Mealtime Madness: OT’s role in pediatric feeding

Dr. Paula Rabaey with OT students at the Minnesota State Fair. 

When thinking about the Minnesota State Fair, food is usually one of the first things that comes to mind. Food and crowds. That makes it an ideal location for Dr. Paula Rabaey to conduct her “Mealtime Madness” study on pediatric feeding and eating challenges.  

Rabaey, an associate professor in the occupational therapy program at the University of Minnesota College of Pharmacy, specializes in pediatrics, particularly infants and young children. Alongside her colleague Dr. Maria Baldino and a handful of OT students, Rabaey recruited fair-attending families to participate in her survey about mealtime challenges with young children. 

“As occupational therapists, we are concerned with everyday occupations and meal time is one big occupation, something we have to do several times a day,” Rabaey said. “It's parents and children together, which is a very important bonding and learning opportunity…child development impacts the mental health of the whole family.”

A child’s problem with chewing, swallowing, or food textures can lead to more complicated medical issues later on, Rabaey said. Some children with sensory issues end up eliminating entire food groups, she added, causing nutritional deficiencies or preventing them from eating the same foods as their siblings. With a busy society and the rise of screen time, some parents of developing children struggle with introducing solid foods and getting their child to sit at the table or expand their diet. All of these factors can induce stress for families.

“There are very critical periods of development where babies are learning and if you miss those then that can cause issues,” Rabaey explained. “If babies aren't given the opportunity to explore and learn how to manipulate solid foods and chew over and over, they are not going to develop the skills that they need to progress to the textures that typically all developing kids are eating by the age of one and two.”

Students volunteering with Rabaey scouted for parents and caregivers of children between two and six years old at the state fair, though no formal diagnosis was required. Participants simply had to report experiencing at least one of four mealtime behaviors or challenges. Rabaey defines these as “interactions that limit the amount of food a child eats, create conflict between family members, or disrupt the quality of family interactions while eating,” as well as “behaviors that keep children from achieving adequate nutrition or growth or that keep family members from participating in the social routine of mealtime.” Learning about the needs of families helps Rabaey know what support may help them in the future. Her survey also asks parents or caregivers what resources they’ve consulted— books, blogs, podcasts, social media, etc.— and the efficacy of those resources.

“We want to be able to help families navigate through everything that they find and provide better support,” Rabaey said. “The other big piece is that many families whose children need feeding therapy [face] huge wait lists and full clinics. In fact, I had a mom fill out the survey at the fair who said two of her children who have been on a waitlist for feeding therapy for two years.”

In rural Minnesota, access to care is even more difficult, Rabaey said. When she lived in the city of Marshall, some of the families she worked with had to drive to neighboring states two or three hours away to find specialty care. 

Rabaey and her team collected around 100 responses from fairgoers. Kiara Clusiau, a second-year OT student at the college, said the opportunity to participate in Rabaey’s study at the fair helped her learn more about feeding issues and how widespread they are. 

“It was clear from the reactions of the participants when we brought up the research topic of feeding that this is an impactful, often stress-inducing topic that multiple families deal with,” Clusiau stated. “Feeding and eating is a basic need that can cause tremendous stress and familial relationship issues if struggles are occurring.”

An incoming cohort of the Minnesota Leadership Education in Neurodevelopmental and related Disabilities (MNLEND) Program will be tasked with analyzing the data from the survey and developing a second, more qualitative phase of the study. Rabaey also said that next summer she plans to work with an OT student completing her capstone project at the Masonic Institute for the Developing Brain, which would develop materials for a potential Project ECHO series around mealtime challenges for families. 

All of this works hand-in-hand with Rabaey’s plan to launch a lab at the college centered on not only pediatric feeding and preventative health, but also early attachment and bonding experiences. Her connections at the Masonic Institute for the Developing Brain and in various neonatal intensive care units (NICUs), the many students she’s working with on related projects, as well as international collaborations she’s fostered will all help fuel that lab. And her lab, she hopes, will help ensure children and families facing problems around eating aren’t neglected.  

“There are a lot of children who fall through the cracks. I've seen family members with major concerns around feeding and nutrition who got ignored and told to wait and see if [the child] outgrows it— a lot of times that doesn't happen,” Rabaey said. “My main vision is to be able to help families who are struggling with this and who don't have access [to support]... We're missing this huge window of opportunity to help families and children.”