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Mealtime support is crucial for children who have been adopted or have experienced foster care

Mealtime offers a chance to bond with your foster or adopted child and help them learn new eating habits. Adoption Medicine Physician Judith Eckerle, MD, shares tips for parents.
It is important to model healthy mealtime behavior for a child who may have experienced food insecurity prior to adoption. Adoption Medicine Physician Judith Eckerle, MD, shares mealtime support tips for parents.

Good eating habits form the basis for lifelong health, and these habits begin in infancy.

Children who join their family through foster care or adoption may need time to learn new habits and routines around food in your home. Children who faced early adversity and trauma may have experienced food insecurity—which includes not getting enough to eat, having unpredictable mealtimes and having access to a limited selection of foods and textures.

You can help your child adjust by learning about your child’s former habits, experiences and preferred foods. The way your child was fed in the past will affect the child’s transition to a new diet.

We asked Adoption Medicine Physician Judith Eckerle, MD, director of the Adoption Medicine Clinic at University of Minnesota Masonic Children’s Hospital, for advice regarding mealtime support. Here are her tips.

Founded in 1986, the University of Minnesota Health Adoption Medicine Clinic is an outpatient clinic serving families with children in adopted domestically, internationally and in foster care. Learn more about our services.

Ask your child or their previous caregivers about their food preferences.

By developing a comprehensive understanding of your child’s food preferences, potential allergies or intolerances and any other feeding problems, you can better provide appropriate mealtime support for that child. To become more informed about your child’s preferences, consider asking the following questions:

  • Does your child have favorite foods? What are they?
  • Does your child prefer to eat a lot or a little each day? Are they used to a varied diet or have they often eaten the same things over and over?
  • Do they like certain food textures (soft, crunchy, spongy, tough) more than others? What textures has the child regularly eaten in the past?
  • If your child has been on a soy-based formula, then it is important to ask why. It is unusual for infants and young children to have problems digesting lactose. Lactose intolerance typically begins in adulthood.

If you visit your child’s orphanage or foster home, you may want to consider watching how the home handles mealtimes and eating habits. You will see whether the children feed themselves, are fed by a caregiver or fed with a bottle propped up on a pillow. Note if mealtimes are quiet with little chance to talk, or if they are lively and social. Find an opportunity to ask your child’s caregivers about feeding issues, including the following questions:

  • Does the child have any feeding problems such as choking, trouble swallowing or vomiting?
  • Does the child have food allergies or other types of allergies?
  • Does the child routinely take vitamins, iron or other supplements?

Most children handle the change to a new diet fairly well, but it helps to serve familiar foods for your child during the first few days or weeks following adoption and integration into the home. After a few days, begin to serve new foods along with more familiar foods. Listen to and respect your child’s food preferences.

Understand why your child is rejecting food.

Some children may reject food no matter what options you offer or how loving and supportive you are. Food rejection may be due to the unfamiliar textures of food. Most institutional food is bland, liquid or pureed. If a child was not introduced slowly to solid foods, he or she may need to move slowly from purees to chunky and solid foods. Children may also reject food because of past traumatic feeding experiences. For example, in some orphanages children are fed quickly with a large spoon or are not given enough time to chew and swallow. Some may have been fed from bottles that had large nipple with big holes, which caused choking. Always remember that mealtime may not have been a good experience for your child in the past.

Be vigilant for digestive issues.

Some children have digestive problems caused by parasites or unaddressed medical conditions. This can cause diarrhea and cramping. Bacterial or parasitic infections can cause poor appetite due to chronic stomach pain and vomiting. If you child has had symptoms such as diarrhea, vomiting, constipation, bloating or abdominal pain, have your doctor examine your child. The symptoms may be due to infections, diseases, or severe malnutrition.

Low muscle tone can affect feeding.

Low muscle tone in the mouth can cause feeding problems. Children with low muscle tone sometimes drool or hold their mouths open. They are at risk for choking or aspirating their foods. Premature infants and children with neurological problems are at higher risk for these challenges. Every child who has trouble feeding should receive a thorough medical exam. If needed, the child will be referred to a pediatric specialist.

Make mealtime enjoyable and model healthy mealtime behavior.

Have your child or children help prepare food, set the table and take part in mealtime planning, prep and cleanup as is age appropriate. Eat meals together as often as you can away from screens and other distractions. Talk about your day, share pleasant memories and discuss upcoming events.

It’s also important to model healthy mealtime behavior for your child or children. Modeling is another way to introduce new foods. When your child sees that you enjoy a certain food, he or she is more likely to try it. But be patient during this process. Even if a child rejects a food one week, they may eat it the next it is served. Encourage but do not pressure your child to eat their food. Feeding in a loving way nurtures your child and strengthens the bond between you. Your child will begin to look to you to meet his or her needs. You are fulfilling your child’s hunger for food as well as a need for security through a trusting, consistent relationship.

Understand and address your child’s survival behaviors.

Often children who come from an orphanage or have been placed in foster care did not get enough to eat. They may be underweight or used to having little food. Some children may:

  • Eat as much as they can, as quickly as they can.
  • Eat quickly fearing that caregivers or other children will take their food away.
  • Eat as much as much as they can, pocketing food in their mouths.
  • Hide or steal food.
  • Eat large amounts of food and ask for more between meals.

The child may have learned these behaviors as a means to survive. We usually see these behaviors decrease or disappear within 6-12 months of adoption, depending on the age of the child. Children will begin to adjust their food intake on their own and may self-regulate when they:

  • Understand that food will be there when they are hungry.
  • Feel assured of your love and support.
  • Have caught up in their growth (typically in the first six months).

Your child’s appetite may vary greatly from day to day – a huge appetite one day and no interest the next day. You will want to make sure that your child knows there will always be enough food. It may be helpful to keep a snack on hand in case he or she wants more.

For children who eat ravenously, try serving smaller portions. Then, when the child asks for more, you can respond by giving more food and saying, “Of course you can have more food”. You are showing your love in a concrete way. Allowing them figure out when they are full will be important as they grow and become more independent.

Your child’s feeding behaviors might regress during this time. For example, younger children who are able to feed themselves may want you to feed them. During feeding, hold, talk to, smile at and make eye contact with your child. Don’t worry about “babying” your child. You are meeting their needs at his or her present level of emotional development. Once needs are met, your child will be able to move on to the next level.

Supplement vitamins may be needed as your child “catches up.”

Children who are malnourished may need extra iron and vitamins during their period of catch-up growth. This period can last up to six months after placement or adoption. Your child’s iron and vitamin D should be checked soon after placement or adoption, and again over the next six months. Supplements are the usual treatment for low iron. You can also offer foods rich in iron and fortified with vitamins and minerals.

Contact the Adoption Medicine Clinic.

The University of Minnesota Health Adoption Medicine Clinic works with families worldwide for pre-adoption consultations and referral reviews. We also see families from all over the world who travel to visit our clinic in person for Comprehensive Well-Being Assessments.

Learn more about our services. 

Editor's note: This article was originally published on Aug. 22, 2018, and has been updated to ensure continued accuracy and comprehensiveness.