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...

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...

Moving from GET to LET: Supporting the Child with Picky Eating

“I couldn’t get him to eat anything.” While reviewing the progress of the children in my feeding program with my graduate student clinicians, I hear this type of statement all the time. There is sometimes so much ‘get’ that I have to stop the discussion and tell the students to remove that word from their vocabulary during feeding therapy. Why? The words we say out loud, and even in our own heads, can make a huge difference in how we think and feel about others, ourselves, and our actions. How we behave is influenced by what we’re thinking . . . and words are a direct reflection of our thoughts. Words matter. They shape our thinking and other’s perceptions of our message. They can color a conversation, and can change someone’s mind. Words can drive a wedge between partners or support someone so they can go on to change the world.   Henry Ward Beecher said “All words are pegs to hang ideas on”. If we view words in that way, it can help us to see how our language can make a huge difference in not only how our children react to us, but how WE react to THEM. If you have an agenda and the child isn’t cooperating, your instinct is to do something to GET them to play along. So many parents I work with say the following types of things: “How do I GET her to eat more?” “I can’t figure out how to GET him to drink.” “His doctor said we need to GET 24 ounces in him.” “I just can’t GET him to...

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