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*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.

Is STEPs+ Approach “Enough” for Children with Complex Developmental or Medical Challenges?

Is STEPs+ Approach “Enough” for Children with Complex Developmental or Medical Challenges?

The following is Jenny’s (SLP, co-author) response to a comment that the STEPs+ approach described in our book, Helping Your Child with Extreme Picky Eating may not be “enough” for children with complex medical or developmental problems. The comment implied that the approach was solely about placing food on the child’s tray day after day; the response follows: “While I understand your concerns about progress with a medically complex child, we feel strongly that our approach can and does work for these children. Using the strategies at home while an experienced therapist guides you and your child in making specific skill gains is the best-case scenario. Putting food in front of a child on the tray doesn’t paint the whole picture. As the director of a feeding clinic, I have worked with hundreds of children who are NOT neurotypical, have multiple complex medical challenges, and who are severe enough in their feeding issues to require feeding tubes, using this approach. Most of my patients and my co-author’s clients have already had other therapies, from behavioral to SOS and sensory play therapies, and haven’t made progress. When the STEPS+ approach is applied, which can often take weeks or months for some families to get the hang of, with attention to gaining skills and addressing issues such as you describe your son having, these children make significant gains over time. Many have their feeding tubes removed. However, it doesn’t happen overnight, and it may not be what every parent feels is right for their child, and that’s okay. What is learned over a long period of time (months or years) cannot be undone and... read more
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

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