Facilitating (Not Forcing) Your Child’s Eating (Extreme Picky Eating Edition)

“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...

Trust Your Turtle: Patience with Picky Eating Progress

Here’s a story I read recently and shared with a client when she asked, “How can I get my daughter to accept new foods on her plate once she’s feeling good about her safe foods? Can’t I just put them on her plate?”   A woman was with her college geology class on a field trip by a river. She noticed a turtle up the river bank near a road and worried that the turtle would get hit by a car. So, she carried the turtle back down the hill and put it in the water. Afterwards, the professor came to her and said, “That turtle has probably spent weeks crawling up the hill to lay her eggs in the muddy slope and now she will have to start all over again.” The moral was, “Ask the turtle first.” (Gloria Steinem from her book, My Life on the Road) (See below our clarification of “ask”. Most children won’t want to be verbally queried along the way. Our moral is to be responsive to your turtle.)    What does this have to do with feeding? Well, many children with extreme picky eating have anxiety around foods, and often have struggled for years. As parents, and even professionals, we hope for and want improvements NOW, or in say,  six weeks. But progress is generally slow, slow, slow, and it might not look like what we think of as “progress” (eating new foods). Sometimes when we miss early signs of progress (less anxiety, eating more safe foods, curious about foods but not yet tasting or eating them...) it is easy to want to rush the process, to pick up our little turtles and carry...

Navigating Relational Feeding in a Medically-Minded World: When Calories Aren’t the Whole Picture

For many families, weekly (sometimes daily) doctor and therapy appointments are the norm rather than the exception. They strive to make everything fit into the schedule, because doing so keeps their child “well”- or at least not sick- and hopefully making medical or developmental gains due to professional, sometimes intensive intervention.  This may be a temporary scenario, or not. For parents of chronically ill or medically fragile children, every day begins with a status check: Is he running a fever? Is she going to hold down her feeds today? Did I give her all of her meds on time? Why is he doing X? Then on to the scheduling and phone calls- to the doctor’s office to sign a request for records to be sent to the out-of-state specialist, to the insurance company to fight yet another battle about payment for the child’s numerous procedures and office visits. For the parents who live this reality, it can be mind-numbing and terrifying all at once. Having a child who is well is the exception rather than the rule. Being truly well, however, is not the same as not being sick. For many kids, they have never been truly “healthy”, as the WHO states: “Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” What about these situations in otherwise “healthy” children? the baby who screams every time she sees a bottle, but takes a small amount when it is forced into her mouth the toddler who throws up at least once a day after being fed the preschooler who exists on Pediasure because he doesn’t...

Childhood Fears: Food or Fluffy, the Fear is Real

When M was little she had a dog phobia. I’m talking screaming, climbing on me, uncontrollable fear of even a toy poodle.  I can’t count how many people tried to talk her out of her fear, usually with a dog thrust into her personal space, and often against my explicit requests for them to stop. Take the German shepherd owner whose dog was off-leash, jumping on me while M clawed at my hair shrieking, and the owner kept smiling, “Oh, she won’t hurt you! She’s very gentle.” Well-intentioned dog owners (including friends and family) would bring dogs closer, insisting the dog wasn’t scary and everyone loved the dog, and, “Stop being so silly!” (super helpful)  or, “Look, Timmy is younger than you, and he’s petting the doggie!” (Throw some shame in while you’re at it! Works every time!)  I wish we could have had a sign at those times that said, “Seriously afraid of dogs. Back off. It’s not your job to get my kid over her fears…” It is this sticker that I saw on my walk home that led to this post. If I was behind a car on a hill and it started rolling, I might get mad or honk. But with this sign (Kid Driver   Manual), I know it’s a young person who is learning and I’ll be more patient. This sign reminds us to cut this kid driver some slack; have a little patience and understanding (something I struggle with behind the wheel sometimes). Of course it made me think of kids learning to eat. Imagine the child with extreme picky eating who only takes crackers at...

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...

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