“It feels like we have tried everything!” - a follow-up qualitative study on mealtime experiences with parents with high levels of alexithymia

Alexithymia refers to a general deficit in interoception whereby individuals struggle to identify and describe emotions and feelings and exhibit an externally oriented thinking style. In our previous research, high caregivers' alexithymia scores were associated with poor awareness of infant hunger and satiety cues during feeding. The present study aimed to explore mealtime emotions, parental sensitivity, and feeding practices of caregivers who scored high for alexithymia. With participants selected based on their scores on the 20-item Toronto Alexithymia Scale (mean: 59.4 ± 5.4, range from 53 to 74) from the previous study, a follow-up qualitative study was conducted using one-to-one semi-structured, video elicitation embedded interviews. Overall, 12 mothers and 2 fathers of children aged 18-36 months (mean age = 26 ± 7m; 7 boys, 7 girls) completed the interview, including discussion of a mealtime reported one year earlier and of a recently filmed typical mealtime interaction. Reflexive thematic analysis revealed that participants perceived mealtimes as more than feeding, as an important social activity. Participants reflected on specific challenges such as their child's food sensory needs, but felt that feeding resources were unhelpful. Multiple coping strategies were described as a means of "doing their best". Progress with feeding was both reported and noticed during observations of the video-clips. In conclusion, caregivers with high alexithymia scores described mealtimes as challenging, adopting a variety of ways to meet feeding challenges and adapting to their child's appetite cues as they grew. Caregivers with high levels of alexithymia may benefit from tailored responsive feeding support beyond generic feeding guidelines to improve their mealtime experience.