by Jennifer | Jul 22, 2018 | anxiety, extreme picky eating, parent experience, research, Responsive 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...
by Katja | Mar 23, 2017 | extreme picky eating, parent experience, research, Uncategorized
“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...
by Jennifer | Oct 29, 2015 | infants, parent experience, research, Responsive Feeding
When I came across this new invention that made it on to Shark Tank recently, my first thought was “huh”. The “Beebo’s industry-leading technology holds your baby’s bottle for you, allowing you to use your free hand without restriction.” When describing what the Beebo does, the biggest draw for parents is that it is “hands-free”. According to the manual found online, here are some of the perks: “Hands free feeding lets you: Read a book to your baby. Answer the phone. Use the remote.” Digging into what these perks actually mean is what got me, though. Let’s take them one at a time. Read a book to your baby. Yes, reading to your baby is a good thing. But where are your eyes when you are reading? On the book. NOT on your baby. When you are feeding a baby, especially a newborn, it is very important to pay attention to their cues and signals. Is the flow too fast? Do they need a break? When the bottle is tilted continuously like this contraption does, the baby does not have control over the flow of the milk, so the milk can flow more quickly than your baby can swallow, increasing the risk of choking or aspiration (liquid in the lungs). If the baby falls asleep while the bottle is still in her mouth and you aren’t looking at her (because you are reading a book or looking at the TV/phone), she is at risk for aspiration as well because the milk keeps flowing into her mouth and she isn’t actively swallowing. Making the feeding the priority creates the opportunity to...
by Jennifer | Jul 31, 2015 | extreme picky eating, parent experience, picky eating, research
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...
