by Jennifer | Nov 2, 2020 | family meals, oral motor skills, parent experience, Responsive Feeding
By: Ashlei Fisher Brody William Fisher was born on July 5, 2015 weighing in at 7 pounds 8 ounces and measuring 20 ½ inches long. He was perfect in every way and still is. He nursed well and took pumped breast milk from a bottle with no problems. He loved baby food when he was 6 months old and ate every drop of yummy fruits & veggies. Around 2 ½ months old, I noticed a dip in Brody’s chest wall as I was about to bathe him one evening. I immediately showed my husband and called the pediatrician the next morning. She had us get x-rays taken and quickly referred us to an orthopedic surgeon. He sent us to get an MRI when Brody was 3 months old. He was diagnosed with scoliosis and needed to be monitored. The curves continued to progress in that time, so the orthopedic surgeon applied a Mehta cast when he was 7 months old. The first cast went well, however his second cast application was extremely tight. Frightening vomiting started and then he quickly stopped eating, drinking, peeing, and pooping. I had never seen vomit like what I was seeing come out of my baby boy. I would give him 1 oz. of milk and he would projectile vomit it all over me and the floor. I rushed him to the emergency room, where they removed the cast. After that, he wasn’t keeping anything down and started to drastically lose weight. We were referred to a GI specialist who did numerous tests and told me Brody had a sliding hiatal hernia, which means...
by Jennifer | Sep 12, 2019 | food, picky eating, Responsive Feeding, Responsive Feeding Therapy
Part 2: The Case For a Responsive Approach to Feeding Therapy (Missed Part 1: Applied Behavior Analysis (ABA) Professionals & Feeding Intervention? Find it HERE.) Drawbacks of Behavioral Methods in Feeding Therapy Practitioners who use behavioral modification methods in their therapy sessions do so because they believe them to be useful tools for achieving their agenda of getting a child to eat. I have worked with therapists who use them, have been directly referred patients from inpatient behavioral feeding programs, and have seen many behavioral protocols that parents have been asked to follow within these programs/therapies. My core belief system rejects the idea that it is my job to “get” a child to eat, and therefore it is not necessary for me to use any tool that may cause anxiety in child I am treating, which is often the case when these methods are used. I have heard ABA clinicians use the term “break the child” in reference to the point in therapy where a child ultimately gives up and begins complying with “taking bites” in therapy; this smacks of dehumanization and is cruel, in my opinion. Another explanation for “giving in” could be found in trauma theory. Research is needed to examine if giving in and eating is actually a trauma response. “When the dorsal vagal nerve shuts down the body, it can move us into immobility or dissociation”…that comes after “fight or flight”, where a child is trying to avoid eating whatever the adult is presenting. A child who ‘zones out’ after fighting tooth and nail to avoid something they perceive to be dangerous is not ‘complying’. They are...
by Jennifer | Sep 10, 2019 | Uncategorized
Part 1: Applied Behavior Analysis (ABA) Professionals & Feeding Intervention Your child’s ABA therapist wants to develop a feeding plan for him right away. What should you know? Applied Behavioral Analysis (ABA) began in the 1930’s with BF Skinner, who believed that radical behaviorism was the lens through which we needed to view human motivation. Even though there have been many advancements in our understanding of behavior and motivation, his work continues to be used as the basis for an entire therapeutic and business model. With the advent of neurological imaging technology and the scientific measurement of cognitive processes (DeSouza et al., 2012; Kühn et al., 2014), behaviorism has ceased to be a leading theory of learning. Nevertheless, there has been a surge in the number of ABA clinics and providers around the country, with many integrating ‘feeding plans’ into their therapy sessions with children. I was recently asked to explain how I view the role of behavioral modification principles in feeding therapy and how the therapy model/approach that I practice and promote is different (see part 2 for my answer). Many feeding therapy programs (inpatient and outpatient) and some therapy providers (Speech-Language Pathologists-SLPs, Board Certified Behavior Analyst-BCBAs, etc) use ABA (Applied Behavioral Analysis) methods to “get” children to eat more or different foods than they are currently comfortable eating. The proponents of these approaches point to research that heavily relies on low-level evidence such as “individual case-control studies, case series, or expert opinion without explicit critical appraisal or based on physiology bench research or “first principles” with small sample sizes” (often one child). I offer my perspective on behavioral approaches as someone trained in college by...
by Jennifer | Jun 14, 2019 | extreme picky eating, food, picky eating, toddlers, Uncategorized
It’s summertime and as the weather heats up, staying hydrated is even more important, especially for our little ones! Dehydration can lead to loss of energy, lethargy, irritability, headaches, difficulty sleeping, constipation, fainting and if severe, can lead to more dire consequences*. Sometimes that cranky toddler is really a thirsty toddler, but with regular opportunities to drink and take in food with high water content, almost all children do just fine. (Use common sense around activity on hot days and sun exposure. Some kids are more sensitive than others, so watch your child and maybe skip that all-day soccer tournament when the temperature is in the 90’s!) Here are some tips to keep your children well hydrated and happy during the summer months. Pushing children to do anything around eating and drinking can backfire, so avoid pressuring them to drink more. Instead, try these ideas: For the child who enjoys strong or interesting flavors, consider offering tart juices like cranberry or pomegranate, or add lime or lemon juice to water. If they seem to enjoy the carbonation of soda, offer flavored seltzer water or mix sparkling water with juice. Turning up their nose at plain water? Consider adding water flavoring like Mio, Hansen’s Natural Fruit Stix, or watered-down juice or Gatorade. Get shaped ice cube trays and make ice from juice or water for a fun addition to water. Let them pick out a special new cup that they can drink from at home and on the go. Keep an insulated cup in the car during days spent driving around in the heat. Show your child how to use the...
by Jennifer | Jul 22, 2018 | anxiety, extreme picky eating, parent experience, research, Responsive Feeding
Trauma: • an injury (such as a wound) to living tissue caused by an extrinsic agent • a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury • an emotional upset We don’t usually use the word trauma when discussing feeding disorders, but we should. Children who have experienced significant emotional stress during feeding because of GI discomfort, poor oral control, cardio-respiratory issues, or forced feeding are at risk for disordered behavioral responses around feeding for many months (or years) to come. Infants born prematurely exhibit feeding problems due to neurological and respiratory immaturity and the myriad of issues that can arise while in the NICU. These challenges follow them out of the NICU and into the home, and while being able to go home is a milestone in and of itself, there are many more milestones to overcome when it comes to feeding. “During development, the cognitive, motor, emotional and ‘state’-regulating areas of the brain organize in response to experiences. And in each of the diverse brain systems which mediate specific functions, some element of previous experience is stored.” (Perry, 1999) The infant’s early experiences (good or bad) and their responses during feeding down the road are inevitably linked. Take Nash*, an 18 month old (corrected age) who struggles to get through a meal without gagging and vomiting. Born at 30 weeks gestation, he relied on a naso-gastric (NG) tube for nutrition for 6 months, which involved the trauma of reinsertion when the tube had to be changed as well as the chronic discomfort inherent in the placement of a...
