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,...

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...

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...

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)...

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...

Pin It on Pinterest