5 Tips to Support, Not Sabotage, Your Child’s Appetite

Four- year-old Nathan ate fewer than ten foods, “failed” twelve months of behavioral and sensory feeding therapies, and was holding steady at the first percentile for weight. Medical and oral-motor work-up was unremarkable. On the advice of a dietitian, his mom offered his favorite straw cup with Pediasure several times a day, which he would sometimes sip. Mom, Elise tried effusive praise and rewards of stickers for any bites he would take, but this was becoming less and less effective. Mom described Nathan as cautious, not overly anxious, but “incredibly strong-willed.” She shared, “If he even thinks we want him to eat something, he shuts down. The only food he has tried in the past year was entirely on his terms, usually away from home.” Elise describes their routine: 6:30– 7:00 a.m.: sippy cup of milk— Nathan enjoys cuddle time in bed with mother, father, and baby sister, who gets a bottle at the same time 8– 9:15 a.m.: at the table for breakfast (with cartoons) 10– 11:30 a.m.: snack, sips of Pediasure and crackers while wandering around 12– 1:30 p.m.: lunch (with iPad) 3– 4:00 p.m.: snack (crackers while playing) 5– 6:45 p.m.: dinner, with Mom, Dad and sibling, Nathan is last to leave the table Nathan’s story is not uncommon, and illustrates five opportunities to support appetite: 1. Phase out the morning pre-breakfast drink. Many families use supplements or milk to support calories and nutrition, giving a sippy cup or bottle first thing when their children are likely to drink a good amount, often with a cuddle. Alas, this kills appetite for breakfast, but parents may fail to make the connection....

Take the Headache Out of Holiday Meals, For You and Your Selective Eater

 Holidays can be hard for any number of reasons. But with the intense focus on food and meals, they can be especially challenging for parents of children with extreme picky eating. So let’s say… Timmy is a selective eater… You’ve hated cranberry sauce since your folks forced you to eat it as a child and they try to make your kids eat it every year… Marie is heading into puberty and has put on a little weight in preparation… Bobbie is smaller than cousin Cort who was born six months after him… Susie has been in feeding therapy for a month, and the family wants to see “progress”… Sam gets overwhelmed by all the noise and new people and tends to melt down… All will be fodder for the Thanksgiving and Holiday tables. Your feeding (thus parenting) may feel in question. “What are you feeding him!?” “Just make her eat it, she won’t let herself starve.” “Here Marie, have some more salad if you’re still hungry!” “If you add gravy to his potatoes, he won’t be so scrawny.” “Stop spoiling her, that’s not how I raised you!” Gramma Eve raised six kids and they’re all “fine,” so she is the expert, Uncle Steve just lost 30 pounds, winning his work’s Biggest Loser contest (which he also won two years ago and then gained it all back), Betty actually force-fed your three-year-old bacon and garlic smashed potatoes last year (then he threw up) because she’s convinced he’d “like potatoes if he just tried them!” What to do? Your family may intrude, say or do the opposite of what you are...

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...

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...

Pin It on Pinterest