Fun with Food!

Welcome to Fun with Food! This site was designed to help parents and caregivers find, share and ask about fun foods for your selective toddler!

As a speech-language pathologist specializing in pediatric feeding and swallowing disorders, I encounter many children who have experienced negative associations surrounding food. These children often have accompanying oral motor feeding difficulties and sensory processing difficulties--making eating a very stressful experience instead of an enjoyable one.

This website will hopefully serve as an "idea place" for meals as well as questions and support from other parents and caregivers. Enjoy!

Monday, April 24, 2023

ARFID, selective eating and PFD—where to start?


If you suspect ARFID and you are researching and starting there I also suggest you seek out a therapist specializing and treating pediatric feeding disorders. Your child or teen or yourself may likely need a psychologist or psychiatrist and a cognitive behavioral therapy plan in conjunction with other therapy, but I can personally attest to what I know as an SLP working primarily with feeding since 2003 and that there is rarely a one factor root to very selective eating.

Maybe I shouldn’t mention ARFID at all but rather the fact that there are certain criterion that send a red flag for noticing a difference in what could be typical vs atypical or just a difference that is affecting lives in a way that is less than ideal or optimum. Whether struggles in the arena of eating and mealtime began due to this or that there WILL often be accompanying oral motor feeding patterns, sensory disturbances and associations that have been created likely without the person or their caregivers absolutely knowing that those inefficient patterns or differences in anatomy were present. 

It can be as “simple” as a history of early feeding difficulty, a slew of “wait and see” mindset determined by yourself or a medical professional, etc, but the bottom line is that a thorough evaluation can at least look into background history and help identify patterns and along with that comes the feedback from someone with experience of knowing what other patterns including oral motor function and sensory and a whole body mindset to further investigate all possible influences and where a starting point should be At the TIME of assessment.

There is no need to fixate on why “this was overlooked” or “why didn’t I or they identify this or that” aside from having a newfound perspective or new information. This may be opinion but I also feel it is helpful in making strides in the present. What do you know now, today, that could lead to a direction of a plan and progress? Stay there and know that if you haven’t considered or haven’t been aware of the possibilities, that now you are and you can get started right away on seeming solutions and implementing a plan. Sometimes the “plan” is simply letting all of the new information soak in and allowing empathy to root in the ways that you will certainly find are necessary. We are an interconnected web of information and if you start somewhere that can lead you to the next step then you are already making progress in the journey to increased awareness and action. There’s a lot to be said for that! I am opening this up to hopefully allow connections to be made in whatever location you are, there are numerous resources available and sometimes it is just a matter of logistics and experience and people connecting with each other so that the journey can begin for you.

I encourage you to check out the Feeding Matters resources provided in this link! https://www.feedingmatters.org/pfd_and_arfid/


Wednesday, March 29, 2017

Cups!




Q: What type of cup or sippy cup should I be using with my 12 month old son?


Hi! I would first begin working with open cup and straw drinking. I use yogurt drinks, baby food puree mixed with formula, milk, or water and sometimes powder pudding mix for beginning cup drinking. Thickening slows the flow allowing some independence while learning as well as practice with lip closure. You can gradually thin the liquid as he becomes more efficient.

As far as sippy and transitional cups, I like to recommend this one first https://reflo.net/   It flows slowly and limits the risk of surprising dumps of liquid on the face that often happens with beginning cup drinking!  I also like this one without the valve, playtex tumbler....http://www.amazon.com/Playtex-Coolster-Tumbler-Sippy-Girls/dp/B0011E4HBM as it is similar to open cup and does not require as much suckling when valve is out. Also the toss and go cup he was using at school was fine too as well as straw cups...You should allow him opportunities for open cup drinking and sippy without valves. The suction required for sippy cups, especially with valves, often results in the same suckle pattern with manipulation of foods requiring a consecutive lateral munching pattern. I also like these:  



Likely outdated since original post; however, if you’ll notice the idea behind all of these cup choices is to move away from a spouted valve. 
http://citikids.com/ProductImages/24026.1.jpg http://usera.imagecave.com/loveski777/Munchkin%20Dora%20Big%20Kid%20Cup.jpg You can also take valves out of this one as well.

Here is a link to a great article by Melanie Potuck related to this blog topic:
https://www.google.com/amp/blog.asha.org/2014/01/09/step-away-from-the-sippy-cup/amp/

**The cup options are plenty, overwhelming at times and since the original date of this blog there have been numerous changes including discontinuation of cups, new products and other options.  I'm including some pictures as examples of some cups currently available!  My go to practice cups in therapy are still often the very basic open cup with a thickened liquid to slow the flow and straw practice! I love the spoutless options available and you can never go wrong with the basic disposable coffee cup and lids that you would receive at most restaurants, drive thrust or find at the store. I recently bought a cup at the dollar tree (also pictured). My oldest daughter has claimed this one as you can see by the artwork :). Tervis lids are also ideal.

Please feel free to Share your finds!   A child who is having a lot of difficulty transitioning from bottle to any other cup is a different scenario in my opinion. Often the anxiety is very much escalated at the idea of any new presentation and in those instances and other child specific examples, there may be acceptance of the silicone sippy cups and straws and this can open the door for other changes to take place!  It's difficult to cover all of the challenges and different scenarios in one post, but finding what you have to work with is essential and taking things one step at a time to reach the long term goal is often the key to success!





















Saturday, February 6, 2016

The challenges of sensory processing differences

Why are pediatric feeding disturbances difficult to treat in children with sensory processing disorders?

By Kristina Starnes, M.S. CCC-SLP

Pediatric feeding disturbances are not only common in children with sensory processing disorders (SPDbut are often more difficult to treat due to the many factors that contribute to feeding aversions. Children who experience sensory processing difficulties frequently have increased anxiety and aversion to accepting even small variations of a favorite food, whether it be a sandwich cut in a different way, a colored goldfish cracker instead of a solid goldfish they have come to know and expect, or their drink in a different cup. Take the child’s usual and accepted meal to a new setting, possibly a babysitter’s home or a restaurant, and discover that even when presented in the way the child always eats the food at home or in school, he simply cannot bring himself to take a bite of the food. The frustration and difficulties surrounding mealtime and eating may also be an indication of difficulties in other areas of function.

If these patterns sound familiar to you as a caregiver, then you are likely to also relate to the following anxieties and frustrations that countless parents have expressed to me over the last 12 years while working with pediatric feeding. Here are some concerns I have heard from parents:

-All of the other kids at the birthday party get so excited about the cupcake and ice cream, and my daughter cries and wants to go home.
-I just wish he would eat chicken nuggets!
-He will only eat the chicken nuggets from chick fil A and only in the box. If they are taken out of the box, he throws a tantrum.

Now, if you are anyone other than a family member experiencing this on a daily basisyou may assume that these feeding behaviors have developed solely as a result of parents falling into some typical power struggles to which we can mostly all relate if having raised children or grandchildren at any point. So parents are often told by well-meaning friends and relatives:

-You have to make him eat.  
-If she is hungry enough she will eventually eat that. 
-Or maybe“Hdoes that because you let him. He’s holding out,and he knows you will give him what he really wants in the end.   

Although some of these statements may indeed be a part of the problem behavior, they are likely just that – a part.  

In order to address eating concerns, you must break down the entire pattern and identify contributing factors, as well as what clinical experience and research have shown us. In order to change thesepatterns and get from point A to point E (eating!), we must pay attention to B through D in the process. A feeding assessment helps to bring the pieces of the process together by identifying typical vs.atypical oral sensory-motor development, feeding history, patterns used with types of foods eaten, as well as the child’s relationship with eating and those who are the mealtime partners or doing the feeding with a baby or those needing assistance.  Even when strong sensory aversions are identified, these may be indications of respiratory, gastrointestinal discomfort, family eating patterns, as well as food allergy or intolerance that are actually exacerbating existing hypersensitivities. Therefore, forcing or bribing will likelylead to deepened feeding aversions and increased anxiety.  

Children with the feeding complications of accepting only certain foods in certain ways along with a number of other factors for each accepted food may have learned to expect that the same foods will be offered at each meal in the same wayAdditionally, the reason they may be eating something at home and not in daycare or vice versa is because the routine in the new environment had not been adapted to their predictable routine wherever that may be. The stress surrounding mealtime may have become too much for the parent to handle when they have repeatedly tried introducing new foods unsuccessfully. Without an understanding of the overall condition and factors contributing to refusal, parents and caregivers can become stuck in a cycle without support and, at the end of the day,we all do what we need to do to get by especially under stress.

These children typically progress with feeding goals and expanding foods by establishing a predictable, consistent routine in therapy as well. This allows for the new changes to be introduced within that framework. Bridging the progress into other environments may come much later but can be accomplished also by establishing a predictable routine in which these new skills and foods can then be incorporated (See Establishing Predictable routine at http://notjustpicky.blogspot.com/2010/01/email-responses-to-families.html?m=1)

I often hear the question, “What causes this?” in regard to a child’s feeding complications.  Rarely, there is only one factor. In children with SPD, it is common to find inadequate oral sensory-motor feeding patterns leading to disorganized and undeveloped chewing skills, difficulty with food bolus preparation within the oral cavity, and, in turn, difficulty and discomfort initiating the swallow. Which came first, the chicken or the egg? This saying comes to mind when stepping back to look at the big picture. 

Did sensory concerns contribute to oral motor feeding delays, or did the oral motor feeding delays contribute to the sensory issues with feeding? There is not right or wrong answer because both can be true. Visualize yourself feeling nauseous and you don’t want to look at a certain food, much less put it in your mouth. If you do put it in your mouth and something feels off because you are already feeling queasy, you might gag and even vomit. 

Sometimes chewing skills have never developed because a child has never actively chewed food. Therefore, the organization and patterns needed to chew were never developed. Food scattered across the tongue can feel especially undesirable, just downright gross, to the person already hypersensitive to certain food textures. Developing the needed oral sensory-motor feeding skills and systematically decreasing hypersensitivities can help eating become enjoyable and manageable for a child. When sick, or if there is underlying reflux, food sensitivity, or allergy then it is difficult to progress with feeding. This is why addressing each component of a child’s feeding is necessary.

A checklist from http://www.sensory-processing-disorder.com/provides helpful information regarding signs that may indicate that a child has a sensory processing disorder or specific needs that should be further assessed. “The purpose of the "SPD Symptom Checklist for Infants and Toddlers" is to help parents and professionals who interact with children become educated about particular signs of sensory processing disorder in the youngest children and babies. It is not to be used as the absolute diagnostic criteria for labeling children with sensory processing disorders, but rather, as an educational tool and checklist. Professionals (usually occupational therapists) who diagnose this disorder have their own tools in addition to checklists to observe and test for SPD (formerly called SID or Sensory Integration Dysfunction).”

ABOUT THE AUTHOR  

Kristina Starnes, M.S. CCC-SLP is a Speech Language Pathologist who specializes in pediatric feeding and swallowing disturbances. Kristina lives in Fayetteville, Arkansas where she and her daughters spend time together enjoying their college town and the Ozark Mountains. She is the owner of Therapy Tree, LLC and also enjoys writing and sharing information related to pediatric dysphagia on her blog, Fun with Food, and Facebook support pages
She has a passion for promoting awareness, treatment and prevention of feeding and swallowing disorders, connecting with others who share the same vision and strives to help others overcome negative associations surrounding food. 


Tuesday, October 14, 2014

‘Tween “toddlers”---Twoddlers?


 
Twoddler food!  This is the first grouping of a hopeful growing list of ‘In between” puree and table food stage for all of our babies, toddlers and older children who are wishing for grown up food but not quite ready with their oral motor feeding skills. Just remember that you will need to be very aware of allergens in these recipes and check with your pediatrician or dietician before introducing ingredients that have not yet been introduced. I will include store bought and homemade. Think soft on inside and texture on outside, like McCains Potato smiles :)

Caulitots
http://cupcakesandkalechips.com/2013/10/01/baked-cauli-tots/ http://yourlighterside.com/2010/03/caulitots-baked/

Homemade soft Nuggets
http://www.momables.com/lunchbox-wars-4-chicken-nuggets/ http://pickytots.blogspot.com/2012/04/ch-ch-ch-chia-chicken-bites.html http://pickytots.blogspot.com/2009/10/turkey-nuggets.html

Tasty Veggie patties
http://pickytots.blogspot.com/2013/07/avocado-cakes-with-banana-and-basil.html
http://pickytots.blogspot.com/2009/08/crunchy-spinach-cakes.html http://pickytots.blogspot.com/2009/09/squish-your-squash-indian-style.html

Bread Lovers Beware
http://pickytots.blogspot.com/2013/12/cinnamon-pumpkin-banana-yummalicious.html
http://pickytots.blogspot.com/2009/03/savory-veggie-waffles.html http://pickytots.blogspot.com/2009/01/chicken-bopps.html http://pickytots.blogspot.com/2009/11/easy-dairy-free-pumpkin-cupcakes.html

The Sweeter side of Protein
http://pickytots.blogspot.com/2012/07/power-packed-cookie-dough-bites.html

Thursday, March 6, 2014

Five Signs that Your Toddler May Benefit from Feeding Therapy

5 Signs that Your Toddler May Benefit from Feeding Therapy Thank you Melanie Potock from www.mymunchbug.com for the very helpful information. Please spread the word!

Sunday, December 1, 2013

Cinnamon Pumpkin Banana yummalicious waffles--gluten free version


 
 
These turned out so good!
 
2 cups Gluten Free Bisquick
2 tablespoons vegetable oil
1 1/4 cups milk
1 cup canned or puree pumpkin
1 mashed ripe banana
2 tbsp. maple syrup of your choice
pumpkin pie spice and/or cinnamon to taste
1 egg

mix together and make into delicious waffles!!


Saturday, November 9, 2013

FPIES--What is it and What are the signs?

What is FPIES?

" FPIES is a non-IgE mediated immune reaction in the gastrointestinal system to one or more specific foods, commonly characterized by profuse vomiting and diarrhea. FPIES is presumed to be cell mediated. Poor growth may occur with continual ingestion. Upon removing the problem food(s), all FPIES symptoms subside. (Note: Having FPIES does not preclude one from having other allergies/intolerances with the food.) The most common FPIES triggers are cow's milk (dairy) and soy. However, any food can cause an FPIES reaction, even those not commonly considered allergens, such as rice, oat and barley. A child with FPIES may experience what appears to be a severe stomach bug, but the "bug" only starts a couple hours after the offending food is given. Many FPIES parents have rushed their children to the ER, limp from extreme, repeated projectile vomiting, only to be told, "It's the stomach flu." However, the next time they feed their children the same solids, the dramatic symptoms return.

     - See more at: http://www.kidswithfoodallergies.org/resourcespre.php?id=99#sthash.6gqb8Arw.dpuf


The FPIES Foundation, http://fpiesfoundation.org/, is a wealth of information on all information FPIES related.  The Foundation lists some of the following important questions to ask:

 Has your child experienced severe episodes of vomiting after eating infant cereal and/or first foods; or drinking formula?

Do you question whether or not a specific food or foods may be contributing to your infant’s worsening symptoms of periodic vomiting, chronic diarrhea, reflux and/or failure to thrive?

These symptoms may indicate a need to speak with your child’s doctor about an FPIES evaluation.

Please read the following recent news story featuring a family whose son faces many challenges associated with FPIES, including a new intolerance to their ever trusted formula, Neocate Junior:

http://www.ketv.com/news/local-news/food-supply-runs-short-for-boy-with-rare-allergy/-/9674510/22863834/-/madk5v/-/index.html