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....

When “It’s Not Working”: 10 Opportunities to Support Children with Extreme Picky Eating

Helping your child with picky eating, extreme or not, is a marathon, not a sprint… When we work with clients, or hear from parents at workshops or parents who’ve read our book, the STEPS “click” right away for some: their children are less anxious, enjoying meals, and tuning in to appetite and curiosity about new foods. But occasionally we hear, “It’s not working!” Sound familiar? Then this post is for you. Much of the time when families struggle or see no progress, they are still working on getting some (or all) of the steps in place. Perhaps there is unaddressed fear and worry, or families are afraid to go “all in.” We’ve compiled a list of the ten most common opportunities that we see. But first, a reminder in broad terms of the STEPS+ we outline in our book (with chapter numbers for reference) Step 1: Decrease stress, anxiety (yours and your child’s), and power struggles (chapter 4) Step 2: Establish a routine (chapter 5) Step 3: Enjoy pleasant family meals (chapter 6) Step 4: Build skills in “what” and “how” to feed (chapter 7) Step 5: Strengthen and support oral motor and sensory skills (chapter 8) Top Ten Opportunities to Get in STEP and Help Your Picky Eater 1: You and your partner aren’t on the same page. Let’s say Dad makes Timmy earn dessert by eating a bite of veggie, or requires milk with meals, while Mom is trying not to pressure. (A 2014 study found that dads tend to pressure more than moms.) Result: There is no consistent approach, which is confusing for Timmy, and this increases his anxiety! (STEP...

Medscape’s ‘War and Peace at the Dinner Table’: Is MAKING Kids Eat the “Only Way”, and Other Points to Ponder

This clip won the America’s Funniest Home Video $10,000 prize. Is it helping her learn to like green beans?   As clinicians, parents, and experts in childhood feeding struggles, we are concerned about the one-sided nature of the online article and video War and Peace at the Dinner Table: Advising Parents of Picky Eaters, presenting advice to physicians on how to help children with extreme picky eating. Below, we present a discussion and resources for parents and professionals who might like to learn more. First off, we agree with the following points in the article: clinicians should take a parent’s concerns about picky eating seriously (Kerzner), and that ARFID (avoidant restrictive food intake disorder) or extreme picky eating (EPE) impacts family life and the social and emotional development of the child. We also agree that without support, a significant proportion of children will not outgrow their eating struggles and that mealtime “hygiene”, like avoiding grazing, supports appetite and curiosity around new foods. However, we feel that several statements are not supported by the evidence, and in the absence of a widely accepted ‘best’ practice, must be examined. 1) This sweeping generalization: These children don’t have sensory sensitivities. Many children who suffer from ARFID or EPE had medical or underlying conditions and challenges, including sensory issues, that contribute to the establishment of a feeding disorder (Arts-Rodas, Chatoor). The DSM-V ARFID diagnostic criteria recognize three subtypes of the disorder sensory (emphasis ours), associated with an aversive experience, or associated with low appetite. Sensory challenges are at least a contributing factor for many children with EPE, particularly for those on the autism...

“Help! My Child Isn’t Eating at School!” 8 Fuel-at-School Tips for Picky Eaters

School has started for some of us, and will start for the rest of the country soon! A big worry for parents of picky eaters, especially those with more extreme picky eating and anxiety, is what happens at school around food. We get emails with a variation on this theme all the time: “My son is six, we’ve struggled to get him to eat enough his whole life. It’s all worse at school where he is already anxious. He has twenty minutes, and lunch staff try to make him eat which makes him upset. They threaten to take away recess time. He comes home with his lunch untouched most days and is understandably crabby when I pick him up.” Government programs address child hunger, often through schools: from breakfast in the classroom to free and reduced lunches, millions of children are getting fuel for their day. But what about the “hidden hungry”? The kids these programs can’t help? There are hundreds of thousands of kids heading to school every day from homes with enough food and resources. But they are too distracted, anxious or scared to eat.   Helping Your Child with Fuel at School Gather information How much time does your child have to eat? Can he open containers on his own? Is temperature an issue? Does he prefer foods hot, warm or very cold? Is lunch right before recess, so he’s eager to get outside to maximize playtime? Is he eating in his snowsuit or carrying gloves, or has a hat that gets in his way? Are adults or other children pressuring him to eat? Ask him to...

Doctors: Support Parents of Children with Picky Eating (from Typical to Extreme)

We were so excited to see this recent article, A Practical Approach to Classifying and Managing Feeding Difficulties (Kerzner et al. 2015) from the Journal of Pediatrics. It does a great job of providing an overview of feeding challenges: underlying factors, screening, red-flags, and a user-friendly format for primary care providers who are the front lines on this issue— most of whom receive little to no training in feeding challenges. This paper provides an excellent overview. Here are our summary points for clinicians: 1) Take every worry and complaint about picky eating seriously before jumping to reassurance. “…pediatricians must take all parental concerns seriously and offer appropriate guidance.” Parents may do well with reassurance and a handout, or they may need a referral to specialist care. You can’t reassure parents without listening to and addressing their concerns. 2) History, physical exam, potential lab tests, and red flags are discussed and help determine severity and what general category challenges fall under: misperceptions of typical variants, low appetite, medical/organic, selective, sensory, fear of feeding, and feeding style. This helps guide referral and treatment. Some sample red flags: using distraction to increase amount eaten, prolonged time at the table, gagging or coughing/choking, significant conflict, history of choking, or forceful feeding. “When it is apparent that a potential feeding difficulty exists, a complete history and physical examination, including carefully done anthropometrics and a brief dietary assessment, are necessary with special attention to serious red flags…” 3) Assess parents’ feeding style by asking parents how feeding is going, what they worry about, what they do if they think a child needs to eat more...

The Lonely Kitchen Island: Physical Obstacles to Family Meals

This post isn’t specifically about the spectrum of picky eating… but it is. One of the major goals of our STEPS+ approach is for families to enjoy eating together again— or perhaps for the first time. We wrote a whole chapter on rehabbing family mealtimes, and one often overlooked piece of the puzzle is the physical space where meals happen. Consider the kitchen island. Other than just being a place to throw keys and homework, the kitchen island in many houses and apartments has replaced the kitchen table. Granite countertops sell homes— humble tables don’t. Growing up in the ’70s and ’80s, most Midwestern middle class kitchens I dined in did not have elaborate islands or counters with stools. I remember sitting around tables. As homes generally got bigger over the last 30 years, it seems the kitchen island became standard and the eat-in kitchen disappeared. On house-calls and play-dates over the years as a childhood feeding specialist and mom, I’ve watched the parent or childcare provider standing behind the island counter preparing food and serving children. By design, the island makes line-cook/wait-staff the easiest option— and there’s nothing wrong with this on occasion. But if it mostly or always happens, it robs children of the most important mealtime ingredient—a loving adult providing company and eating from the same foods (including at least one item the child generally enjoys). So, did form follow, or dictate function? Were parents already standing and serving meals and needed a more efficient way to do so, or did the changing design of modern homes assist the slide of communal family meals?  Moms  (both...

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