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...

Food Allergies and the “Spotlight of Difference”: Guest Post

Children may face eating challenges for various reasons. Children with extreme picky eating tend to experience higher levels of anxiety, around food and in general. Perhaps the most anxiety-provoking feeding challenge that parents face is life-threatening food allergies. Some children with extreme picky eating also struggle with food allergies, which can complicate the picture even further. Kristin Beltaos has made it her mission to help parents and children not just be safer and healthier, but thrive. We were intrigued and impressed with Kristin Beltaos’ work with parents, children, and schools (A Gift of Miles). She has graciously agreed to share some wisdom in our first guest blog post.   1. We are intrigued by your “Spotlight of Difference” TM. Can you tell us more? First off Katja and Jenny, thank you for the opportunity to communicate with you and your followers. Usually when you think of placing a spotlight on a child you think of something positive, i.e., accomplishing an awesome grade, playing a great sport game, writing a wonderful paper or doing well in a recital. These are all great ways to shine a positive spotlight on a child. It’s fascinating how when we are confronted with a challenging situation, such as creating a safe environment for a food allergic child, our initial instinct is to determine how a child will adapt to our environment, rather than how the situation can be modified so that it’s safe for everyone. When we only address the individual child it will almost always create a Spotlight of Difference TM. In our efforts to create safe environments for children with food allergies, parents and schools alike...

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...

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...

“But It’s Healthy!” The Lure of Nutrition Talk and How it Fails with Extreme Picky Eating

We had a little boy over for lunch recently. His mom asked what I do for work and when I told her, her eyes lit up. “He’s so picky! Maybe you can get him to eat something!” From the spread at lunch, he happily stuck with bread and butter, and we had a lovely time. (I won’t make your child eat vegetables, that’s not how it works.)  During the meal, this six year-old shared that he LOVED his grandmother’s “homemade chicken soup” that was “organic, from scratch and has no chemicals in it!” When I delivered him back to his RV (we are living/traveling/working in an RV across the US this year) I shared his story about how much he loves Grandma’s homemade soup. His mom rolled her eyes. “Campbell’s” she said, “…from a can.” Small Children Can’t Understand Complex Nutrition Messages We chuckled and it reminded me of a conversation I had with my then almost four year-old. “Mom, is lettuce protein?” When I asked why she wanted to know, she explained that every day at school, the children had to all share what “protein” they had in their lunch. The following year in kindergarten she was teased by two classmates for choosing 1% milk, “You’ll get fat! It has fat in it!” What do these stories have in common? They illustrate how small children pick up on nutrition messages and words, and while they may seem to understand, in general they don’t. It doesn’t help their eating to try to use nutrition messaging as a way to get them to eat more or different foods. It’s another form of...

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...

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