Empathy and Understanding, The Foundation for Helping Your Child with Extreme Picky Eating

“Learning what issues play a role in our son’s picky eating helped us  connect the dots and problem-solve creatively.” *You can learn to trust yourself and your child around food. That may feel impossible when you worry that she won’t eat enough or hasn’t progressed in months or years, and that things may even be getting worse.  Understanding what is typical, what isn’t and the many factors that can contribute to extreme picky eating (EPE) will help you decide what you can let go, what you can work on to support your child’s eating, and above all, how to not make matters worse. Feeding Challenges From Your Child’s Point of View   Children with EPE are not just being naughty or willful (though they are at times more than capable of being so). Helping a reluctant eater is not a matter of making her comply. Rather, there is almost always an underlying reason that starts a child and his parents down the path of feeding difficulties. Struggles can start in the neonatal intensive care unit, during the transition to self-feeding, or in the tricky toddler phase. Understanding the factors that may contribute to your child’s challenges and the dynamics at play can help you empathize and facilitate her eating with confidence. Here are some of the main reasons why a child might struggle with eating (with a focus on sensory challenges and a few resources focused on understanding): Medical Challenges: “It hurts! It doesn’t feel good!” Contributing medical issues must be ruled out or addressed. These might include allergies, reflux, or severe constipation—basically anything that can cause pain or make a child feel poorly. Young children...

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...

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...

What is the STEPS+ Approach to Extreme Picky Eating?

What can parents do when feeding is such a struggle that it feels like their only options are to fight over every bite, or to surrender and serve a child’s limited accepted foods day after day, year after year? How can parents lovingly support their child with extreme picky eating? That is the essential question we aim to answer with our STEPS+ approach  in Helping Your Child with Extreme Picky Eating. STEPS+ is not about finding the one trick or rule to get a few more bites in. Rather, it’s about helping your family heal while facilitating your child’s enjoyment of a variety of foods in the right amounts so he can grow in a healthy way. It’s about ending the battles over food, and looking forward to family meals—maybe for the first time! It’s about celebrating and enjoying your child, no matter what his challenges are, and not letting his eating define his life or your family’s. How? We call our approach STEPS+.  Supportive Treatment of Eating in PartnershipS. What is STEPS+? STEPS+ approach is a blending of the work of Jenny McGlothlin, a pediatric feeding therapist and Speech Language Pathologist (SLP) and Katja Rowell, a family doctor specializing in relational and responsive feeding. “STEPS” (Supportive Treatment of Eating in PreschoolerS) is Jenny’s therapy-focused feeding program that she developed at the UT Dallas Callier Center. When we (Katja and Jenny) began working on the book after being virtual colleagues for a few years, we wanted to include and expand on the relational aspects of feeding that are often overlooked in the therapy world to empower parents to support their...

Say Cheese! Exploring Preference and Changing Tastes with Picky Eating

When I was a child, I hated cheese. I couldn’t imagine eating it. Although I ate pizza, it didn’t really register that it was cheese on top. Once, when I was about 12, a good friend thought it would be hilarious to force me to eat some cold cheddar cheese. She easily held me down (being quite a bit taller than I was) and crammed a large chunk of cheese into my mouth and then kept her hand over my mouth so I couldn’t spit it out. In my memory, fumes were coming out of my ears. It was traumatic, and I haven’t ever let her live down that little stunt. Early in college, I went on a trip to Europe with my dad and we spent two days on the Orient Express. Every afternoon on the train, they served stinky French cheeses at tea. I literally had to stick my head out of the tiny window next to my seat while my father enjoyed the array of veined cheeses. My senior year found me at a friend’s parents’ house where they served us wine and, you guessed it— cheese. This time, though, there were grapes and strawberries and crackers to go with it. I voiced my apprehension, and my friend gently explained how I might enjoy Brie or Gouda since they were milder. And she suggested I try a small amount on a large cracker— with a grape in the same bite. To my surprise, I enjoyed it. And my love affair with cheese began. Mealtime Hostage blogger Skye VanZetten discusses her son’s journey toward cheese in this...

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