by Katja | Feb 13, 2018 | anxiety, extreme picky eating, low appetite, Uncategorized
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...
by Katja | Nov 7, 2017 | extreme picky eating, Responsive Feeding, Uncategorized
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...
by Katja | Apr 17, 2017 | Uncategorized
The following is Jenny’s (SLP, co-author) response to a comment that the STEPs+ approach described in our book, Helping Your Child with Extreme Picky Eating may not be “enough” for children with complex medical or developmental problems. The comment implied that the approach was solely about placing food on the child’s tray day after day; the response follows: “While I understand your concerns about progress with a medically complex child, we feel strongly that our approach can and does work for these children. Using the strategies at home while an experienced therapist guides you and your child in making specific skill gains is the best-case scenario. Putting food in front of a child on the tray doesn’t paint the whole picture. As the director of a feeding clinic, I have worked with hundreds of children who are NOT neurotypical, have multiple complex medical challenges, and who are severe enough in their feeding issues to require feeding tubes, using this approach. Most of my patients and my co-author’s clients have already had other therapies, from behavioral to SOS and sensory play therapies, and haven’t made progress. When the STEPS+ approach is applied, which can often take weeks or months for some families to get the hang of, with attention to gaining skills and addressing issues such as you describe your son having, these children make significant gains over time. Many have their feeding tubes removed. However, it doesn’t happen overnight, and it may not be what every parent feels is right for their child, and that’s okay. What is learned over a long period of time (months or years) cannot be undone and...
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 | Dec 12, 2016 | anxiety, extreme picky eating, family meals, food, parent experience, picky eating, Uncategorized
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....
by Jennifer | Nov 17, 2016 | Uncategorized
Jenny presented at the National American Speech Language and Hearing Convention (ASHA) this week, along with the clinical coordinator of the Tube Weaning Program, Heidi Moreland, SLP at Spectrum Pediatrics. There were extensive references included in their presentation and this research supports our work with responsive feeding and creating a healthy relationship with food for new and fragile eaters. We thought others might find these references to be helpful as well. If you are interested in learning more about the book or responsive feeding therapy you can look here and if you want to know more about the intensive tube weaning program at Spectrum Pediatrics check out their post here. References Addessi, Elsa, et al. “Specific social influences on the acceptance of novel foods in 2–5-year-old children.” Appetite 45.3 (2005): 264-271. Ainsworth, M. D., S., & Bell, S. M. (1969). Some contemporary patterns of mother-infant interaction in the feeding situation. In A. Ambrose (Ed.), Stimulation in early infancy (pp. 133-170). New York, Academic Press. American Speech-Language-Hearing Association. Van der Horst, Klazine. “Overcoming picky eating. Eating enjoyment as a central aspect of children’s eating behaviors.” Appetite 58.2 (2012): 567-574 (2001). Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders: Technical Report [Technical Report]. Available from www.asha.org/policy. American Speech-Language-Hearing Association. (1990). Issues in oral motor, feeding, swallowing, and respiratory-phonatory assessment and intervention. [A Building Blocks Module]. Alexander, R. (1987). Oral-motor treatment for infants and young children with cerebral palsy. Seminars in Speech and Language, 8(1). 87-100. Babbitt, R. L., Hoch, T. A., Coe, D. A., Cataldo, M. F., Kelly, K. J., Stackhouse, C., et al. (1994). Behavioral assessment and treatment of pediatric feeding disorders. Journal of developmental and Behavioral Pediatrics, 15, 248-291....
