Medscape’s ‘War and Peace at the Dinner Table’: Is MAKING Kids Eat the “Only Way”, and Other Points to Ponder

This clip won the America’s Funniest Home Video $10,000 prize. Is it helping her learn to like green beans?   As clinicians, parents, and experts in childhood feeding struggles, we are concerned about the one-sided nature of the online article and video War and Peace at the Dinner Table: Advising Parents of Picky Eaters, presenting advice to physicians on how to help children with extreme picky eating. Below, we present a discussion and resources for parents and professionals who might like to learn more. First off, we agree with the following points in the article: clinicians should take a parent’s concerns about picky eating seriously (Kerzner), and that ARFID (avoidant restrictive food intake disorder) or extreme picky eating (EPE) impacts family life and the social and emotional development of the child. We also agree that without support, a significant proportion of children will not outgrow their eating struggles and that mealtime “hygiene”, like avoiding grazing, supports appetite and curiosity around new foods. However, we feel that several statements are not supported by the evidence, and in the absence of a widely accepted ‘best’ practice, must be examined. 1) This sweeping generalization: These children don’t have sensory sensitivities. Many children who suffer from ARFID or EPE had medical or underlying conditions and challenges, including sensory issues, that contribute to the establishment of a feeding disorder (Arts-Rodas, Chatoor). The DSM-V ARFID diagnostic criteria recognize three subtypes of the disorder sensory (emphasis ours), associated with an aversive experience, or associated with low appetite. Sensory challenges are at least a contributing factor for many children with EPE, particularly for those on the autism...

What is the STEPS+ Approach to Extreme Picky Eating?

What can parents do when feeding is such a struggle that it feels like their only options are to fight over every bite, or to surrender and serve a child’s limited accepted foods day after day, year after year? How can parents lovingly support their child with extreme picky eating? That is the essential question we aim to answer with our STEPS+ approach  in Helping Your Child with Extreme Picky Eating. STEPS+ is not about finding the one trick or rule to get a few more bites in. Rather, it’s about helping your family heal while facilitating your child’s enjoyment of a variety of foods in the right amounts so he can grow in a healthy way. It’s about ending the battles over food, and looking forward to family meals—maybe for the first time! It’s about celebrating and enjoying your child, no matter what his challenges are, and not letting his eating define his life or your family’s. How? We call our approach STEPS+.  Supportive Treatment of Eating in PartnershipS. What is STEPS+? STEPS+ approach is a blending of the work of Jenny McGlothlin, a pediatric feeding therapist and Speech Language Pathologist (SLP) and Katja Rowell, a family doctor specializing in relational and responsive feeding. “STEPS” (Supportive Treatment of Eating in PreschoolerS) is Jenny’s therapy-focused feeding program that she developed at the UT Dallas Callier Center. When we (Katja and Jenny) began working on the book after being virtual colleagues for a few years, we wanted to include and expand on the relational aspects of feeding that are often overlooked in the therapy world to empower parents to support their...

What is ‘Extreme’ Picky Eating?

It’s a hot topic at the playground and preschool pick-up; parents commiserating over their child’s sudden refusal of long-time favorites, or yearning for all foods “beige”. There is a lot of talk and worry around picky (fussy, finicky, choosy…) eating. Then there is the mother not saying much, wishing if only she had a child who would eat macaroni and cheese, or cucumbers with Ranch while other parents complain about the ubiquitous white sauce. Then there are the few moms and dads in the bunch who enthuse that if you only knew how to crisp kale chips properly, all the children would surely love them like theirs do. These discussions mirror what research tells us about the experiences of parents of young children: various studies suggest that between one and two-thirds of parents will describe their young child as “picky” at some point. Most will grow out of it and expand their tastes, but about 10-15% of children will become “persistent” picky eaters and many in that group have what we call “extreme” picky eating.   What’s in a name?   Researchers are still trying to agree upon consistent language and definitions. Clinicians and health insurers try to define ‘pathology’ that needs treatment and billing codes for reimbursement. Many of the labels and diagnoses we see include: feeding disorder, failure to thrive, infantile anorexia (outdated term), problem feeder, ARFID (avoidant restrictive food intake disorder), feeding aversion, selective eating, and selective eating disorder… Parents have also heard “spoiled”, or themselves been labeled as “neurotic”, “neglectful” or even “abusive” for letting their children eat foods not up to nutrition police standards....

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