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...

Picky Eating Progress Reports: Spirited 3 1/2 year-old

Sharing one mom’s early successes (and tips) with her son with extreme picky eating. My 3.5 year old and I needed some help. I read your book, Helping Your Child with Extreme Picky Eating and started the process this past Friday. While reading the book I realized how emotional I have been about our struggle with food. My husband was on board when I told him about it. My family said they’d be respectful and help. My son’s daycare already operates just as your book describes. While I teared up several times while reading the book, as it so closely related to my sense of failure, it gave me hope to try something new. He is developmentally fine, but is spirited and strong willed. The struggles seemed to be escalating and I was ready for help. Since starting last Friday (one week of trying) things have already gotten so much better!!! I started our dinners new with all glass serving dishes so he can see the food. Changed the placemats and put flowers on the table so I felt like it was a fresh start. Since starting STEPs+ he helped make blueberry pancakes (winced when the blueberries came out, but I wanted them so I stayed the course) and then at the table he put one on his plate!!!! He has watched me eat cherries (many times) acting as if he’s not watching. Today he asked if I eat the stem. When the dessert is on the table he eats a bit of it, but goes to his safe foods and eats them instead. His asking for crackers has almost...

When “It’s Not Working”: 10 Opportunities to Support Children with Extreme Picky Eating

Helping your child with picky eating, extreme or not, is a marathon, not a sprint… When we work with clients, or hear from parents at workshops or parents who’ve read our book, the STEPS “click” right away for some: their children are less anxious, enjoying meals, and tuning in to appetite and curiosity about new foods. But occasionally we hear, “It’s not working!” Sound familiar? Then this post is for you. Much of the time when families struggle or see no progress, they are still working on getting some (or all) of the steps in place. Perhaps there is unaddressed fear and worry, or families are afraid to go “all in.” We’ve compiled a list of the ten most common opportunities that we see. But first, a reminder in broad terms of the STEPS+ we outline in our book (with chapter numbers for reference) Step 1: Decrease stress, anxiety (yours and your child’s), and power struggles (chapter 4) Step 2: Establish a routine (chapter 5) Step 3: Enjoy pleasant family meals (chapter 6) Step 4: Build skills in “what” and “how” to feed (chapter 7) Step 5: Strengthen and support oral motor and sensory skills (chapter 8) Top Ten Opportunities to Get in STEP and Help Your Picky Eater 1: You and your partner aren’t on the same page. Let’s say Dad makes Timmy earn dessert by eating a bite of veggie, or requires milk with meals, while Mom is trying not to pressure. (A 2014 study found that dads tend to pressure more than moms.) Result: There is no consistent approach, which is confusing for Timmy, and this increases his anxiety! (STEP...

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....

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...

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