Sleeping & Feeding Assessments
Sometimes a single coaching session is not enough to get support with feeding or sleeping issues that have been troubling your infant or toddler for a while. While scheduling a coaching session is a good first step, more complex or established issues respond better to a structured assessment and series of guidance sessions as you embark on a new routine with your baby.
These assessment and guidance sessions operate from an assumption of competency: all humans have an innate capacity for competent sleeping and eating behavior. Just like all infants learn to move and communicate in ways that are right for them, so too are all infants self-motivated to learn to eat and sleep competently. And yet, it can happen that eating or sleeping is thrown out of balance. The natural processes for learning can be disrupted.
If your child is experiencing long standing issues with eating or sleeping, the question we will work together to answer is, "What is getting in the way of the child's ability to be competent, and what can we do to address this?"
Together, we will come up with a plan that takes into account the full history of the problem. During your assessment, we will review all historical and relevant medical data relating to your child's eating or sleeping patterns. We will evaluate your child’s growth and development through key stages of learning to eat or sleep. We will identify what went "wrong" and what you and your child are ready to change. Through a series of guidance sessions, you will experience the support you need to implement your plan and embark on a new path of healthy sleeping and eating with your child. The assessment and guidance will help you untangle what is your responsibility and where your child is ready for autonomy.
Registered Dietician and psychotherapist Ellyn Satter developed a model of Eating Competence that helps define the end goal of eating development. She defines Eating Competence as:
Feeling good about food and about eating--and feeling good about feeling good.
Feeling comfortable experimenting with new food.
Trusting yourself to eat the right amount of food for you.
Having regular meals and snacks.
Taking an interest in food and taking the time to pay attention while you eat.
Although nothing in the Eating Competence model dictates the type or amount of food people should eat, studies show that people with high Eating Competence scores have nutritionally superior diets, superior wellness and metabolic indicators, lower BMI, better quality-of-life indicators, and an easier time feeding their children (source).
Although children are born with the capacity to learn to eat, they are not born Eating Competent. It takes many years of dependable and pressure-free feeding to develop Eating Competence. Children (and parents) need time and space to learn, make mistakes, make discoveries, and continue practicing. If you feel you are not able to give your child this trust due to eating or feeding difficulties (in other words, if you feel you have to “get” your child to eat more, less, or different foods), you and your child can benefit from assessment and guidance.
Generally speaking, our goal will be to establish a plan utilizing Ellyn Satter's model of Division of Responsibility where you are comfortable assuming the responsibility of choosing what to prepare, when to offer food, and where meals and snacks will occur. Meanwhile, your child can be responsible for choosing what to eat from what is prepared, how much to eat, and, indeed, whether or not they want to eat at all.
To allow children this much trust–and to be comfortable with the many tasks associated with choosing and preparing food to offer–asks a lot of parents and caregivers. This is why the guidance sessions that follow assessment are so helpful.
All humans need regular sleep. Good sleep increases our emotional regulation, cognitive skills, and physical aptitude. People who have good sleep competence:
Feel positive and relaxed about bedtime
Fall asleep within a few minutes of getting into bed
Fall back to sleep within a few minutes if they wake in the night
Do not feel sleepy or about to nod off during awake periods
Are comfortable prioritizing sleep
Allow time in their schedule for adequate nighttime sleep and, if needed, daytime naps
Although infants are born with the capacity to learn to sleep well, they are not born competent sleepers. Competent sleep develops over years of dependable sleep opportunities and compassionate co-regulation from parents and caregivers. Infants and toddlers need lots of opportunities to practice independent sleep skills before they become competent. They need adults to gradually give up control and replace it with trust in the child’s autonomy. If you feel you are not able to give your child this trust, or if you feel like you have to spend a lot of emotional or physical energy getting your child to sleep, you might benefit from a structured assessment and series of guidance sessions.
As a parent, your child’s sleep impacts your own. Few things effect a child's development more than being cared for by a well-rested parent, so it is important to find solutions that work for everyone. Together, we will come up with a plan that works for everyone in your family.
Generally speaking, you as a parent will be responsible for establishing a routine for sleep and offering sleep at predictable times. You are also responsible for soothing your child when they are too agitated to attempt to fall asleep. However, the task of falling asleep will always belong to your child. It is not something an adult can “make” a child do.
Giving up control over sleep as your child grows can feel quite challenging, and changing a sleep routine often involves big feelings (from both children and adults). Guidance sessions support you as you make these changes.
How Assessment & Guidance Works
The assessment will ask you to gather information that gives us a full picture of your child’s eating or sleeping including:
an intake questionnaire that asks questions about the history of the issue and your family dynamics
a questionnaire that establishes your own and your child’s levels of eating or sleeping competence
growth charts and relevant reports from your child’s pediatrician and/or other specialists you have worked with
a 1-week sleep or food diary
a video showing a typical meal or nighttime sleep routine in its entirety
Assembling all the pieces of this puzzle takes a bit of time and effort, which is why we recommend that you sign up for a single coaching session first, to determine how important an assessment is in your situation. Sometimes a single coaching session is all that is needed, but you are likely to benefit from assessment and guidance sessions if…
The issue with your child’s eating or sleeping has persisted for more than a year.
You have tried other ways to help your child, without success.
You feel very stressed about how to help your child.
You are also working with occupational therapists, psychotherapists, and/or medical professionals to resolve the issue.
You or your child is not getting adequate sleep on a regular basis.
If the above descriptions sound like you, you are probably feeling tired, frustrated, and even desperate. Please know that the structure of an assessment and the empathetic guidance sessions that follow are specifically designed to help people in your situation. You can get started today.
There are three steps to Assessment and Guidance
Initial Coaching Session
During your initial coaching session, you will give an overview of the problem and together we will decide if and how to proceed with assessment and guidance. You can choose a phone or video session, or you can book a home visit. If you choose a home visit, the visit can include an observation of feeding or sleeping that you will need for your assessment, instead of sending a recording. During the initial coaching session, you will receive more information about what is needed for a full assessment for your particular circumstances.
Cost: $85 for phone, $95 for video, $200 for in-home
Please have all your assessment materials ready before you book an assessment. When you book an assessment, you will be asked to choose a date for the assessment meeting, and you will receive information on how to share your assessment materials. These materials will be throughly reviewed before your assessment meeting. This process takes 1-2 weeks.
At the assessment meeting itself, you will hear impressions about the scope of the problem and what might be done to address it. You will receive a formal write up with this information that can be shared with other early interventionists, caregivers, or healthcare providers. You will also receive a recommendation for a number of guidance sessions to support you as you decide on and implement changes.
Weekly guidance sessions are scheduled after the assessment meeting. Typically, you will receive a recommendation for 4-12 weekly guidance sessions. You can choose either phone or video sessions each week, and each session is 50 minutes. It is recommended that you schedule all of your guidance sessions at once, to reserve a weekly time and provide consistency as you work towards implementing your new routine.
Cost: $85 per phone session, $95 per video session
This is a new service, so there are no questions and answers yet. If you have a question, please ask!