tummy bug, not as severe as the first, but he was sick for ten days, and his mother worried that he would lose weight again. When he was better he returned to nursery accompanied by his mother. At snack time, sitting on his mother's lap, he started to force grapes into her mouth. She turned her head away, asking Jack to stop and telling him she did not like it, but he persisted.
The nursery assistant who saw this interaction was able to help make the connection between what Jack was doing and his mother's own anxious force-feeding of him while he was ill and also as a baby. She was then able to see how her worry about his weight and well-being might have made things worse, and she began to allow him to decide how much to eat.
IN COMBINATION
This case study shows how a combination of events interfered with Jack's relationship to food. It is possible that his mother, exposed to her own mother's death, may have worried that her ill baby could also die. Feeling emotionally depleted herself, she may have thought that the only resource she had to comfort him was food. She may also have attributed some of her distress and wish for a mother to comfort her, to her baby, feeling that he needed feeding and mothering more than he actually may have done. These factors combined to make it hard for her to learn to read accurately the messages of his appetite. Food became connected to emotions rather than to hunger.
Sometimes difficulties arise when a mother tries to wean a baby off the bottle or breast. One depressed single mother from a deprived background offered her son sugar lumps to compensate for the loss of his feed. This would particularly happen at the moment of transition between nursery and home, as if mother could not bear either her own or her child's pain at the prospect of loneliness.
Once this mother was helped to understand how her feelings were making it hard for her to say no to her child, she began to find it easier to offer alternative, healthier ways of distracting the child during transitions. She also started talking with her child.
Often difficulties do not show until a baby becomes a toddler, when they begin, appropriately, to want more control over their body. This phase is particularly difficult if the adults around experience this powerful wish for control in their child as a rejection of them. In the first example, it was only when Tamara's father began to recognise that he too sometimes felt terribly victimised by battles for control in his own family that he was able to relinquish some of his battles over food with Tamara and allow her to eat more of what she wanted.
TAKING CONTROL
Eating difficulties are complex, but if children in your care are beginning to be difficult about eating - whether too much, too little or too choosy - what can you do?
- Ask yourself if there may be reasons why you or the child's parent are losing sight of their true hunger cues.
- Is a battle for control interfering? If so, step back and consider whether it is all right for the child to want to take more control of what they eat (after all, growing up is often about taking more control over the body).
- Are there ways in which the child can be allowed more choice over where, when and what to eat?
- Ask yourself if you are attributing hunger to the child when you are hungry or tired yourself. You may be mistaking their appetite for your own.
- Above all, try to relax. Anxiety and heightened feelings about the situation will make it worse.
Remember, not many children deliberately starve themselves. Left to their own devices, following the cues of their own bodies, most children end up with a reasonably healthy mixed diet.
This article is based on a Nursery World 'Behaviour' series by psychologists at the Anna Freud Centre in north London, a registered charity, offering treatment, training and research into emotional development in childhood
