Mealtime Stories for Children with Feeding Difficulties
By Ashley Opp Hofmann
Photo at right: Mealtime Stories present goals to children with feeding difficulties through personalized stories.
Mary Neifert and Maggie Tai Tucker, both students at the University of Washington (UW) in Seattle, have tapped into the appealing nature of stories to support the occupational therapy goals of children with feeding difficulties. For their master’s thesis, Tucker and Neifert developed the concept of Mealtime Stories—small, personalized books that present feeding goals in child-friendly language. The books also contain photos of the child’s family and friends and of specific types of food they are learning to eat. In 2007, Mealtime Stories won first place in the Maddak competition in the Student category at AOTA’s Annual Conference & Expo.
The Story Begins
“I have to go back to my own personal history to explain the origins of Mealtime Stories,” says Tucker. “When I was little, my parents encouraged me to create my own books about things that were scary or difficult for me, such as lightning storms.” Now that Tucker has her own children, 4-year-old twins, she found herself using modern technology such as digital photos and desktop publishing software to make, for example, a book to prepare her kids for the move to a new house.
“Stories are reassuring to children,” Tucker explains. “It’s anxiety-reducing to have a familiar story read to you and to know how it’s going to turn out. Kids are also fascinated by stories about things that are hard for them.” The key, says Tucker, is delivering the message indirectly. For example, flipping off the lights and telling a child who is afraid of the dark, “Look! The dark is okay!” is counterproductive. However, a story about someone who is afraid of the dark but learns she can see by the light of the stars and moon might reassure the child over time.
In 2006, Tucker did an independent study course in feeding at Children’s Hospital and Regional Medical Center in Seattle. Occupational therapists on staff suggested that she attend a support group for parents of children with feeding difficulties. “Listening to how these parents were struggling with feeding, how frustrating meals could be, and how difficult it was for them to stay positive, or even neutral, about their child’s eating behaviors, I thought, ‘What about making some books for them?’” Tucker says. She suggested it to the hospital staff, who encouraged Tucker not only to go ahead with it, but to make it her master’s project.
The Main Characters
Tucker got lucky in being assigned Neifert as a partner. In UW’s occupational therapy program, faculty present students with different master’s project ideas and leads, students think about their special interests and the populations with whom they want to work, and faculty make the final assignment based on what and who they think would be a good match. Neifert, who wants to work with children and was extremely interested in the Mealtime Stories project, was paired with Tucker.
Neifert and Tucker found volunteer families through Children’s Hospital and through UW’s Experimental Education Unit, a developmental preschool. “We got to know the families first through phone calls and e-mail, introducing our ideas, finding out about their child’s history with eating, and learning what was going well and what was still a struggle,” Neifert said. She and Tucker spent time with all of the families at home as well.
Four families participated and the children (coincidentally all boys) ranged in age from 2 to 7 years. The 2-year-old had had severe gastroesophageal reflux and food allergies as an infant and was fed by a gastric tube. The 3-year-old was fed mainly by a gastric tube as well and had had many invasive treatments due to cancer. The 4-year-old consumed mostly Pediasure by bottle and had a history of nursing and bottle-feeding difficulties. The 7-year-old ate small amounts of a limited variety of foods and had slow growth and failure to thrive.
“We didn’t have any expectations or hopes that [this project] would be just the right thing that would move the child on to eating. We were really just trying out a concept, so it had a very relaxed feel,” explains Neifert.
Tucker and Neifert initially spent 1 or 2 hours with each family, getting to know them and obtaining photos for the books. They returned a second time with a draft of the book and asked the parent to read it to the child to determine what phrases sounded awkward, where the child lost interest, or what was pushing the child too far. “We think [reading the draft] is a crucial step in our process. If you observe the child carefully, almost every book we tried had one or two pages where he tuned out or wandered away,” Tucker says. At that point the parents often had helpful ideas, such as adding a new food their child was trying to the story.
Mealtime Stories was not a research study, but parents anecdotally reported that their children made significant progress in therapy after the books were introduced. The occupational therapists treating them reported the same.
Because of their role as students, Tucker and Neifert’s project does not reflect how they envision occupational therapy practitioners using the books. “A therapist would just incorporate it into their regular sessions; they wouldn’t have to set up separate times to collect photos or talk about what the books might look like,” Tucker says.
Neifert agrees. “In a clinic, school, or hospital setting, the therapist would already have rapport with the family and know that child’s history very well. Our process was more time-consuming than it will be for future therapists who might use Mealtime Stories.”
Because of the time-consuming nature of making the books from scratch and the importance of certain nuances in writing them, Neifert and Tucker have created a guidebook and a CD with story templates and photos of food items and children eating and playing. (It was this guidebook and CD that won the Maddak award, which recognizes innovative occupational therapy products.) They expect to make these available for distribution within the year.
Kathy Stewart, MS, OTR/L, FAOTA, an occupational therapist at Boyer Children’s Clinic in Seattle, has integrated the Mealtimes Stories concept into her own practice. “Once I learned how to create Mealtime Story books for children, I made several for my pediatric clients at an early intervention center,” said Stewart, who was one of several field testers for the guidebook and CD. “I've expanded the notion of these books to include other areas of childhood occupations, such bathing, playing, following routines at school, and understanding safety rules at home and the community. I have found them to be an effective teaching tool for children, as well as their parents," Stewart says.
Retelling the Story
For Neifert and Tucker, creating books is an opportunity to open a new chapter in children’s lives. “For children who have struggled and struggled with it, feeding can become a very high-anxiety activity,” says Tucker. “We’re trying to recast [feeding] in a new context and help them retell their own story.”
Neifert and Tucker will present Mealtime Stories in a short course at AOTA’s Annual Conference in Long Beach, California, in April 2008. For more information on Mealtime Stories, visit www.mealtimestories.com.
Ashley Opp Hofmann is AOTA’s senior staff writer.