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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.
When You Worry That it Won’t Work: Lessons from Responsive Tube Weaning (Guest Post 2)
This is the second part of our series around using Responsive Feeding Therapy when the stakes are the highest. Our first guest post from Heidi Moreland from Thrive by Spectrum Pediatrics can be found here. When You Worry That It Won’t Work Elisabeth Kraus, MiT; Becky Keifer, MA-SLP, CCC; Lisa Grentz, RD Growing Independent Eaters I’ll never forget that phone call. I was speaking with a mom who had spent the last years trying to be everything, and everyONE, that her little girl needed. A dietitian herself, she wept as she told me that she never imagined that her child would struggle to eat – struggle badly enough to require tube feeding in order to grow, in order to stay alive. And here they were, years into their journey, her daughter eating and drinking nothing by mouth, all while she tried to function as dietitian, nurse, doctor, feeding therapist, house cleaner, chauffeur, cook, and everything else that you can possibly imagine. Nothing, she told me, was helping her daughter learn how to eat, and she was exhausted – tired from the years of trying to do it all. “I just want the chance to be a mom,” she said. “I’m don’t think I can keep doing it all.” I’m not sure if she knew, but I sat on the other end of that phone call, crying myself as I recognized so deeply the pain she felt. She wanted her baby to be okay. She just wanted her baby to eat, not just because she had to, but because she experienced the wonder of family mealtimes and the food... read more
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
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
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
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