Confessions of a Mommy Feeding Therapist

Working with families who struggle to feed their children on a daily basis, I often hear, “Your kids must be great eaters!” or “I bet you don’t have any trouble at the table with your kids!”.  Well, let me tell you, it isn’t quite that simple. As a feeding therapist, I am confident that what I am suggesting to parents will at least help, and not hinder, their child’s progress with eating. When I am working with someone else’s child, I can see their issues objectively. That makes it fairly easy to navigate next steps and to tease apart what may be going wrong. I have done loads of research and reading on the topic, wrote a book, and provide therapy for children from newborns to teenagers. I do trainings for other therapists, physicians, and students. So you would think I would have all the answers with my own three kids, right? Not so much. At home, things are a little more complicated. Do my kids sit at the table and eat at most meals? Yes. Are mealtimes a beautifully harmonious experience where all three of my children eat complicated dishes with a smile on their face? Hasn’t happened yet- I am still waiting. So what does a feeding therapist’s family mealtime actually look like?  Here is a window into my world: Setting:  We eat at our kitchen table for all meals, using family-style serving. I do a lot of “pile-on” and deconstructed meals and we don’t pre-plate the kids’ food. I work full-time and the kids have lots of activities, so our meals are fairly simple, and I get take-out about once a week....

The Manners Monster: 5 Tips for Taming the Beast at the Table

Do you ever find yourself wanting to pull out your hair at mealtimes because your children’s manners are atrocious? I do. From my almost-tween putting his feet on other people’s chairs and sitting sideways while he eats, to my second son burping loudly and using his hands to eat, to my preschooler throwing her food at her brothers (among other things). Sigh. It is a daily occurrence, and it requires even the most Zen of parents to dig deep for that calm place. I find myself asking my husband, “Are we raising a brood of Neanderthals?” But, we aren’t (even though I could swear it at times!). We are raising children, and they are not little adults. They don’t have the social awareness to know that their behavior isn’t appropriate, and it is up to us to gently guide them so they won’t end up being shunned from social gatherings. However, even though we know what the end goal is, there are considerations when we are talking about the acquisition of manners. Much of what seems like bad manners may actually be typical development, or may help children with sensory issues learn about their food. Using hands instead of utensils is normal as little ones explore the physical properties of their food and gain skills with utensils. They may switch back and forth for a while, depending on what type of food it is, how hungry they are, and what their experience and comfort is with that particular food. There is also the possibility that your child actually can’t help it. Consider the elementary-aged child who was constantly told to chew with her mouth closed; she finally was able to...

Milk is Food: Improving Appetite for Toddlers with Picky Eating

Lately, we’ve been getting questions from parents whose toddlers are struggling with poor appetite for solid foods but eagerly take a bottle or want to nurse around the clock. Cow’s milk (or a milk alternative) is a recommended part of a toddler’s overall diet, and many toddlers continue taking formula or breast milk into the second year of life. Some children may need a more fortified liquid supplement like Pediasure if growth has been poor. The American Academy of Pediatrics recommends that low-fat/reduced-fat milk not be started before 2 years of age, and at age two, toddlers need approximately two cups of dairy per day. (And if your child prefers whole fat dairy, serve what he likes. There is no compelling evidence that low fat dairy reduces the risk of being overweight down the road.) A common problem with milk occurs when the amount he consumes or the timing of consumption interferes with appetite for other foods. Not only can nutritional variety suffer, but crucial early experiences eating a variety of foods can be missed. Whatever type of milk we are talking about, it is digested in the same way as food, and contains filling fat and protein. There’s only so much room in that toddler tummy! Let’s be honest. We all prefer the path of least resistance, and children are no different. Drinking most of their calories is just easier for some children. The comfort of being in mom’s arms, the soothing nature of sucking, and the ease of just swallowing- and not having to chew- are all reasons why some toddlers can have trouble transitioning to a more...

Chew on This: Considerations for Development of Oral Skills in Extreme Picky Eaters

When I evaluate a toddler that hasn’t made the transition to table food, one of the first questions I ask is “Did he mouth on toys/hands/lovies as an infant?” If the answer is yes, I always ask how much and how that child compared to other children in the home with regard to mouthing and early acceptance of oral play. However, more often than you would think, I hear from parents that these children with extreme aversion to texture in their food did not mouth at all. They blithely say “We didn’t have to baby-proof!”, unaware that their well-behaved infant’s choice to leave that paperclip on the floor is at least part of why he hasn’t moved on from pureed foods. I recently saw an older toddler who fit this description exactly—to the extreme. When observing her oral motor skills without food, there were no noticeable deficiencies. Lateral tongue movement was present, she could open and close her mouth in mock chewing, was able to blow a kiss, and kept her tongue in her mouth where it is supposed to be. No outward signs that this child had never had one bite of actual food. Not one bite swallowed. Theirs was a successful breast feeding dyad, but that was the only sustenance she got, and not from lack of trying on the parents’ part. So why couldn’t this child learn to eat? Interestingly, the family had many older siblings who had mouthed as infants, accepted spoon feedings of purees without incident, and had no trouble learning to eat the family foods. So it wasn’t what the parents had or...

The Art of the Pile-On: Family-Style at It’s Finest

I learned about the “pile-on” from friends at work many years ago—the modern version of a pot-luck, where everyone brings 1-2 ingredients to put together a meal. We usually enjoyed the Mexican Pile-On, with tortillas, chips, ground beef, shredded chicken, beans, tomatoes, lettuce, sour cream, cheese, olives, etc. The “pile-on” is the fun part: everyone gets to choose from all the separate items to build their own taco, burrito, or nachos. With my own kids, the pile-on dinner has become an easy way for me to serve family-style in a manner that suits the very different feeding temperaments of my children. I have expanded this to the “Potato Pile-On”, “Pasta Pile-On”, and “Pancake Pile-On”. I get out lots of toppings and put them all on the table, and am continuously surprised at the “inventions” that my boys make from the offerings. The pasta night includes spaghetti, tortellini, or some other pasta, pesto and tomato sauce, cut up tomatoes, bell peppers, onions, and avocados, Parmesan and mozzarella cheese, and diced chicken or ground turkey. Pancake pile-on is made up of sweet potato or apple pancakes (I add sweet potato puree or applesauce), various fruit cut up in bowls, yogurt, turkey bacon or apple-cinnamon sausage, gouda or goat cheese, and scrambled eggs. The other night, we had baked potatoes, and my oldest came up with this: My younger son went a completely different way (no surprise there) but ended up with quite the food sculpture! Mine was a more traditional stuffed baked potato with cheese, sour cream, broccoli, and turkey bacon, with the tomatoes and avocados on the side as a...

Moving from GET to LET: Supporting the Child with Picky Eating

“I couldn’t get him to eat anything.” While reviewing the progress of the children in my feeding program with my graduate student clinicians, I hear this type of statement all the time. There is sometimes so much ‘get’ that I have to stop the discussion and tell the students to remove that word from their vocabulary during feeding therapy. Why? The words we say out loud, and even in our own heads, can make a huge difference in how we think and feel about others, ourselves, and our actions. How we behave is influenced by what we’re thinking . . . and words are a direct reflection of our thoughts. Words matter. They shape our thinking and other’s perceptions of our message. They can color a conversation, and can change someone’s mind. Words can drive a wedge between partners or support someone so they can go on to change the world.   Henry Ward Beecher said “All words are pegs to hang ideas on”. If we view words in that way, it can help us to see how our language can make a huge difference in not only how our children react to us, but how WE react to THEM. If you have an agenda and the child isn’t cooperating, your instinct is to do something to GET them to play along. So many parents I work with say the following types of things: “How do I GET her to eat more?” “I can’t figure out how to GET him to drink.” “His doctor said we need to GET 24 ounces in him.” “I just can’t GET him to...

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