Q&A

The following questions and answers are adapted from my responses to some specific feeding questions from friends via email.

Q: My child loves bread and crackers but is refusing almost all fruits, veggies and most proteins. What can I do to help introduce healthier options into his diet?

A:

You may want to try baking pureed foods into his waffles or pancakes since this is already an accepted texture of his. While he is becoming comfortable with these other textures and tastes, etc That would be an excellent way to still give him nutrition in a way that is likely fun and yummy to him! Example...I make 'savory' waffles for Adalyn sometimes and give her ranch to dip them in. I just use a baby food processor or the regular one. You can use a blender if you don't have either. I use the steamer bags because they are quick and easy and you can steam broccoli, cauliflower, whatever!

I also recently tried a potato pancake mix and added chopped onion and some bacon crumbles as well as sea salt and some rosemary which was all very good! Of course I was fixing this for my family and would adapt this recipe depending on likes and dislikes. This morning I opted to make some pancakes instead of our usual quick routine of the frozen kind and I used the rest of our strawberries and a container of mixed fruit to toss in the food processer. You can always take an hour or so on a weekend to freeze the purees or make a bunch of pancakes or waffles and freeze them. These are options to help ease the transition back into these other foods he has dropped out of his diet. Deceptively Delicious, the cookbook, has great recipes and examples, a little more elaborate than the ones I’ve just made up, but they look good. I tend to find easier, simpler versions of something similar.

You mentioned that he likes all things with bread, breading or cracker consistency. You are basically just taking his fruits veggies that he is not eating on his own...and putting them into a way he may accept. I think it is important to always expose him to those foods regardless but since they are causing him anxiety, just go at his level...even if it is just sitting on the table while he is eating his other foods! Things will start to look up, I promise. I do feel your frustration as I've spent lots of time with parents who have often cried in the evaluation or therapy room---sometimes friends and even family do not understand how complicated or frustrating a meal can be until they have been in your shoes. Everyone has their "Well I just fix it and if he doesn't eat then I do this..." etc, and it is just NOT true for all children--if that were the case then you would have it all figured out by now!

**It is very important to rule out underlying conditions such as reflux, food allergy, other gastrointestinal complications as these are often present in children with feeding difficulties. If you have concerns about this please talk to your pediatrician about these issues and a referral for a feeding evaluation.

Q: We are noticing several signs of possible milk intolerance in our child. Since she is so limited in her diet already and eats so many foods containing dairy, what will we do to replace milk?

As far as trying a dairy elimination--its not too hard, it just sounds intimidating. You wouldn't believe the foods out there that are actually milk free and still very good (duncan hines cake mixes and most of their frostings, even the chocolate and buttercream) You just have to look at it as a trial process and take it one day at a time. I can help you with really good butter, milk and cheese alternatives. Cheese--you may want to just limit or leave out because the substitutes, in my opinion, do not taste as good as other milk alternatives; however, there is a pretty good, "meltable" casein-free rice cheese and that is the one that I would recommend. But Smart Balance, Earth Balance and Fleishman's light butters are milk free and are good...you can also cook with oils, etc.

Feeding is so involved and the environment plays a huge role as well. I have had kids come in for feeding therapy who would initially cry at the sight of the chair or the spoon...so we had to work on making that a positive place first and sometimes that meant using the high chair just for some play to create more positive associations. Sometimes a cd with calming or rhythmic music can be helpful as well as making things predictable . Small portions when introducing new foods is key in my opinion. Too much food on the plate or surrounding her can be overwhelming and she may refuse everything in that case. Since she loves crackers, dd some cracker crumbs on top of the foods with softer textures (use similar colors paired together if possible)--if she works hers hardest to pick off only the tiny crumbs, that OK because she is at least getting exposed to the 'new' food or texture. When I watched her eat I stuck a cheeto on top of a bean and she ate the cheeto with the 'bean juice' on it and then copied me dipping it into it. This is a step! So if she has a favorite crunchy food, like the cracker, you can keep some pieces plain and some with a bit of mashed food on it. Might sound strange but she will be in control of what she is eating and will surprise herself! I mentioned the Veggie stix in my email because they have green, orange and yellow mixed in and she may be more likely to try the green 'crunchy' food before a green vegetable but then you can pair the two green foods (squishy one and crunchy) or do crumbs...and gradually she becomes comfortable with that. This is not to have to rely on everything always being textured, but a way to help her lessen her anxiety with those foods that she is really objecting. Use those foods for the exposure and food play for now. This takes patience and that is ok--you want her to enjoy the feeding process, not just endure it!

**Again, consult your pediatrician if you have concerns of food allergy or intolerance as a nutritional consult may be recommended.

Oven Baked Squash "Fries"

This recipe was inspired by a toddler's love of Tings--a dairy free puffed corn chip very similar to Cheetos. My daughter Loves them and many of the kids I work with love them too! If you have a 'picky' toddler or VERY selective eater, you may notice that he/she has a diet full of yellow foods, do I hear an Amen? Most crunchy snacks are yellowish as well as breading for lots of toddler accepted foods. I find that a lot of toddlers and older children love the feedback that these crunchier foods give them. Parents wonder why in the world their child will not eat wonderfully cheesy casseroles or vegetables with butter, etc but these textures and tastes may be "too much" for them to handle from a sensory standpoint. Meet your child where he is at by exposing him to these foods--but at no point should you ever force the issue. One thing I have my families I work with do is keep a list of "accepted foods"--I then help find a starting place to expand on those foods. Similar tastes, colors, shapes, textures and always a subtle change. I will list some examples below:

Accepted Food--Spiral noodles with melted butter
Food to Try--Spiral noodles with melted butter + seasoning such as salt or garlic powder/salt (depending on child's likes) or different shaped noodle with melted butter

Accepted Food--French fries
Foods to Try--potato smiles, tator tots

Accepted Food--silver dollar pancakes
Foods to Try--bread cut into small circles, potato smiles, circle sandwiches

Accepted Food--beef hot dog
Foods to Try--turkey dog, pork hot dog, ham (Some kids may only accept the hot dogs when cut into circles, so you would want to present the turkey dog in circle shapes as well when first introducing)

The goal is to expand on each accepted food, no matter how small the change because you are aiming for a goal your child can actually REACH. It feels good to accomplish a goal and your child needs to feel that he can do this. I realize that this is a Very different approach than some feeding clinics across the country but I think there is a lot to be said about the feeding process and actually enjoying it!

I was recently told about a book called Food Chaining in which this like-minded approach to increasing your child's food repertoire is discussed in a 6 step program. I have not even read the book and am already recommending to people based on what I have read on their blog. I also highly recommend reading Expanding Children's Diets by Suzanne Evans Morris. I'm pretty sure all of us would get along really well if we ever met in person!

Getting back to "Squash Fries"-- As you can see from previous posts I enjoy creating and pairing foods together and presenting them in a way that feels 'safe' for children. I've recently become a fan of Panko bread crumbs as they produce a nice Crunch to foods and they are also appropriate for milk and egg free diets. These came out delicious with a nice and crunchy coating!

Recipe for 1-2 servings of Squash Fries
1 yellow squash, cut lengthwise and into fries (cut about 1/4 inch thickness)
1 bag of "tings" (or favorite crunchy chip)
2-3 tbsp Panko breading
olive oil spray
sea salt

Place Tings in food processor or blender, blend into fine crumbs
Mix with Panko
Coat pan and squash with oil spray and sprinkle coating all over and roll to fully coat
Bake at 375 for 25 minutes....enjoy!

Almond Milk

I just read a great post by Roni of GreenLiteBites and wanted to share her recipe for almond milk, which includes some great pictures. I have not tried this yet but I do encounter many kids with soy and milk allergies as you can see from my other posts and links!

http://greenlitebites.com/2009/04/27/homemade-almond-milk-take-1/

Food Allergies and/or Intolerances and their impact on Feeding

Common referalls: child not progressing to age appropriate textures and would rather graze throughout the day than sit for meals. Often have high intake of dairy, such as yogurt, pudding milk, goldfish crackers. IgE allergy testing reveals no allergies, however there may be a strong indication of food intolerance as congestion is increased when these foods are eaten, darker areas or lines (Denni morgan lines) appear below the eyes, Constipation that has to be stimulated by thermometer or Miralax or other treatment.. or Diarrhea that has been persistent. May have diaper rash and eczema or just one red cheek or ear that seems 'flushed' and is hot to the touch, not to mention recurrent ear infections. Does anyone have this experience and if so do you mind sharing?

This is a scenario that has repeated time and time again over the past 7 years in my work and more likely than not the above mentioned symptoms subside, or at least lessen with a milk elimination trial of 2-4 weeks. You would not expect to see any sudden changes in the eating, other than a possiblity of the Willingness to try foods that would have otherwise been put on the back burner. We all know how huge that is though! I hope to post a letter I am writing to area physicians on this particular topic of food allergy and its impact on feeding development, specifically the sensory component of feeding--at a later time.

If a child were to have a food intolerance that in turn leads to silent, non regurgitant reflux, it may not be too much of an issue in some children, but in others it seems that the sensory aversions are heightened and sensory feeding information is processed in a very different way. That statement is based on numerous cases over the years in which a child with reflux and/or food intolerance had accompanying sensory aversions, hugely impacting mealtime and feeding development. Those toddlers in particular do not have a normalized response to various sensory stimuli. This could be observed in a child who does not tolerate walking barefoot on grass or sand, does not enjoy the feel of playing in rice or bean boxes, tags on the back of shirt, and who may experience gagging on all food textures with the exception of smooth foods or very crunchy, etc. Those are just a few examples. Imagine how it feels for a child to be uncomfortable with certain textures and input on hands and feet, the thought of exploring such textures in their mouth is less than appealing to them.

I mention this topic so families can be aware of these 'red flags' which may indicate a food sensitivity to milk. A child who has congestion, history of ear infections, history of diaper rashes often needing anti-fungal cream (Indicating presence of yeast)...these are all indicators of a possible food intolerance or allergy that often go overlooked as some symptoms are not typical of a classic IgE mediated response. Symptoms may not appear immediately after the food consumption and the only indication may be the history of ear infections or the thought that your child "always has a cold". Immediate reactions are often taken more seriously than these delayed reactions, as there could be anaphylactic reactions leading to life threatening circumstances.

From the feeding standpoint I feel it is very important to rule out the presence of these food intolerances. A child's battle with food, his finicky eating, his anxiety increasing at the very thought of being in front of a food he is expected to eat, despite a known underlying diagnosis such as sensory processing dysfunction or Autism, Asperger's, developmental delay, etc and despite an immediate allergic reaction---All may be related to a food offender. Treatment is available, but I encourage you to do you research before randomly choosing a feeding therapist or a program. Some intensive feeding programs take a very different approach than mine or other therapy clinics.

We must look at the big picture, the whole child and all factors involved, not just medications to help with the possible reflux, the eczema, the constipation, etc. Although these may be warranted in time, I feel it is important to really look into these food intolerance possibilities as well. We have many success stories, or should I say these families I have worked with have many success stories and wish they would have looked into the possibilites of food allergies sooner than later. I suggest taking a detailed food journal for 3 days and be sure to list any and all changes in any physical changes (bowel, appearance of eyes, rash, etc) behavior, sleep patterns, eating (new foods tried?) and anything else worth noting.

It is a little overwhelming how often I and other therapists working with feeding have seen this connection to delayed food allergy/intolerance and the sensory component. Perhaps the elimination of the food reduces or eliminates silent reflux that had been occuring unknowingly. Symptoms of Reflux can be found in this article Gastroesophageal reflux and Childhood Feeding Disorders and http://reflux.org/. We know that with sensory integration therapy, as the child progresses with various sensory goals, there is often an increase in eating. I strongly encourage looking at all modalities and to not rule out possibilities of underlying GI discomfort such as food intolerance as a strong culprit to the feeding aversions. When I had morning sickness with my daughter I did Not want to smell coffee (which i loved before) I could not pick up my dog's waste from the yard (intense smell made me gag). I compare those changes in sensory experiences to the changes these kids must be feeling! They know what feels best to them and they know what sets them off. There is help for these children and so many ways to build on their current accepted foods. I just wanted to take this long post and highlight the need for a wholistic treatment approach for these kids. Do you have a child craving their milk or pediasure in addition to the little voice inside of your head saying "Something he is eating is making him sick or making him have a very difficult time in a lot of areas" At least worth looking into! Email me for further information re: Milk Allergies and Elimination trials.

Suggested Reading:

http://www.nutramed.com/children/kidsmilk.htm
http://www.askdrsears.com/html/4/t041800.asp
http://www.nutramed.com/Foodallergy/fachildren.htm

Whole Foods "Make it Natural" cupcakes

Have a child with multiple food allergies and looking for a treat? Just follow this link!
http://blog.wholefoodsmarket.com/2009/04/make-it-natural-cupcakes-for-special-diets/

Fun with Food!: Laughter is the best Medicine!

Fun with Food!: Laughter is the best Medicine!
Where Laughter Lives

Laughter is the best Medicine!

I recently found out about a free online magazine called Serious Life Magazine. The magazine is owned and published by a family who have seven kids, three adopted and one who has Leukemia (www.riggsfamilyblog.com). The magazine gives away a lot of ads to charities and ministries. They feature inspiring stories and include "life" topics involving family, adoption, personal finance, spiritual life, and humor.

The creators of this magazine have a family blog, today's post is part of "Laughter Lives! Tuesday" on the Riggs Family Blog. Check our their blog to read everyone else's "Laughter Lives!" posts.

In honor of "Laughter Lives!" and keeping in line with the content of my blog, I wanted to share a video of my own 2 1/2 year old daughter helping in the kitchen. Her vocabulary is changing daily, last week she was all about being "fantastic" and in this video she is commenting on the sauce which she finds "Awfully good!"


Some of my other favorite "Adalyn" moments and words:

Scene--Adalyn on the potty with my mother in law standing by
Grammy: "Hurry up, try to go potty"
Grammy: "Are you done yet?"
Adalyn: "Just be patient, Grammy"

Having to start over dinner prayers because Adalyn "forgot to pray for her biscuit" or other food items

Telling me she can do something herself because she is "superman"

Oh, and one more blast from the past: