Theoretical basis of Mealtime Stories

The original Mealtime Stories project included interviews with therapists (OTs, SLPs, and social workers), interviews with parents, structured observations of children, and pilot work conducted with a range of families and therapists. Please note that this project was not a research study; no attempt was made to measure the effect of this supplemental intervention on clinical outcomes. However, feedback from parents, therapists, and children in follow-up surveys has been overwhelmingly positive.

For this project we conducted a thorough review of the literature on pediatric feeding problems, mastery motivation, parent-child feeding interactions, and the therapeutic use of storybooks with children. Here is a summary of what we learned:

About characteristics of feeding problems:

• Up to 25% of typically developing children, and 35-80% of children with developmental delays, experience feeding or eating problems (Babbitt, Hoch, & Coe, 1994).
• In a study of factors contributing to feeding problems, researchers found that behavioral issues occurred 85% of the time (Burklow et al., 1998).
• Maternal depression or other psychosocial factors may combine with a child’s temperament to exacerbate a child’s poor feeding capacity (Beautrais, 1982; Manikam & Perman, 2000).

About young children's mastery motivation:

• Beginning around age 2, toddlers begin to experience mastery motivation to meet social criteria (Barrett & Morgan, 1995).
• Toddlers are interested and persistent in attempting tasks that have enhanced social meaning (Bober et al., 2001).
• Parents use proximity, interactive speech, scaffolding activities, and routines to engage children in mealtime activities (Humphry, 2002; Justice, 2005).

About parent-child feeding interactions:

• Even when a feeding aversion begins with a clearly identified illness such as cystic fibrosis, “mismanagement” of feeding resistance can lead to maladaptive interactions (Stark et al., 2000).
• In an observational analysis of feeding interactions, eating difficulties were significantly associated with negative mealtime behaviors by parents and disruptive mealtime behaviors by children (Sanders et al., 1993).
• The more under-nourished an infant becomes, the more strain is shown in the parent-infant interaction (Casey, 1983).
• Children diagnosed with “failure to thrive” ate more during an intervention period focused on improving mother-child interactions – and less during an intervention period focused on caloric intake (Sullivan, 1991).
• Researchers found that 5-year-old girls’ intake of fruits and vegetables was positively related to their parents’ intake of these foods, and negatively related to greater pressure to eat these foods (Fisher et al., 2002).
• When researchers told preschoolers repeatedly, “finish your soup, please,” the preschoolers ate less and made more negative comments about the soup. This effect was exacerbated among children whose parents reported pressuring them at home (Galloway, Fiorito, Francis, & Birch, 2006).

About the use of stories with children:

• Parents can read storybooks with a child to scaffold new behaviors or new attitudes (Justice, 2005).
• Stories provide children with encouragement, support, and reassurance (Anderson, 2006).
• Books allow children to visualize images, explore roles, and see similarities between a story and their own experiences (Jalongo, 2004).
• With multiple readings, a child can focus on different aspects of the book, prompting better understanding and more questions from the listener as compared to books that are read fewer times (Partridge, 2004).
• Books with photorealistic pictures are more easily understood by typically developing young children than drawings (Simcock & Deloache, 2006).

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