Feeding Therapy Approaches Differ When Children Struggle to Eat: Find the Right Help for Your Family

The article, When Your Baby Won’t Eat chronicles the heartbreak and triumph of one family’s journey with pediatric feeding struggles. The author and mother shares some of the confusion around finding the right help for her family. Virginia Sole-Smith writes, “Do you try to correct the behavior- training a child to eat well –Pavlov Style- or do you try to rediscover that primal urge and trust her to take it from there? It’s a divisive question among the doctors and therapists who work with children like Violet, as well as a debate unfolding consciously or not, around most kitchen tables in the country.” Feeding therapy programs differ; from the ABA, or applied behavioral approach on one end of the spectrum (the Pavlovian approach) where adults may hold a child’s hands down, may use “gentle mandibular guidance” and “escape extinction“, to a more responsive approach where the child’s reactions and behaviors are not viewed as behaviors to eliminate, but as vital communication and clues to guide treatment. Confusing for parents is that many treatment programs, even with opposing approaches, sound the same online, using words like “child-led” and “family-centered” to the point that parents might have no idea what is actually happening in therapy. Parents, we know it is beyond confusing; experts in the field of feeding kids often express opposite viewpoints, with OTs, SLPs, MDs, RDs, PhDs disagreeing on the best ways to treat pediatric feeding challenges. Consider the following sentiments, from folks in positions of authority. Which is “correct”? Never force your child to eat. You’re the parent, it’s the same as with seat-belts, just make them eat it! If your child gags the puree,...

Empathy and Understanding, The Foundation for Helping Your Child with Extreme Picky Eating

“Learning what issues play a role in our son’s picky eating helped us  connect the dots and problem-solve creatively.” *You can learn to trust yourself and your child around food. That may feel impossible when you worry that she won’t eat enough or hasn’t progressed in months or years, and that things may even be getting worse.  Understanding what is typical, what isn’t and the many factors that can contribute to extreme picky eating (EPE) will help you decide what you can let go, what you can work on to support your child’s eating, and above all, how to not make matters worse. Feeding Challenges From Your Child’s Point of View   Children with EPE are not just being naughty or willful (though they are at times more than capable of being so). Helping a reluctant eater is not a matter of making her comply. Rather, there is almost always an underlying reason that starts a child and his parents down the path of feeding difficulties. Struggles can start in the neonatal intensive care unit, during the transition to self-feeding, or in the tricky toddler phase. Understanding the factors that may contribute to your child’s challenges and the dynamics at play can help you empathize and facilitate her eating with confidence. Here are some of the main reasons why a child might struggle with eating (with a focus on sensory challenges and a few resources focused on understanding): Medical Challenges: “It hurts! It doesn’t feel good!” Contributing medical issues must be ruled out or addressed. These might include allergies, reflux, or severe constipation—basically anything that can cause pain or make a child feel poorly. Young children...

Feeding Contraption for Convenience Doesn’t Make the Cut

When I came across this new invention that made it on to Shark Tank recently, my first thought was “huh”. The “Beebo’s industry-leading technology holds your baby’s bottle for you, allowing you to use your free hand without restriction.” When describing what the Beebo does, the biggest draw for parents is that it is “hands-free”.  According to the manual found online, here are some of the perks: “Hands free feeding lets you: Read a book to your baby. Answer the phone. Use the remote.” Digging into what these perks actually mean is what got me, though.  Let’s take them one at a time. Read a book to your baby. Yes, reading to your baby is a good thing. But where are your eyes when you are reading? On the book. NOT on your baby. When you are feeding a baby, especially a newborn, it is very important to pay attention to their cues and signals. Is the flow too fast? Do they need a break? When the bottle is tilted continuously like this contraption does, the baby does not have control over the flow of the milk, so the milk can flow more quickly than your baby can swallow, increasing the risk of choking or aspiration (liquid in the lungs). If the baby falls asleep while the bottle is still in her mouth and you aren’t looking at her (because you are reading a book or looking at the TV/phone), she is at risk for aspiration as well because the milk keeps flowing into her mouth and she isn’t actively swallowing. Making the feeding the priority creates the opportunity to...

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...

Musings on Anxiety, Sensitivities, and Extreme Picky Eating

Earlier this week, a study came out linking moderate and extreme picky eating with anxiety and depression in children. It has caused quite a stir in the media, with headlines like, “Is picky eating causing depression?” That grabs attention! With one in three parents describing their child as “picky” at some point, the reporting on this study has probably caused more anxiety.  Quick answer, no, typical picky eating, which impacts one in three kids at some point, does not lead to depression, anxiety or ADHD, nor was it associated. A small percentage of children have severe or moderate selective eating which were the two groups associated with anxiety and other concerns. Of note, this study, like all studies had some limitations. Among them, it was voluntary (meaning some parents opted not to partake which could alter findings), and the study followed a portion of the children for a few years, not to adulthood, and didn’t take into account how the challenges were addressed among other factors. The study itself doesn’t claim that picky eating causes depression, another example of how the media distorts science. Here is a nice summary of the study, and below are some more thoughts that we (Jenny and Katja) had on the issue to help parents unpack these scary headlines.   IS picky eating causing anxiety and depression? Do you see anxiety in children with more severe picky eating? This study found a correlation, not causation, between moderate to severe picky eating and other conditions like anxiety and ADHD, which has been suggested in other research. It does not mean that picky eating causes depression or anxiety...

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