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*The information on this blog and website is for informational purposes only. It is not meant to replace careful evaluation and treatment. If you have concerns about your or your  child’s eating, nutrition or growth, consult a doctor.

Responsive Feeding Therapy with Severe Feeding Challenges: Lessons from Responsive Tube Weaning (Guest Post 1)

Responsive Feeding Therapy with Severe Feeding Challenges: Lessons from Responsive Tube Weaning (Guest Post 1)

From parents and even professionals at workshops, we are often asked, “Well, Responsive Feeding Therapy sounds good, but does it work for children with severe challenges, or who ‘can’t’ feel hunger due to medical issues or feeding tubes?”  In this first guest post of two, we explore responsive therapies where relationship, autonomy and trust are guiding principals. The lessons learned from these challenging cases can apply to every family struggling with a child who is an anxious or reluctant eater.                             Heidi Moreland graciously shares some of her thoughts around tube weaning. Heidi Liefer Moreland, MS, CCC-SLP, BCS-S, CLCKids who are on feeding tubes have often missed the early period of learning to eat. For some of them, the medical difficulties that led to the placement of the feeding tube may continue to impact their development.  On top of that, the feeding tube itself will impact hunger, making learning to eat seem like unnecessary work. Children who are fearful, who learn more slowly, or have more difficulty with physical coordination are at even greater risk of getting “stuck” in a pattern of fear, feeding refusal and family frustration.Unfortunately, that often leads to the belief that they can’t or won’t learn to eat in the way that other children do. Parents and other professionals feel that if they want to help children become oral eaters they have no alternative to direct instruction, bribing, or forceful feeding tactics.  The problem is that we know those strategies are harmful to a healthy relationship with food and result in the most fragile eaters... read more
Weaning off Distractions with Extreme Picky Eating

Weaning off Distractions with Extreme Picky Eating

We recently got a question from a psychologist working with a family. (Details changed.) “I’m working with parents of a seven year old boy with sensory challenges and extreme picky eating. He brings several stuffed animals to the table and insists on feeding them bites before he will eat anything. He seems reluctant to give them up. In the past the family has done sensory based therapies where the child was to touch and lick certain foods which seemed to make his anxiety worse. Dad is reluctant to take the stuffed animals away as for now it does seem to help him come to the table and get a few bites in. They are very new to the STEPs approach and wonder if they can let him have his stuffed animal friends for now. They worry if they take those away, he won’t eat. Thoughts?” Quick answer is “Yes he can keep his stuffed animals for now, and…”These parents are asking a great question that shows that they are tuned in to their son’s anxiety and are looking for ways to keep anxiety at bay as much as possible. REDUCING ANXIETY for the child and parent is the first STEP in our responsive process.This family is very early in making the transition to a responsive feeding approach. There are many things they are likely working on and they don’t have to do it all at once! Honor the parent’s instinct to work on other things first. They might work on having more regular meal and snack times, (STEP two is routine) and avoiding any pressure, both more “negative” (multiple prompts to... read more
“What do I say when…” Extreme Picky Eating Edition

“What do I say when…” Extreme Picky Eating Edition

A big challenge that trips parents up daily is, as one mom put it, “Knowing what to say in the moment.” Sitting across from a child,  parents often feel pulled into those familiar, but counterproductive patterns: the negotiating, bribing, nutrition lectures, sticker charts, or threats around video game time. When the old patterns haven’t worked, but parents aren’t quite sure what to say, we offer some suggestions that: reduce conflict, build relationships, support appetite (anxiety and conflict can kill appetite and curiosity) and make mealtimes more enjoyable for everyone. These “scripts” can be used flexibly and adapted for different situations. We even recommend parents practice some of the phrases. Here are a few that we include in the book with the reasoning behind them. For more thorough discussion of how to transition to responsive feeding and more script examples, check out Helping Your Child with Extreme Picky Eating. One caveat: If you say something like, “We won’t make you try foods anymore,” be sure you are ready to mean it. This is tricky stuff. Learn as much as you can before you jump in, learn about common obstacles and ideas on how to approach them, know what to expect, consider online support (we love the private Mealtime Hostage group) or get help from a responsive feeding professional. These are just suggestions; adapt and find the words that work for you and your child (be responsive). Acknowledge your child’s feelings. Anxiety often plays a big part in extreme picky eating. If it helps your child, begin by slowing down and acknowledging his feelings. “I’m sorry you’re upset about X.” “I... read more
Find Your Fit: Your Family’s Feeding Therapy Partner

Find Your Fit: Your Family’s Feeding Therapy Partner

We recently wrote about how different the feeding therapy experience can be and how confusing it is for parents who may be simply handed a referral. One mom who described the eight months her son was in a behavioral feeding therapy program as “traumatic for us both,” was furious to learn that she had options. Her son thrived after a tongue-tie release procedure and responsive therapies that worked on healing his reluctance (worsened by coercive feeding and therapy), supporting appetite and decreasing anxiety. Most of our clients have “failed” months or years of various feeding therapies. Jenny was the 6th feeding therapist for a 3 year old client she worked with recently who made more progress in six weeks than he had in the three previous years. When you don’t know much about a program, and the website uses language that is confusing, or you don’t get a clear idea of what kinds of therapies they offer, you may need to dig further to find out if a therapist or program is a good fit for your family. Here are some questions you can ask and discussion points (link here: Finding Your Feeding Therapy Partner PDF) Of note, these are complex issues, and we go into this in depth in chapter eight in our book, Helping Your Child with Extreme Picky Eating. Sometimes, even if you are contemplating formal therapies, you can make progress at home. We practice Responsive Feeding and Therapies  with our STEPs+ approach (including links if you’d like to learn more). If this is what you are looking for, here are some suggested questions to see if a potential therapist... read more
The Trauma Trap: Impact on Families and Feeding

The Trauma Trap: Impact on Families and 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... read more
My Child Choked and Won’t Eat! Help!

My Child Choked and Won’t Eat! Help!

We recently got a question from a mother whose daughter had a choking episode and is refusing to eat. “Our six year old had a choking episode two weeks ago, but the food popped out pretty quickly. She is now only drinking Pediasure. Our pediatrician is not concerned since she is drinking Pediasure (“Total nutrition” he said!), but our daughter is panicked about choking again and seems to be getting worse. We called the local eating disorder treatment center, and they can see her- in three months! We don’t know what to do!” (Assuming her weight is stable or minimal decline, and that her development and eating were typical before the aversive event, and assuming the pediatrician has ruled out any reason behind the choking event…) A few general thoughts for this mom and others with the same concern: You are right not to wait three months! Most children in this situation don’t need inpatient or intensive Eating Disorder treatment, but things can get worse quickly. This is not an uncommon event, but scary all around. EARLY support leads to best the outcome. Your doctor isn’t too worried, but you are seeing a dramatic difference and your gut says you need help. The phobia can become more entrenched the longer it goes on. (See case study below we wrote for doctors on Medscape for more. Part of why we are sharing this is for parents to have it to show to the child’s doctor if they need help finding resources, or having concerns taken seriously.) This is a traumatic event, and can take time to heal, but you should see steady progress with support. Find a therapist... read more
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