We’ll post a few times a month on relevant research, timely topics, tips from the kitchen and frequently asked questions. To join the conversation, please check out our facebook page.

*The information on this blog and website is for informational purposes only. It is not meant to replace careful evaluation and treatment of a child. If you have concerns about your child’s eating or nutrition or growth, consult your child’s doctor.

Facilitating (Not Forcing) Your Child’s Eating (Extreme Picky Eating Edition)

Facilitating (Not Forcing) Your Child’s Eating (Extreme Picky Eating Edition)

“I’m not forcing, I’m just aggressively facilitating…” I was watching a show on Netflix* when I caught this line, “I’m not forcing, I’m just aggressively facilitating.” My ears perked at the words facilitation and force, and of course made me think of children with extreme picky eating, of feeding, and the “aggressive facilitation” that can sometimes happen, even in feeding therapies. There is much research that suggests that when children are pressured or coerced to eat, overall intake, and intake of fruits and veggies decreases.  Here are a few examples… “…approximately half of all mothers and a greater proportion of fathers… ignore the child’s hunger signals and may use force, punishment, or inappropriate rewards to coerce the child to eat. These practices initially appear effective, but become counterproductive, resulting in poor adjustment of energy intake, consumption of fewer fruits and vegetables, and a greater risk of under- or overweight.” (Kerzner 2015) “…stringent parental controls can… limit children’s acceptance of a variety of foods and disrupt children’s regulation of energy intake by altering children’s responsiveness to internal cues of hunger and satiety.” (Brown & Ogden, 2004) Pressure to eat likely disrupts child’s ability to respond to internal cues of hunger and satiety (Carper et al., 2000) Pressure to eat … “exacerbate feeding problems and make mealtimes more negative for both parent and child.” (Harris 1992; Skuse 1993) Pressuring strategies could be implicated in the development and persistence of these problems (Farrow & Blissett, 2008) Pressure to eat predicted food avoidance behaviors: slow eating, emotional undereating, satiety responsiveness (Powell 2011) Parent prompts assoc w/ food avoidant behaviors, correcting for child emotionality and maternal... read more
Trust Your Turtle: Patience with Picky Eating Progress

Trust Your Turtle: Patience with Picky Eating Progress

Here’s a story I read recently and shared with a client when she asked, “How can I get my daughter to accept new foods on her plate once she’s feeling good about her safe foods? Can’t I just put them on her plate?”   A woman was with her college geology class on a field trip by a river. She noticed a turtle up the river bank near a road and worried that the turtle would get hit by a car. So, she carried the turtle back down the hill and put it in the water. Afterwards, the professor came to her and said, “That turtle has probably spent weeks crawling up the hill to lay her eggs in the muddy slope and now she will have to start all over again.” The moral was, “Ask the turtle first.” (Gloria Steinem from her book, My Life on the Road) (See below our clarification of “ask”. Most children won’t want to be verbally queried along the way. Our moral is to be responsive to your turtle.)    What does this have to do with feeding? Well, many children with extreme picky eating have anxiety around foods, and often have struggled for years. As parents, and even professionals, we hope for and want improvements NOW, or in say,  six weeks. But progress is generally slow, slow, slow, and it might not look like what we think of as “progress” (eating new foods). Sometimes when we miss early signs of progress (less anxiety, eating more safe foods, curious about foods but not yet tasting or eating them...) it is easy to want to rush the process, to pick up our little turtles and carry... read more
Confessions of a Mommy Feeding Therapist

Confessions of a Mommy Feeding Therapist

Working with families who struggle to feed their children on a daily basis, I often hear, “Your kids must be great eaters!” or “I bet you don’t have any trouble at the table with your kids!”.  Well, let me tell you, it isn’t quite that simple. As a feeding therapist, I am confident that what I am suggesting to parents will at least help, and not hinder, their child’s progress with eating. When I am working with someone else’s child, I can see their issues objectively. That makes it fairly easy to navigate next steps and to tease apart what may be going wrong. I have done loads of research and reading on the topic, wrote a book, and provide therapy for children from newborns to teenagers. I do trainings for other therapists, physicians, and students. So you would think I would have all the answers with my own three kids, right? Not so much. At home, things are a little more complicated. Do my kids sit at the table and eat at most meals? Yes. Are mealtimes a beautifully harmonious experience where all three of my children eat complicated dishes with a smile on their face? Hasn’t happened yet- I am still waiting. So what does a feeding therapist’s family mealtime actually look like?  Here is a window into my world: Setting:  We eat at our kitchen table for all meals, using family-style serving. I do a lot of “pile-on” and deconstructed meals and we don’t pre-plate the kids’ food. I work full-time and the kids have lots of activities, so our meals are fairly simple, and I get take-out about once a week.... read more

REFERENCES for ASHA 2016: Provision of Feeding Intervention in the Context of Responsive Feeding

Jenny presented at the National American Speech Language and Hearing Convention (ASHA) this week, along with the clinical coordinator of the Tube Weaning Program, Heidi Moreland, SLP at Spectrum Pediatrics. There were extensive references included in their presentation and this research supports our work with responsive feeding and creating a healthy relationship with food for new and fragile eaters.  We thought others might find these references to be helpful as well. If you are interested in learning more about the book or responsive feeding therapy you can look here and if you want to know more about the intensive tube weaning program at Spectrum Pediatrics check out their post here.   References   Addessi, Elsa, et al. “Specific social influences on the acceptance of novel foods in 2–5-year-old children.” Appetite 45.3 (2005): 264-271. Ainsworth, M. D., S., & Bell, S. M. (1969). Some contemporary patterns of mother-infant interaction in the feeding situation. In A. Ambrose   (Ed.), Stimulation in early infancy (pp. 133-170). New York, Academic Press. American Speech-Language-Hearing Association. Van der Horst, Klazine. “Overcoming picky eating. Eating enjoyment as a central aspect of children’s eating behaviors.” Appetite 58.2 (2012): 567-574 (2001). Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders:   Technical Report [Technical Report]. Available from www.asha.org/policy. American Speech-Language-Hearing Association. (1990). Issues in oral motor, feeding, swallowing, and respiratory-phonatory assessment and   intervention. [A Building Blocks Module]. Alexander, R. (1987). Oral-motor treatment for infants and young children with cerebral palsy. Seminars in Speech and Language, 8(1). 87-100. Babbitt, R. L., Hoch, T. A., Coe, D. A., Cataldo, M. F., Kelly, K. J., Stackhouse, C., et al. (1994). Behavioral assessment and treatment of pediatric   feeding disorders. Journal of developmental and Behavioral Pediatrics, 15, 248-291.... read more
Navigating Relational Feeding in a Medically-Minded World: When Calories Aren’t the Whole Picture

Navigating Relational Feeding in a Medically-Minded World: When Calories Aren’t the Whole Picture

For many families, weekly (sometimes daily) doctor and therapy appointments are the norm rather than the exception. They strive to make everything fit into the schedule, because doing so keeps their child “well”- or at least not sick- and hopefully making medical or developmental gains due to professional, sometimes intensive intervention.  This may be a temporary scenario, or not. For parents of chronically ill or medically fragile children, every day begins with a status check: Is he running a fever? Is she going to hold down her feeds today? Did I give her all of her meds on time? Why is he doing X? Then on to the scheduling and phone calls- to the doctor’s office to sign a request for records to be sent to the out-of-state specialist, to the insurance company to fight yet another battle about payment for the child’s numerous procedures and office visits. For the parents who live this reality, it can be mind-numbing and terrifying all at once. Having a child who is well is the exception rather than the rule. Being truly well, however, is not the same as not being sick. For many kids, they have never been truly “healthy”, as the WHO states: “Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” What about these situations in otherwise “healthy” children? the baby who screams every time she sees a bottle, but takes a small amount when it is forced into her mouth the toddler who throws up at least once a day after being fed the preschooler who exists on Pediasure because he doesn’t... read more
Childhood Fears: Food or Fluffy, the Fear is Real

Childhood Fears: Food or Fluffy, the Fear is Real

When M was little she had a dog phobia. I’m talking screaming, climbing on me, uncontrollable fear of even a toy poodle.  I can’t count how many people tried to talk her out of her fear, usually with a dog thrust into her personal space, and often against my explicit requests for them to stop. Take the German shepherd owner whose dog was off-leash, jumping on me while M clawed at my hair shrieking, and the owner kept smiling, “Oh, she won’t hurt you! She’s very gentle.” Well-intentioned dog owners (including friends and family) would bring dogs closer, insisting the dog wasn’t scary and everyone loved the dog, and, “Stop being so silly!” (super helpful)  or, “Look, Timmy is younger than you, and he’s petting the doggie!” (Throw some shame in while you’re at it! Works every time!)  I wish we could have had a sign at those times that said, “Seriously afraid of dogs. Back off. It’s not your job to get my kid over her fears…” It is this sticker that I saw on my walk home that led to this post. If I was behind a car on a hill and it started rolling, I might get mad or honk. But with this sign (Kid Driver   Manual), I know it’s a young person who is learning and I’ll be more patient. This sign reminds us to cut this kid driver some slack; have a little patience and understanding (something I struggle with behind the wheel sometimes). Of course it made me think of kids learning to eat. Imagine the child with extreme picky eating who only takes crackers at... read more

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