Mealtime Power Struggles
There are times in every parent's life when gathering around the dining room table feels more like wartime than mealtime. Complicating the “eat-your-food” power struggle for parents of kids with cystic fibrosis is the knowledge that good nutrition is integral to long-term survival.
Dr. Scott Powers, the director of the Center for Child Behavior and Nutrition Research at Cincinnati Children's Hospital, encourages parents to become “junior nutritionists” in order to maximize energy per bite in the foods they cook and present to their children.
“Addables and spreadables are the key,” says Powers, who gives parents easy-to-implement ideas about how to add calories to their kids' food, including:
- Cooking vegetables in butter
- Adding butter to a PB&J sandwich
- Picking out the bread with the greatest number of calories per slice
Powers knows that meal prep is only half the battle, however, especially with the under 12 crowd. Once the food is served, parents then have to navigate their child's dawdling or downright obstinate behavior, not an easy thing to do when the health stakes are high.
In fact, families sometimes get trapped in a self-perpetuating power struggle over food, with the end result being the child with CF getting fewer calories and less nutrition, the exact opposite of what the parents want.
“If the child is doing something that we want them to do, we might inadvertently ignore it,” says Powers, a pediatric psychologist by training who helps parents maximize mealtime calorie intake for their children. Ignoring good behavior and focusing on bad behavior can create the “perfect nutrition storm” at mealtime.
“If they do something inconsistent with what we hope they do, we're going to talk to them, and command them to eat. Often, that's very reinforcing for a child. Even if it's a parent who's not happy, it's still a lot of attention.” Powers says the children will then learn to be uncooperative at the dinner table in order to get attention from mom and dad, a stressful situation for any parent, even without CF as a factor.
The more stressed parents become, the more likely a child is to dawdle during mealtime; and, of course, the more the meal drags out, the more stressed the parents become. To top it off, studies indicate that longer meals don't always result in a higher calorie intake. It's a no-win situation for everyone.
What's a parent to do?
Powers and his colleagues agree that the parent-child interaction at mealtime is instrumental in helping kids with cystic fibrosis get the nutrition they need. To facilitate successful mealtimes, they suggest:
- Set rules and expectations for mealtime, just as you would for children without CF, and then enforce them
- Keep mealtime to 20 minutes
- As hard as it may be in the beginning, compliment or comment on your child's good eating habits and ignore the dawdling
Changing mealtime behavior – everyone's – takes time, commitment and practice. The good news is that, if you need some extra support or guidance, you can find it at your nearest CF clinic. There, you'll have access to nutritionists, social workers and other health care providers ready to partner with you in your quest for mealtimes that pack in the calories, while maintaining the peace.
- Powers, S. W. (2005). A tool to individualize nutritional care for children with cystic fibrosis: Reliability, vailidity, and utility of the CF individualized nutritional assessment of kids eating (CF INTAKE). Children's Health Care , 3 (2), 113-131.