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Communication between Children and Carers during Mealtimes

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Title: Communication between Children and Carers during Mealtimes
Language: English
Authors: Harding, Celia, Wade, Candace, Harrison, Kirsty
Source: Journal of Research in Special Educational Needs. Oct 2013 13(4):242-250.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
Peer Reviewed: Y
Page Count: 9
Publication Date: 2013
Document Type: Journal Articles
Reports - Research
Descriptors: Interpersonal Communication, Caregivers, Interaction, Mothers, Parent Child Relationship, Video Technology, Child Behavior, Verbal Communication, Nonverbal Communication, Reinforcement, Repetition, Eating Habits, Young Children
DOI: 10.1111/j.1471-3802.2012.01261.x
ISSN: 1471-3802
Abstract: Mealtimes are identified as an important learning environment where socialisation and language development takes place. Caregivers can facilitate the structure of a child's learning in the mealtime setting. The aim of this study was to gain an understanding about the nature of communication in a normal population during mealtimes. This is important to help understanding about the nature of communication and interaction in children with disabilities during mealtimes. Participants were six typically developing preschool children aged from 8 months to 3:05 years. Caregivers of the children supported their child having a typical meal at home. Each mother--child dyad was video-recorded by the researchers during a typical meal for up to 30 minutes. Each recording was transcribed by the researchers, and specific communicative features were counted and coded; caregiver comments about appropriate mealtime behaviour, child verbal and nonverbal initiation, caregiver questions and comments about meal enjoyment, caregiver praise of child, and caregiver repetition to coax feeding. A caregiver questionnaire was also completed to obtain information about the child's feeding, any early history of feeding difficulties and typical mealtime routine. The results indicated that the most considerable difference were between the dyads who had reported early feeding difficulties and those who had not reported any. Carers who supported children who had a history of early feeding difficulties used more language to manage and guide the child's behaviour during the mealtime. Caregivers who reported early feeding difficulties appeared to be more concerned with how their child was presenting at the meal (i.e., appropriate behaviour and meal enjoyment). This information has important implications for supporting children with complex needs during mealtimes.
Abstractor: As Provided
Entry Date: 2014
Accession Number: EJ1029262
Database: ERIC
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  Value: <anid>AN0091535443;0lc01oct.13;2018Jul03.10:02;v2.2.500</anid> <title id="AN0091535443-1">Communication between children and carers during mealtimes. </title> <p>Mealtimes are identified as an important learning environment where socialisation and language development takes place. Caregivers can facilitate the structure of a child's learning in the mealtime setting. The aim of this study was to gain an understanding about the nature of communication in a normal population during mealtimes. This is important to help understanding about the nature of communication and interaction in children with disabilities during mealtimes. Participants were six typically developing preschool children aged from 8 months to 3;05 years. Caregivers of the children supported their child having a typical meal at home. Each mother–child dyad was video‐recorded by the researchers during a typical meal for up to 30 minutes. Each recording was transcribed by the researchers, and specific communicative features were counted and coded; caregiver comments about appropriate mealtime behaviour, child verbal and nonverbal initiation, caregiver questions and comments about meal enjoyment, caregiver praise of child, and caregiver repetition to coax feeding. A caregiver questionnaire was also completed to obtain information about the child's feeding, any early history of feeding difficulties and typical mealtime routine. The results indicated that the most considerable difference were between the dyads who had reported early feeding difficulties and those who had not reported any. Carers who supported children who had a history of early feeding difficulties used more language to manage and guide the child's behaviour during the mealtime. Caregivers who reported early feeding difficulties appeared to be more concerned with how their child was presenting at the meal (i.e., appropriate behaviour and meal enjoyment). This information has important implications for supporting children with complex needs during mealtimes.</p> <p>Mealtime social language; parent language style; application for children with learning disabilities</p> <p>Mealtimes provide an important opportunity for the development of independent skills, social interaction and language learning for children (Bowerman and Levinson, 2001). It is also a time where young children can learn to develop their oral motor skills by being introduced to new textures and tastes in a familiar and safe environment where caregivers can provide encouragement through the use of visual modelling and verbal prompting (Aukhurst and Snow, 1998; Ferm, Ahlsen and Bjork‐Akesson, 2005). Communication during the meal may focus on developing independent eating and drinking skills, maintaining appropriate eating abilities or discussion of important events meaningful to the caregiver and the child (Aukhurst and Snow, 1998).</p> <p>This paper examines normal mealtime communication with six preschool children aged between 8 months and 3;05 years of age. A normal preschool population was selected to gain a baseline of the type of language that caregivers would use with children who have been developing language skills and who may also be using mainly preverbal communication. Gaining this information can provide valuable insight into natural communication during an everyday functional context.</p> <hd id="AN0091535443-2">Normal language development</hd> <p>The process of language acquisition begins at birth with the infant's nonverbal skills acting as a pragmatic platform to stimulate interaction between caregiver and baby (Bochner and Jones, 2003). Feeding times as well as other routine events such as nappy changing, bath time and so on provide opportunities for interaction through use of eye contact, facial expression and the use of non‐specific vocalisations that caregivers respond to and use reciprocally. Such skills offer important precursor strategies of joint attention, gaze following and later tracking and following gesture (Tomasello, Carpenter and Liszkowski, 2007). These skills of shared attention and interest in gesture are recognised as important in the acquisition of word knowledge and first words (Tomasello et al., 2007). Turn taking, both at the preverbal and verbal stage relies on interaction both for shared experience and for social interaction (Bochner and Jones, 2003).</p> <hd id="AN0091535443-3">Mealtime socialisation</hd> <p>Some studies have explored the nature of communication during the mealtime context. Family mealtimes can vary from between 20 minutes to over 45 minutes, depending on the context and age of the child (Ferm et al., 2005; Fiese and Schwartz, 2008). Research has suggested that due to the functional and routine aspect of mealtimes, they have an important role in vocabulary growth and vocabulary consolidation especially if there is an absence of background noise and distraction (Beals and Snow, 1994; Fiese and Schwartz, 2008).</p> <p>Comparing communication at mealtimes between typically developing children and their caregivers with children with disabilities and their caregivers, more social communication may occur with those without disabilities such as narratives and extended dialogue (Fiese and Schwartz, 2008). Mealtimes have been defined as being important for providing opportunities to learn, develop and socialise (Bowerman and Levinson, 2001). Caregivers will often comment on the mealtime itself with younger children, but as the children develop, they will start to talk about events beyond the mealtime context (Ferm et al., 2005).</p> <p>Aukhurst and Snow (1998) considered mealtimes within a social context as in choice making and the possibilities for narrative discussion as well as explanation. By narratives, the authors were interested in how caregivers and children talked about events within and outside of the home as well as previous or future events. Explanations referred to spontaneous comments linked to functional and social issues, for example, ‘pick up your spoon’ or comments on behaviour, emotions or competence, for example, ‘You are using your fork well. Good!’ The authors chose two similar groups, 22 Norwegian children (average age 3.3 years) and 22 American children (average age 3.6 years) matched for age and gender. Data collection included number of utterances and mean length of utterance per person. Norwegian families used a significantly high number of narrative utterances related to social routines and recent events compared with their American counterparts (t = 2.956, P <.01) whereas American parents produced significantly more explanatory utterances related to child behaviour and recent family events outside of the immediate context (t = 4.77, P <.001) compared with the Norwegian families. However, both countries had mealtimes as a focus for social language development and social exchange. The multifunctional value of the social setting, the sitting and attending and the vocabulary learning through discussions around past events or events that have yet to take place was recognised by parents as important (Aukhurst and Snow, 1998).</p> <hd id="AN0091535443-4">Summary</hd> <p>Mealtimes are an important opportunity for language learning and development. It is a social activity that occurs frequently and offers language learning beyond naming within an interactive context. This study explores the communication used by caregivers of typically developing children and the language children used in response during mealtimes. It raises some discussion points that may be of importance when developing the skills of children with disabilities.</p> <hd id="AN0091535443-5">Method</hd> <p>This study was approved by the ethics committee at City University's School of Health. Carers were informed that the mealtime recording and the data obtained would remain confidential. Parental consent was obtained for each child.</p> <p>The criteria for inclusion were for the participant to be typically developing with no known learning disability or significant illness in the last 3 months. This was confirmed by each parent who reported that the children had not seen a health care practitioner for the difficulties just outlined. A questionnaire asked parents about early feeding history (Table 1).</p> <p>1 Caregiver questionnaire</p> <p> <ephtml> <table><tr><th>Key questions</th></tr><tr><td>Was he/she breastfed? If yes, for how long?</td></tr><tr><td>Did s/he ever demonstrate any early feeding difficulties?</td></tr><tr><td>Can s/he feed themselves?</td></tr><tr><td>Who is usually present during mealtimes?</td></tr><tr><td>Does an adult eat at the same time as him/her?</td></tr><tr><td>How many mealtimes a day does s/he have with you?</td></tr><tr><td>Where do mealtimes usually take place?</td></tr><tr><td>How often do mealtimes take place outside of the home?</td></tr><tr><td>Are there any older/younger siblings in the household?</td></tr><tr><td>Is s/he in nursery? If yes, how many hours a day/week?</td></tr></table> </ephtml> </p> <p>Six children participated and were aged between 8 months and 3;05 years. They were recruited from an inner city area. Each child and their caregiver are monolingual English and had lived in the UK since birth. The ethnic backgrounds of the children are black Afro‐Caribbean (<reflink idref="bib4" id="ref1">4</reflink>), mixed black and Caucasian (<reflink idref="bib1" id="ref2">1</reflink>) and black African (<reflink idref="bib1" id="ref3">1</reflink>). The sample size was small, but the participants included three girls and three boys (Table 2).</p> <p>2 Information describing each participant</p> <p> <ephtml> <table><tr><th>Participant</th><th>Gender</th><th>Age (year/months)</th><th>History of early feeding difficulties</th></tr><tr><td>A</td><td>F</td><td>0.09</td><td>N</td></tr><tr><td>B</td><td>F</td><td>2.05</td><td>Y</td></tr><tr><td>C</td><td>M</td><td>2.07</td><td>Y</td></tr><tr><td>D</td><td>M</td><td>3.05</td><td>N</td></tr><tr><td>E</td><td>F</td><td>1.08</td><td>Y</td></tr><tr><td>F</td><td>M</td><td>0.08</td><td>N</td></tr></table> </ephtml> </p> <p>1 F, female; M, male; N, no; Y, yes.</p> <hd id="AN0091535443-6">Procedure</hd> <p>Before being video‐recorded, caregivers completed a questionnaire. This was to identify if any of early infant feeding difficulties, for example, reflux were present as these problems could impact on the development of mealtime communication. Following the completion of the questionnaire, each dyad was video‐recorded having a typical meal at home. A Samsung C20 (Samsung, Suwon, South Korea) memory card camcorder was used to record each mealtime interaction. Caregivers were instructed to support their child to have the meal as they usually would, including using the same feeding utensils, and managing the mealtime in the usual way. The objective was to gain typical analysis of a mealtime session, and so it was important that carers conducted themselves as naturally as possible. Mealtime videos lasted for up to 30 minutes, and a researcher was present to supervise the recording but did not participate in any mealtime conversations. Where other members of the family would usually participate in the mealtimes (i.e., siblings), they were not present during the mealtimes analysed for this research. Caregivers were mainly focused on as in the literature it states that those in caring positions with children tend to provide the communication learning and prompting (Bochner and Jones, 2003; Tomasello et al., 2007). The type of communication styles used by caregivers during mealtimes has also shown to impact on a child's eating and social performance (Harding, Faiman and Wright, 2010a). Each video was analysed using the discourse analysis method (Wooffitt, 2006) adapted by Pennington and McConachie (2001), and a transcript was produced by the researcher of the words spoken and actions observed. Analysis of the video transcripts included the identification of the following communicative features (Pennington and McConachie, 2001):</p> <olist> <item> Caregiver's comments to child about appropriate mealtime behaviour (directive communication)</item> <item> Child's verbal/nonverbal initiation with regard to the meal (social communication)</item> <item> Caregiver's questions about child's enjoyment of the meal (social communication)</item> <item> Caregiver's comments about child's enjoyment of the meal (social communication)</item> <item> Caregiver's praise of child (social communication)</item> <item> Caregiver's use of repetition to coax feeding (social communication)</item> </olist> <hd id="AN0091535443-7">Results</hd> <p>The results from this study consisted of (<reflink idref="bib1" id="ref4">1</reflink>) findings from the caregiver questionnaire, and (<reflink idref="bib2" id="ref5">2</reflink>) findings from the analysis of transcripts of each mealtime using discourse analysis method (Wooffitt, 2006) adapted by Pennington and McConachie (2001). Descriptive statistics were used to summarise the findings.</p> <hd id="AN0091535443-8">Questionnaire results</hd> <p>The questionnaire revealed that all of the children were developing within normal parameters with language and feeding skills. However, some subtle early difficulties were identified with some of the children. Each child was born at term and breastfed from birth for at least a month. For child A and child F, nutritional intake was still supplemented with breastfeeding at least once a day at the time of the study. Three children had early feeding difficulties (EFD) for up to 6 months. Caregivers were asked about the amount of support their child required during mealtime; each child, apart from child D, was supervised or supported by an adult. Child B, child C and child E were able to self‐feed with little or no support. Child A and child F were fully supported and spoon‐fed during mealtimes. Child D's mother reported that he was mostly able to feed independently.</p> <p>Caregivers were asked whether their child had ever demonstrated any EFD. This was specified as being up to the first 2 years of life including, but not limited to, concerns about weight gain, vomiting and sucking skills. Two parents reported that their child had colic and reflux, while one parent reported that their child had reflux alone; the final three parents reported that their child had not demonstrated any EFD. Due to 50% (n = 3) of the participants having demonstrated identifiable EFD, comparisons between those who had early difficulties with those who did not were made (Figure 1).</p> <hd id="AN0091535443-9">Transcription analysis</hd> <p>The video recording of each mealtime interaction was watched and analysed by the researchers to identify nonverbal as well as verbal communication. An independent judge blind‐rated three video‐recordings and categorised the findings according to the six areas focused on. The rater‐reliability agreement was high at 93%.</p> <p>The descriptive statistics obtained from the parental questionnaire were used to group and analyse the data. Each mother–child dyad was assigned to different groups to enable comparisons: verbal and nonverbal children, reported early EFD and typical early feeding (TEF), independent (self) feeders and dependent feeders, and across individual participants. The time of each meal ranged from 8.04 minutes to 23.30 minutes.</p> <hd id="AN0091535443-10">Comments about appropriate mealtime behaviour (directive communication)</hd> <p>Core across all dyads were comments made by caregivers to each child about mealtime behaviour and verbally managing an aspect of the mealtime. This was defined as the caregiver commenting on behaviour exhibited that disrupted the mealtime and where the child needed direction to carryout a task. Appropriate mealtime behaviour comments included sitting properly/attending to the meal, an appropriate pace of feeding, appropriate use of utensils and appropriate ratio of drink to meal.</p> <p>Instructions about behaviour were also classified as comments because at the time of communication, the objective was to decrease the inappropriate behaviour immediately (e.g., caregiver B /you're the one that needs to eat/ blow it and eat it/ and /make sure you chew properly/). Other comments included:</p> <p>Caregiver A: ‘/don't play with your food missy/ and /finish what's in your mouth/’</p> <p>Caregiver B: ‘/blow it and eat it/ and /see what happens when you don't eat properly/’</p> <p>Caregiver C: ‘/sit up close all right/ and /make sure you chew properly/’</p> <p>Caregiver D: ‘/mind your arm in the food on the table/’</p> <p>Caregiver E: ‘/hold your plate so the plate don't move/ and /don't put the spoon in your hair/’</p> <p>Caregiver F: ‘/no, sit up/ and /no, you've got food in your mouth/’</p> <p>Comments were counted for each dyad mealtime; tally of the features identified per mealtime were then grouped into EFD and TEF groups. The results indicate that the caregivers of children who demonstrated EFD made more comments to guide and manage the child's behaviour in relation to the current mealtime (EFD n = 50 > TEF n = 14) (Figure 2).</p> <hd id="AN0091535443-11">Child verbal and nonverbal Initiation</hd> <p>Child initiations with specific regard to the meal or meal episode were identified and counted. Initiation was classified as seeking or gaining the caregivers attention to make a verbal or nonverbal indication about the meal or meal interaction (e.g., child C moved forward and reached for his bowl) and /it's hot/). Participants continued to be assigned to the EFD and TEF groups for comparison. The number of times a child initiated within each group during mealtime was calculated. Results do not indicate a considerable difference in verbal/nonverbal initiations by children with EFD during mealtimes compared with those with TEF (Figure 3).</p> <p>Children sought and gained the attention of their caregiver at times when there had been a mess created or seemingly because the child wished to resume a pace of the meal (i.e., another mouthful). Examples included:</p> <p>Child A: ‘(moves forward and reaches out towards bowl)’</p> <p>Child B: ‘/my knees is all messy/ and /it's a big one/’(referring to size of spoonful she had created)</p> <p>Child C: ‘/unclear/’(picking bits of food of the table)</p> <p>Child D: ‘/oh mummy it keeps dropping/’</p> <p>Child E: (puts finger in yoghurt bowl and shows M)</p> <p>Child F: (stretches out hands out forwards towards bowl)</p> <hd id="AN0091535443-12">Caregiver questions and comments about meal enjoyment</hd> <p>Verbal communication from the caregiver was divided into questions, comments and statements. The features of this verbal communication that were counted were specific to the child's enjoyment of the meal. Questions were often basic, asking whether the child was enjoying the food (e.g., /is it nice/); comments counted included nonverbal sounds to communicate meaning (e.g., /mmm/ yum/).</p> <p>Participants were grouped according to being verbal or nonverbal. The three youngest nonverbal children were asked more questions about whether they were enjoying the meal; similarly, their caregivers made more comments about their enjoyment of the meal (e.g., /mmm/ /here . . . you'll like it/ /nice/). The verbal group included two children with EFD; the small number of questions and comments asked in this group were produced in these EFD dyads. Nonverbal group: 10 questions + 8 comments; verbal group 3 questions + 1 comment (Figure 4).</p> <p>Carers possibly discussed the satisfaction of the meal with nonverbal children (child A, child E and child F) more than verbal children as a form of reinforcement to feeding, as the child would be unable to respond (i.e., essentially telling them they were enjoying the meal).</p> <hd id="AN0091535443-13">Caregiver questions about meal enjoyment</hd> <p>Following on from the results obtained about the number of questions asked by caregivers regarding the child's mealtime enjoyment, the researcher assigned participants to new groups; self‐feeders and dependent feeders. This was to evaluate any differences within other categories which represent typical paediatric feeding development. Caregivers asked more questions about the child's enjoyment of the meal if they were feeding them. Caregivers asked self‐feeding children one question on average whereas dependent feeders were asked three questions on average. (Figure 5).</p> <hd id="AN0091535443-14">Caregiver praise, and repetition to coax feeding</hd> <p>Comparisons were made between dyad interactions individually. Children were listed in order of age in months and years (i.e., 8 months to 3;05 years). The researchers identified and tallied the number of times in each mealtime interaction that the caregiver praised the child. This mainly comprised praising ‘good boy/girl’ with regard to the child's presentation at the meal and/or feeding. The number of times that each caregiver immediately repeated herself with the objective of coaxing the feeding was also counted (i.e., /finish your dinner first/finish your dinner please/). Repetition for coaxing was limited to immediate repetitions [e.g., (1.0) or less], and many of the words were identical to the previous utterance. These features were compared across participants and indicated that the older children (aged 2.07 and 3.05 years) received no praise by their caregiver; similarly, the oldest child received no repetition to coax. There was no indication of a considerable difference between caregiver praise and repetition to coax in the children with EFD versus TEF.</p> <p>Caregivers regularly instructed the child to either attend to the meal or increase the pace of both independent and dependent feeding. The utterances that were repeated were to verbally prompt the child. It is likely that while some of the repetition was subconscious on the part of the caregiver (e.g., not intentionally repeating an instruction), utterances were mostly repeated to reinforce what had already been said and likely to support the child's understanding.</p> <p>Caregiver A: ‘/here/ here you go bubba/’</p> <p>Caregiver B: ‘/ok next one B/next one now/’</p> <p>Caregiver C: ‘/eat first/ finish eat first/’</p> <p>Caregiver E: ‘/eat that up/ eat up/’</p> <p>Caregiver F: ‘/come on chew chew/’</p> <hd id="AN0091535443-15">Conclusion</hd> <p>The objective of this study was to identify features of communication that were prevalent across mealtime interactions between caregivers and preschool children who had no significant medical needs or traumatic birth history. The results tentatively indicate that there may be some differences in the way caregivers communicate with children with EFD and compared with those with TEF. This may support the initial idea that analysis of communication during mealtimes with children who do not have learning needs may provide support for understanding the nature of feeding and communication difficulties in children with disabilities.</p> <p>The results explored the differences in dyad relationships during mealtimes. Children who demonstrated EFD seemed to be given more directive communication from carers in relation to eating their meal and feeding ‘well’. The carers of these children were observed to be more concerned about how the child was ‘presenting’ at the meal such as issuing directive communication comments about how to establish a successful meal; for example, caregiver B: /you have to blow it first/ and /ok have some juice when you're ready/.</p> <p>In one particular dyad (caregiver–child D), some specific differences were evident. It is difficult to state if the results were idiosyncratic or because this child was older than the others in the sample. In many of the categories, child D dyad did not demonstrate the same range of communicative features as the five other participants. Child D did not have any EFD, and his dyad contained the only caregiver who actually participated in the mealtime through eating her own meal.</p> <p>Ferm's study (2005) of naturalistic mealtime interaction stated that conversational topics in a typically developing child's mealtime are less ‘anchored’ to the immediate setting. In contrast to the literature reviewed, the conversational topics of the normally developing children and their carers in this study mainly focused on the mealtime situation. However, the verbal children with EFD appeared more likely to initiate with a topic outside the immediate mealtime context. For example, child B (2.05 years) discussed a television programme, and child C (2.07 years) initiated a comment about his favourite toy that was across the room. It can then be argued that as a result of an adult possibly interpreting topic change as a possible avoidance technique, the carer is predictably more likely to make comments or issue instructions about the meal to redirect the child's attention.</p> <p>A study of children with cystic fibrosis with no cognitive difficulties highlighted that caregivers are more concerned about nutritional intake and weight gain in children with feeding difficulties and therefore focus on prompting the child verbally during the meal to ensure that adequate nutrition is taken (Sanders, Turner and Wall et al., 1997). Caregivers of children with cognition within the normal range, but who had severe early feeding problems leading to insertion of a gastrostomy to maintain adequate nutrition, tend to use more reprimands (including negative comments about the child's eating behaviour) and coaxing (Harding et al., 2010a). This is supported to an extent by the present study, in that caregivers of children with EFD were more likely to make comments about appropriate mealtime behaviour with the perceived objective of coaxing feeding and/or increasing the feeding pace. It is not clear from the research data and the literature to date if children respond specifically to the parents' comments or re‐focus as a result.</p> <hd id="AN0091535443-16">Implications of this study</hd> <p>This is a small‐scale initial study; it provides conversational extracts of a typical mealtime that can be used to identify communicative features that may be specific to the mealtime of a typically developing preschool child. The present study suggests an association between EFD in typically developing children and the verbal and nonverbal communication that takes place between them and the caregiver during mealtimes.</p> <p>It can be argued that the children with EFD seemed to have a more ‘disruptive’ mealtime with more directive comments made by their caregivers about how to participate ‘well’ in the mealtime. In addition, the literature on mealtime communication in normal populations is not extensive, and the sample in this study does not have similar features compared with the other normal population studies (Aukhurst and Snow, 1998; Ferm et al., 2005).</p> <p>The nature of EFD that had been reported by caregivers via the questionnaire (i.e., colic and reflux) was arguably common and short term. It is possible that EFD could still have influenced the way caregivers interacted with the children, even though their feeding problems had resolved. The length of each mealtime in the study varied; while the researchers identified more communicative features between children with EFD and their caregivers, these were some of the longer lasting mealtimes, and so interaction lasted longer resulting in more communication. For example, child B, aged 2.05 years with EFD was praised six times by the caregiver throughout the meal, but child C aged 2.07 with EFD was not praised throughout a much shorter mealtime of less than 10 minutes.</p> <p>Another implication of this study is that the nature of communication identified during a typical mealtime tended to be didactic rather than linked to events outside of the mealtime as found in previous literature (Aukhurst and Snow, 1998; Ferm et al., 2005). It also does not reliably account for the nature of communication within the typical family unit (i.e., siblings and other caregiver). The quality of interaction tentatively seems to be affected by whether or not EFD were reported. This suggests that it would be necessary to explore whether the inclusion criterion of typically developing preschool children should be divided into two groups, EFD and TEF. This study leads to a further hypothesis that a young child's communication with a carer is likely to be affected by the nature of the EFD, including the length of time the EFD lasted. Further research based on this initial study is necessary to obtain more information about the nature of the communication observed.</p> <hd id="AN0091535443-17">Future research and how children with learning disabilities can benefit</hd> <p>This initial study provides useful information regarding mother–child interaction during mealtimes. A larger sample of participants would increase the scale of the study, and the results would be more representative of the ethnic and cultural diversity in the UK. Additional caregiver questions to provide descriptive statistics about the social‐economic status, cultural and caregiver opinion on the nature of communication/interaction during typical mealtimes would be useful.</p> <p>The findings of this study will now be considered in relation to eating and drinking difficulties within the learning‐disabled population. Mealtimes are important as they provide an opportunity for the development of independent skills, oral motor skills, social interaction and language learning for children (Bochner and Jones, 2003; Bowerman and Levinson, 2001; Fiese and Schwartz, 2008; Tomasello et al., 2007). Studies suggest that the quality of communication and interaction within the mealtime context is reduced for people with learning disabilities with carers focusing on managing the eating and drinking problems (dysphagia) rather than on social exchange (Ferm et al., 2005; Mathisen, 2001; Pan Alexander, Perlman and Snow, 2000; Veness and Reilly, 2007). A developing idea is that if communication is used effectively in a mealtime context, then the risks associated with eating and drinking are reduced (Harding and Halai, 2009).</p> <p>The question remains as to how this research is relevant to parents and caregivers of children with complex needs. The authors do not recommend that application of an approach from a normal sample be applied indiscriminately to a learning‐disabled population. However, basic principles from normal early language development such as the use of gesture and/or objects to support word learning, focusing on vocabulary learning in a relevant, functional context, use of eye contact and interaction provide the foundation for many augmentative and alternative communication (AAC) systems used with children who have complex needs (Harding, Lindsay and O'Brien et al., 2010b). There are some important issues that need discussion and further research in relation to mealtime communication and risk reduction. This small study tentatively suggests that caregivers of children who have feeding difficulties but no learning disabilities use language differently compared with those who have no history of feeding difficulties. Knowledge of changes in language styles is possibly indicative of either caregiver stress or a method of management to assist the child and motivate them.</p> <p>Children with learning disabilities are seriously disadvantaged in the mealtime context: (<reflink idref="bib1" id="ref6">1</reflink>) they are at higher risk of serious eating and drinking problems that can lead to risk such as aspiration of food into the lungs and have a higher reliance on others to support them during mealtimes (Emerson, Hatton and Felce et al., 2001; Harding and Wright, 2010); (<reflink idref="bib2" id="ref7">2</reflink>) they are at higher risk of developing disruptive mealtime behaviours that can lead to reduced communication opportunities and poor nutritional intake (Sanders et al., 1997); and (<reflink idref="bib3" id="ref8">3</reflink>) they are at risk of reduced communication opportunities because of their use of AAC or limited receptive and expressive language skills (Ferm et al., 2005; Pan Alexander et al., 2000; Tulviste et al., 2000; Veness et al., 2007). The eating and drinking problems that children with learning disabilities have are likely to be lifelong (Emerson et al., 2001). They also may require specific help to make the eating and drinking process as safe as possible, although research into strategies to support these problems is sparse and involves approaches mainly for adults with acquired disorders rather than strategies specifically for congenital disorders (RCSLT, 2006). Some research is beginning to indicate that the communication style that caregivers use during mealtimes can provide the following: (<reflink idref="bib1" id="ref9">1</reflink>) a language learning and enrichment opportunity as well as receptive language support (Harding et al., 2010b); (<reflink idref="bib2" id="ref10">2</reflink>) motivation and support for the child; (<reflink idref="bib3" id="ref11">3</reflink>) a method that focuses the caregiver's language towards reducing risk as the pace of the communication exchange and the expectation of the caregiver that the child will use their AAC to interact can assist in reducing some aspects of swallowing difficulties (Harding and Halai, 2009; Harding et al., 2010a); and (<reflink idref="bib4" id="ref12">4</reflink>) the child has more opportunity to have some independent control over the pace of the meal and some means of specifying choice and perhaps opinion (Harding and Halai, 2009).</p> <p>Studies that have looked at normal communication interactions do reveal some subtle cultural differences, but a core element appears to be the use of narrative relevant to the children's lives and less about the process of eating and drinking (Aukhurst and Snow, 1998; Beals and Snow, 1994; Fiese and Schwartz, 2008). In contrast, studies that have analysed people with disabilities and their caregivers inevitably focus on the didactic and directive nature of communication during interactions (Ferm et al., 2005; Pan Alexander et al., 2000; Tulviste, 2000; Veness et al., 2007). This paper does not propose that narrative conversation should be embedded within mealtime interactions with children who have learning disabilities and eating and drinking difficulties. The nature of the children's needs are inevitably going to include receptive and expressive language delay, cognitive delay and potentially the need to use AAC to support language understanding and expression. Proposed steps to developing methods of supporting and improving communication during mealtimes includes understanding the nature of the eating and drinking difficulties alongside the child's preferred communication style. These steps are outlined in Table 3. Children who have access to AAC tend to have poorer language interaction opportunities and outcomes, although if they receive a targeted, consistent approach they can develop some communicative competence with familiar caregivers (Harding et al., 2010b).</p> <p>3 Proposed steps to promoting improved communication during mealtimes for children with learning disabilities</p> <p> <ephtml> <table><tr><th>Area to identify</th><th>Action required</th></tr><tr><td>1. Identify with the speech and language therapist, occupational therapist and physiotherapist and key worker the key elements of the nature of the eating difficulties</td><td>Observe a mealtime to ascertain: (1) best position to feed the child and therefore postural stability; (2) child's level of independence; (3) pace of the mealtime; (4) carer language style and response to child; and (5) any risk signs, for example, coughing, colour change, etc.</td></tr><tr><td>2. Identify specific dysphagia goals and how they can be made functional</td><td>Gain a clear understanding of the types of goals being implemented such as motor with swallow strategies, sensory modifications and compensatory approaches.</td></tr><tr><td>3. Identify the child's level of independence</td><td>How much can the child feed themselves and can they independently utilise any and alternative communication to communicate need during the meal?</td></tr><tr><td>4. Identify the child's level of functioning</td><td>What is the child's level of cognition and receptive ability? How can these areas be supported? Does the child need language modification, repetition, visual supports, auditory supports, etc?</td></tr></table> </ephtml> </p> <p>Caregivers find functional therapy and educational goals easier to carryout if they are integrated within an everyday context (Limbrick‐Spencer, 2000). It cannot yet be determined whether the type or degree of early feeding impairment is instrumental in how typically developing preschool children and caregiver interact during mealtime; however, Veness et al. (2007) suggested that feeding impairment does have a ‘bearing’ on aspects of interaction. If communication is a main focus of intervention during mealtimes, then perhaps AAC use would be enhanced; learning and language opportunities could be present in the mealtime context; independence would be maximised; and risk of aspiration potentially could be reduced (Harding and Halai, 2009).</p> <p>The authors recommend that future research about children with disabilities and their caregivers during mealtimes should explore the issues raised. A suggested approach would be for children to be video‐recorded both in their homes and in school. This would involve mealtimes with a parent as well as a learning support assistant in familiar environments. Caregivers and learning support assistants could also be given a questionnaire to complete about their understanding of mealtime difficulties to ascertain how much training about dysphagia they had received. The following methods could be used to analyse the data: (<reflink idref="bib1" id="ref13">1</reflink>) conversation analysis to explore communication during the mealtime and to provide qualitative data on the language and interaction occurring and any communication strategies used that enable a child to respond effectively; (<reflink idref="bib2" id="ref14">2</reflink>) questionnaire data on parents and carers perceptions of dysphagia that would be compared; and (<reflink idref="bib3" id="ref15">3</reflink>) descriptive data on how many spoonfuls of food children completed, time of day of meal, number of coughing events, and the percentage amount of the meal eaten. Images of the meals could be photographed before and after each meal and then analysed with reliability data to judge how much had been eaten.</p> <p>This initial study provides a measure against which to compare interactions between caregivers and respective typically developing children and children with disabilities, during mealtimes. It could be the basis for discussion and to develop a specific approach that will benefit children and their carers during the mealtime context and therefore improve the quality of communication during this time, provide language learning opportunities and contribute towards reducing risk with children who have learning disabilities.</p> <ref id="AN0091535443-18"> <title>References</title> <blist> <bibl id="bib1" idref="ref2" type="bt">1</bibl> <bibtext>Aukhurst, V. & Snow, C. ( 1998 ) ‘Narratives and explanations during mealtime conversation in Norway and the US. Language in Society, 27, pp. 221 – 46. </bibtext> </blist> <blist> <bibl id="bib2" idref="ref5" type="bt">2</bibl> <bibtext>Beals, D. E. & Snow, C. E. ( 1994 ) ‘ “Thunder is when the angels are upstairs bowling”: narratives and explanations at the dinner table. Journal of Narrative and Life History, 4 ( 4 ), pp. 331 – 52. </bibtext> </blist> <blist> <bibl id="bib3" idref="ref8" type="bt">3</bibl> <bibtext>Bochner, S. & Jones, J. ( 2003 ) Child Language Development: Learning to Talk. ( 2nd edn). London: Whurr. </bibtext> </blist> <blist> <bibl id="bib4" idref="ref1" type="bt">4</bibl> <bibtext>Bowerman, M. & Levinson, S. ( 2001 ) ‘Introduction.’ In M. Bowerman & S. Levinson (eds), Language Acquisition and Conceptual Development, pp. 1 – 16. Cambs: CUP. </bibtext> </blist> <blist> <bibl id="bib5" type="bt">5</bibl> <bibtext>Emerson, E., Hatton, C., Felce, D. & Murphy, G. ( 2001 ) Learning Disabilities: The Fundamental Facts. London: Foundation for People with Learning Disabilities. </bibtext> </blist> <blist> <bibl id="bib6" type="bt">6</bibl> <bibtext>Ferm, U., Ahlsen, E. & Bjork‐Akesson, E. ( 2005 ) ‘Conversational topics between a child with complex communication needs and her caregiver at mealtime. Augmentative and Alternative Communication, 21, pp. 19 – 40. </bibtext> </blist> <blist> <bibl id="bib7" type="bt">7</bibl> <bibtext>Fiese, B. & Schwartz, M. ( 2008 ) ‘Reclaiming the family table: mealtimes and child health and wellbeing. Society for Research into Child Development, Socail Policy Report, XXII (IV). </bibtext> </blist> <blist> <bibl id="bib8" type="bt">8</bibl> <bibtext>Harding, C. & Halai, V. ( 2009 ) ‘Providing training for carers of children who have profound and multiple learning disabilities. British Journal of Developmental Disabilities, 55 ( 1 ), pp. 33 – 47. </bibtext> </blist> <blist> <bibl id="bib9" type="bt">9</bibl> <bibtext>Harding, C., Faiman, A. & Wright, J. ( 2010a ) ‘A pilot project to evaluate an intensive desensitisation, oral tolerance therapy and hunger provocation programme for children who have had prolonged tube feeds. Journal of Evidence Based Health Care December, 8, pp. 268 – 76. </bibtext> </blist> <blist> <bibl id="bib10" type="bt">10</bibl> <bibtext>Harding, C., Lindsay, G., O'Brien, A., Dipper, L. & Wright, J. ( 2010b ) ‘The challenges of implementing AAC to children with profound and multiple learning disabilities: a study in rationale underpinning intervention. Journal of Research in Special Educational Needs, 11 ( 2 ), pp. 1 – 10. doi: 10.1111/j.1471 – 3802.201001184. </bibtext> </blist> <blist> <bibl id="bib11" type="bt">11</bibl> <bibtext>Harding, C. & Wright, J. ( 2010 ) ‘Dysphagia: the challenge of managing eating and drinking difficulties in children and adults who have learning disabilities. Tizard Learning Disability Review, 15 ( 1 ), pp. 2 – 13. </bibtext> </blist> <blist> <bibl id="bib12" type="bt">12</bibl> <bibtext>Limbrick‐Spencer, G. ( 2000 ) Parents' Support Needs: The Views of Parents of Children with Complex Needs. Herefordshire: Handsel Trust. </bibtext> </blist> <blist> <bibl id="bib13" type="bt">13</bibl> <bibtext>Mathisen, B. ( 2001 ) ‘Dysphagia and early language development. Australian Communication Quarterly, 3 ( 1 ), pp. 7 – 9. </bibtext> </blist> <blist> <bibl id="bib14" type="bt">14</bibl> <bibtext>Pan Alexander, B., Perlman, R. & Snow, C. ( 2000 ) ‘Food for thought: dinner table as a context for observing parent‐child discourse.’ In L. Menn Bernstein & N. Ratner (eds), Methods for Studying Language Production, pp. 205 – 24. New Jersey, NJ: Lawrence Erlbaum. </bibtext> </blist> <blist> <bibl id="bib15" type="bt">15</bibl> <bibtext>Pennington, L. & McConachie, H. ( 2001 ) ‘Interaction between children with cerebral palsy and their mothers: the effects of speech intelligibility. International Journal of Language and Communication Disorders, 34, pp. 391 – 416. </bibtext> </blist> <blist> <bibl id="bib16" type="bt">16</bibl> <bibtext>Royal College of Speech and Language Therapists. ( 2006 ) Communicating Quality 3: RCSLTs guidance on best practice in service organisation and provision. Pub: RCSLT: Scotprint. </bibtext> </blist> <blist> <bibl id="bib17" type="bt">17</bibl> <bibtext>Sanders, M., Turner, K., Wall, C., Waugh, L. & Tully, L. ( 1997 ) ‘Mealtime behavior and parent‐child interaction: a comparison of children with cystic fibrosis, children with feeding problems, and non‐clinic controls. Journal of Pediatric Psychology, 22, pp. 881 – 900. </bibtext> </blist> <blist> <bibl id="bib18" type="bt">18</bibl> <bibtext>Tomasello, M., Carpenter, M. & Liszkowski, U. ( 2007 ) ‘A new look at infant pointing. Child Development, 78 ( 3 ), pp. 705 – 22. </bibtext> </blist> <blist> <bibl id="bib19" type="bt">19</bibl> <bibtext>Tulviste, T. ( 2000 ) ‘Socialization at meals: a comparison of American and Estonian mother‐adolescent interaction. Journal of Cross-Cultural Psychology, 31, pp. 537 – 56. </bibtext> </blist> <blist> <bibl id="bib20" type="bt">20</bibl> <bibtext>Veness, C. & Reilly, S. ( 2007 ) ‘Mealtime interaction patterns between young children with cerebral palsy and their mothers: characteristics and relationship to feeding impairment. Child: Care, Health and Development, 34, pp. 815 – 24. </bibtext> </blist> <blist> <bibl id="bib21" type="bt">21</bibl> <bibtext>Wooffitt, R. ( 2006 ) Conversation Analysis and Discourse Analysis: A Comparative and Critical Introduction. London: Sage. </bibtext> </blist> </ref> <p>Graph: 1 Pie chart showing the types of EFD caregivers reported</p> <p>Graph: image%5fn/jrs31261%5ff1.gif</p> <p>Graph: 2 Caregiver comments about appropriate mealtime behaviour</p> <p>Graph: image%5fn/jrs31261%5ff2.gif</p> <p>Graph: 3 Number of child verbal/nonverbal initiations with caregiver</p> <p>Graph: image%5fn/jrs31261%5ff3.gif</p> <p>Graph: 4 Caregiver questions and comments about child mealtime enjoyment</p> <p>Graph: image%5fn/jrs31261%5ff4.gif</p> <p>Graph: 5 Average number of caregiver questions about meal enjoyment</p> <p>Graph: image%5fn/jrs31261%5ff5.gif</p> <aug> <p>By Celia Harding; Candace Wade and Kirsty Harrison</p> </aug>
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  Data: Communication between Children and Carers during Mealtimes
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  Data: <searchLink fieldCode="AR" term="%22Harding%2C+Celia%22">Harding, Celia</searchLink><br /><searchLink fieldCode="AR" term="%22Wade%2C+Candace%22">Wade, Candace</searchLink><br /><searchLink fieldCode="AR" term="%22Harrison%2C+Kirsty%22">Harrison, Kirsty</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Research+in+Special+Educational+Needs%22"><i>Journal of Research in Special Educational Needs</i></searchLink>. Oct 2013 13(4):242-250.
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  Data: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
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  Data: <searchLink fieldCode="DE" term="%22Interpersonal+Communication%22">Interpersonal Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Caregivers%22">Caregivers</searchLink><br /><searchLink fieldCode="DE" term="%22Interaction%22">Interaction</searchLink><br /><searchLink fieldCode="DE" term="%22Mothers%22">Mothers</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Video+Technology%22">Video Technology</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Behavior%22">Child Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Verbal+Communication%22">Verbal Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Nonverbal+Communication%22">Nonverbal Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Reinforcement%22">Reinforcement</searchLink><br /><searchLink fieldCode="DE" term="%22Repetition%22">Repetition</searchLink><br /><searchLink fieldCode="DE" term="%22Eating+Habits%22">Eating Habits</searchLink><br /><searchLink fieldCode="DE" term="%22Young+Children%22">Young Children</searchLink>
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  Data: 10.1111/j.1471-3802.2012.01261.x
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  Data: 1471-3802
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  Data: Mealtimes are identified as an important learning environment where socialisation and language development takes place. Caregivers can facilitate the structure of a child's learning in the mealtime setting. The aim of this study was to gain an understanding about the nature of communication in a normal population during mealtimes. This is important to help understanding about the nature of communication and interaction in children with disabilities during mealtimes. Participants were six typically developing preschool children aged from 8 months to 3:05 years. Caregivers of the children supported their child having a typical meal at home. Each mother--child dyad was video-recorded by the researchers during a typical meal for up to 30 minutes. Each recording was transcribed by the researchers, and specific communicative features were counted and coded; caregiver comments about appropriate mealtime behaviour, child verbal and nonverbal initiation, caregiver questions and comments about meal enjoyment, caregiver praise of child, and caregiver repetition to coax feeding. A caregiver questionnaire was also completed to obtain information about the child's feeding, any early history of feeding difficulties and typical mealtime routine. The results indicated that the most considerable difference were between the dyads who had reported early feeding difficulties and those who had not reported any. Carers who supported children who had a history of early feeding difficulties used more language to manage and guide the child's behaviour during the mealtime. Caregivers who reported early feeding difficulties appeared to be more concerned with how their child was presenting at the meal (i.e., appropriate behaviour and meal enjoyment). This information has important implications for supporting children with complex needs during mealtimes.
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