“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...

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...

A Journey to Healing and Growth: One Mother’s Telling

Bethany’s Journal: Amari’s Journey of Healing   Amari, age two, was adopted at age 14 months from Ethiopia and initially had some hoarding behaviors. After being home for about a year, her eating changed dramatically, with no identifiable cause. While underlying medical causes were being evaluated, Bethany needed help. The following are excerpts from Bethany’s notes and emails on the first few months during the transition from an anxious/pressured feeding relationship to one focused on routine, avoiding pressure, and healing anxiety. This post is largely excerpted from Katja’s first book Love Me, Feed Me,  focused on adoptive and fostering families. Bethany used responsive, trust-based philosophies expanded upon in the STEPS+ approach in our book, Helping Your Child with Extreme Picky Eating. This post is for informational purposes, and not meant to replace care of the individual child.   February 10, day one: A few months ago, she started to get pickier and ate less and less, eventually eating about five bites at each meal and down to two cups of milk a day and gaining nothing. She would pocket and take an hour to finish those bites. In one year home, she grew four inches and gained only nine ounces . . . We saw a nutritionist who told us how to sneak calories into her food. We saw a speech pathologist who determined that the issue was “psych” and barely glanced at her. In the last week, Amari has gotten SO much worse. She hardly drinks 1 and a half cups of milk/day, drinks nothing else, and takes about three bites at meals. I can force feed her more, but she gags constantly and...

What is “Responsive” Feeding Therapy?

Responsive feeding therapy is facilitating (re)discovery of internal cues, curiosity and strengths, while building skills (mastery).   “You don’t teach development, development is discovery.” Serena Wieder PhD (video on DIR Floortime)   Responsive therapies respond to each child, meeting the child where he or she is, not following a strict protocol without deviation.         By necessity, this occurs within a relationship. The primary is between the parent and the child, otherwise known as the “feeding relationship.” (Satter, Chatoor…)     Responsive feeding and feeding therapies also happen in relationship between the child and any adult feeding or providing food and meals to the child, and with any therapists involved in more formal therapies.     “Happiness is the most important factor at mealtimes and in therapy programs to help children develop feeding skills.” Suzanne Evans Morris SLP PhD Therapist and author, Pre-Feeding Skills     What do you think? What do responsive feeding therapies mean to you? Share this...

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, scoop...

Facilitating (Not Forcing) Your Child’s Eating (Extreme Picky Eating Edition)

“I’m not forcing, I’m just aggressively facilitating…” I was watching a show on Netflix* when I caught this line, “I’m not forcing, I’m just aggressively facilitating.” My ears perked at the words facilitation and force, and of course made me think of children with extreme picky eating, of feeding, and the “aggressive facilitation” that can sometimes happen, even in feeding therapies. There is much research that suggests that when children are pressured or coerced to eat, overall intake, and intake of fruits and veggies decreases.  Here are a few examples… “…approximately half of all mothers and a greater proportion of fathers… ignore the child’s hunger signals and may use force, punishment, or inappropriate rewards to coerce the child to eat. These practices initially appear effective, but become counterproductive, resulting in poor adjustment of energy intake, consumption of fewer fruits and vegetables, and a greater risk of under- or overweight.” (Kerzner 2015) “…stringent parental controls can… limit children’s acceptance of a variety of foods and disrupt children’s regulation of energy intake by altering children’s responsiveness to internal cues of hunger and satiety.” (Brown & Ogden, 2004) Pressure to eat likely disrupts child’s ability to respond to internal cues of hunger and satiety (Carper et al., 2000) Pressure to eat … “exacerbate feeding problems and make mealtimes more negative for both parent and child.” (Harris 1992; Skuse 1993) Pressuring strategies could be implicated in the development and persistence of these problems (Farrow & Blissett, 2008) Pressure to eat predicted food avoidance behaviors: slow eating, emotional undereating, satiety responsiveness (Powell 2011) Parent prompts assoc w/ food avoidant behaviors, correcting for child emotionality and maternal...

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