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....

Ask, “What’s Important Now” (WIN) to Help Your Child with Extreme Picky Eating

I was at a conference recently speaking about ARFID (avoidant restrictive food intake disorder) with folks who treat eating disorders and some who provide early feeding support in the community. When I can, I reserve a chunk of time for discussion and Q and A– for selfish reasons, partly.  I almost always come away with some new tip, story, or information that has tremendously shaped my work over the years. I had mentioned research that dads tend to pressure children more with eating, and boys tend to be more pressured. (Our theory is that if boys fall on the smaller side of the growth curve, the tendency is to try to get them to eat more to be ‘big and strong.’ Boys also make up a higher percentage of children with extreme picky eating.) Anecdotally, Jenny and I find that more fathers than mothers tend to struggle with letting go of rules and pressure; one area in particular is manners. One attendee talked about her rural area where there are a lot of fathers who are in the military, and that she observes that these dads seem more insistent on rules, order, and compliance with manners. For one family struggling with extreme picky eating, there are many mealtime battles around trying to get the kids to eat with elbows off the table, knives and forks held a certain way, not too loud, all asking to be excused only after everyone has finished… The fighting about manners adds to the tension and conflict over who is eating what and how much. The first STEP when we work with parents (and in our book)...

Picky Eating Progress Reports: Spirited 3 1/2 year-old

Sharing one mom’s early successes (and tips) with her son with extreme picky eating. My 3.5 year old and I needed some help. I read your book, Helping Your Child with Extreme Picky Eating and started the process this past Friday. While reading the book I realized how emotional I have been about our struggle with food. My husband was on board when I told him about it. My family said they’d be respectful and help. My son’s daycare already operates just as your book describes. While I teared up several times while reading the book, as it so closely related to my sense of failure, it gave me hope to try something new. He is developmentally fine, but is spirited and strong willed. The struggles seemed to be escalating and I was ready for help. Since starting last Friday (one week of trying) things have already gotten so much better!!! I started our dinners new with all glass serving dishes so he can see the food. Changed the placemats and put flowers on the table so I felt like it was a fresh start. Since starting STEPs+ he helped make blueberry pancakes (winced when the blueberries came out, but I wanted them so I stayed the course) and then at the table he put one on his plate!!!! He has watched me eat cherries (many times) acting as if he’s not watching. Today he asked if I eat the stem. When the dessert is on the table he eats a bit of it, but goes to his safe foods and eats them instead. His asking for crackers has almost...

When “It’s Not Working”: 10 Opportunities to Support Children with Extreme Picky Eating

Helping your child with picky eating, extreme or not, is a marathon, not a sprint… When we work with clients, or hear from parents at workshops or parents who’ve read our book, the STEPS “click” right away for some: their children are less anxious, enjoying meals, and tuning in to appetite and curiosity about new foods. But occasionally we hear, “It’s not working!” Sound familiar? Then this post is for you. Much of the time when families struggle or see no progress, they are still working on getting some (or all) of the steps in place. Perhaps there is unaddressed fear and worry, or families are afraid to go “all in.” We’ve compiled a list of the ten most common opportunities that we see. But first, a reminder in broad terms of the STEPS+ we outline in our book (with chapter numbers for reference) Step 1: Decrease stress, anxiety (yours and your child’s), and power struggles (chapter 4) Step 2: Establish a routine (chapter 5) Step 3: Enjoy pleasant family meals (chapter 6) Step 4: Build skills in “what” and “how” to feed (chapter 7) Step 5: Strengthen and support oral motor and sensory skills (chapter 8) Top Ten Opportunities to Get in STEP and Help Your Picky Eater 1: You and your partner aren’t on the same page. Let’s say Dad makes Timmy earn dessert by eating a bite of veggie, or requires milk with meals, while Mom is trying not to pressure. (A 2014 study found that dads tend to pressure more than moms.) Result: There is no consistent approach, which is confusing for Timmy, and this increases his anxiety! (STEP...

5 Tips to Support, Not Sabotage, Your Child’s Appetite

Four- year-old Nathan ate fewer than ten foods, “failed” twelve months of behavioral and sensory feeding therapies, and was holding steady at the first percentile for weight. Medical and oral-motor work-up was unremarkable. On the advice of a dietitian, his mom offered his favorite straw cup with Pediasure several times a day, which he would sometimes sip. Mom, Elise tried effusive praise and rewards of stickers for any bites he would take, but this was becoming less and less effective. Mom described Nathan as cautious, not overly anxious, but “incredibly strong-willed.” She shared, “If he even thinks we want him to eat something, he shuts down. The only food he has tried in the past year was entirely on his terms, usually away from home.” Elise describes their routine: 6:30– 7:00 a.m.: sippy cup of milk— Nathan enjoys cuddle time in bed with mother, father, and baby sister, who gets a bottle at the same time 8– 9:15 a.m.: at the table for breakfast (with cartoons) 10– 11:30 a.m.: snack, sips of Pediasure and crackers while wandering around 12– 1:30 p.m.: lunch (with iPad) 3– 4:00 p.m.: snack (crackers while playing) 5– 6:45 p.m.: dinner, with Mom, Dad and sibling, Nathan is last to leave the table Nathan’s story is not uncommon, and illustrates five opportunities to support appetite: 1. Phase out the morning pre-breakfast drink. Many families use supplements or milk to support calories and nutrition, giving a sippy cup or bottle first thing when their children are likely to drink a good amount, often with a cuddle. Alas, this kills appetite for breakfast, but parents may fail to make the connection....

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