"Feeding Disorder Hell"

http://lovingamiracle.blogspot.com/2011/11/feeding-disorder-hell-our-narrow-escape.html

What a wonderful post, written so open and honestly!

Food Play!

Another Trader Joe's snack find--"Fruity Flakes". These are similar to "fruitaboo" roll ups in taste. Here is Adalyn eating "fruity flake leaves" off of our picture! To help your child become familiar with a new food---Play! Today he may feel o.k. with placing the leaves on the tree, tomorrow he may bring one up to his nose or mouth!

"Sensory Processing Issues Explained"

Here is a wonderful article explaining the complexity of children with Sensory Processing Disorder. 

http://www.childmind.org/en/posts/articles/2011-10-26-sensory-processing-issues-explained


"It's like a traffic jam in your head, with conflicting signals quickly coming from all directions, so that you don't know how to make sense of it all."

"What parents often notice first is odd behaviors and wild mood swings, strange at best, upsetting at worst. Often it's an outsized reaction to a change in environment—a radical, inexplicable shift in the child's behavior."

Feeding Issues in the Schools

http://speech-language-pathology-audiology.advanceweb.com/Article/Feeding-Issues-in-the-Schools-2.aspx

Freeze Dried Mangoes

One of my Trader Joe's finds. I love using freeze dried fruits in therapy to help teach lateral biting and munching. They are also great snacks for the child who prefers crunchy foods. These crumble into fine crumbs which is great for small tastes on fingers or Nuk brushes, teethers and toys! Keep in mind for babies and children who are learning about food and who are tube-fed!

Laying the Foundation--Part 2 of "Family Food Fights"

Without a comprehensive feeding evaluation to further investigate feeding history, possible allergies and GI complications, respiratory health, sensory responses and oral motor feeding skills it is impossible to give an accurate opinion in regard to WHY meals are difficult and stressful for you, your family and your child. We must look at the whole child and his everyday feeding environment, current diet, meal schedules and many other factors before reaching a conclusion or starting point. It is best to first seek a feeding evaluation and go from there. In this post I want to give some general tips to help reduce mealtime stress and help lay the foundation for successful feeding.

What is your routine? Do you have regular meals and snacks scheduled for your child or is your child prone to graze throughout the day? Work toward 3 meals and 2 snacks spaced throughout the day, with the snacks being lower in fat and calories in order to allow for increased hunger at meal time.  Some children with feeding tubes can only manage small amounts of food during a given time therefore working toward a consistent schedule can be difficult. It is not always easy to find that balance between gastrointestinal comfort and satiety. For example if your tube-fed child is retching or vomiting during tube feedings then it is not the best time to introduce tastes or new foods--negative associations are formed rather quickly. We find this to be true with the child who has suffered from reflux. Discomfort in general is a barrier to successful eating. To read more about mealtime routines click on Establishing Mealtime Routines.

Does your child insist on eating only a specific food, possibly from a specific restaurant or is he particular with brands, shapes, textures?  Children with sensory based feeding complications have more difficulty with introducing change and variety,  but as a parent of a 5 year old I know that 'food jags' are easily created and it takes a lot of effort to make that transition from McDonald's chicken nuggets to a healthier homemade version of a nugget. Children often have a fear of the unknown or a new food, known as "neophobia" and this can begin at age 2 and earlier!  I suggest you read and share with others on the topics of food jags and sensory 'steps to eating' on page 4 of this issue of Journal of Pediatric Nutrition and Development and work toward expanding on those jags by reading Suggestions on Expanding Current Foods. 

Remember in the post on Family Food Fights  how our own stressors as parents can influence our childrens eating.  Feeding struggles alone can be a big enough stressor, causing arguments and tension between spouses and family members.  Add in work stress and responsibilities, parenting responsibilities, a long day, the 'witching' hour for those who have newborns (ME!) and exhaustion and you have quite the recipe for a disastrous mealtime experience.  I remember how I felt at different times at different points in my life and on those days when I had the time to talk to my daughter about what we would be having for dinner in advance, had her pick out something from the store with me, go to the farmers market or participate in the meal preparation or ideas, set the table with her help, lit a candle and put on some music...we had a pleasant meal.  EVEN with some new or different foods.  Stress was low, expectations were set according to principles from Division of Responsibility paired with her comfort level with various sensory 'steps to eating'.  Sometimes it is best just to let go of all control and see what happens.  It is also good to plan for your child to choose the meal one night.  Take the stress off of everyone.  Allow for success all around.  What are your Attitudes toward Mealtime?   Review these Steps toward Succesful Eating and see what you can do now to make a change for the better.Getting on the same page with the rest of your family can be difficult but hopefully you can get there and be well on your way to a happy mealtime!

Family Food Fights

...And I don't mean tossing meatballs at each other!  Take a minute and try to honestly answer these questions:

*Is mealtime in your household stressful?
*Do you ever find yourself coaxing and bribing your child to just 'take one bite'?
*Did you take the time to prepare a meal for your family only to find your hopes of sitting down with smiling faces shattered by crying, refusal to eat and an overall unhappy experience?
*Do you find yourself having mixed emotions on where to draw the line with what goes on the plate, in the mouth or how much control you should have over your child's meal/intake?
*Does the frustration extend beyond your child?  Are you and your spouse/significant other arguing over what the right or wrong approach is with your child?
*Does this tension cause dread and stress for the entire family?

If you answered No to these questions then congratulations, you have escaped an experience that many of us have not been able to avoid at one point or another!  If you said "yes" to many of these questions then I promise you...you are not alone!  Am I right?  I think we all struggle with finding that middle ground with our responsibilities and expectations.  Being on the same page with our spouse is a feat within itself.  Being on the same page with extended family members and close friends is also a stressor for many.  In fact I am sure many of you reading this have heard "He will eat when he is hungry", "Just tell them they can't have that cupcake if they don't try a green bean", or "Take them to time out" about as many times as you wish to hear.  Everyone wants to label your child with behavioral problems or as having an issue that lies within the responsibility of the parent.  But guess what?  That just isn't the case, is it?  I wish every one of my own family members could attend the conferences that I have attended, courses I completed in graduate school, read the books that I have read or seen firsthand what I have seen with working with many many families over the years.  Those families wish the same for everyone they know. 

What we want families and friends to know is something a little different than the disciplinary suggestions we have all been given.  We want to turn the Family Food Fight into the Fight for our Family.  Since attending courses and conferences and extensive reading is not an option for most then the least we can do for those who could benefit from a greater understanding of feeding development and making mealtimes less stressful is to let them know that you are seeking help and that you trust your resources and need others to trust this as well.  If I were one to care little about what my family and close friends felt then I would not be writing an article entitled "Family Food Fights"...but I do, I like to be understood and more importantly I like to get the message to others so they can follow suit when given the opportunity.  I have readers and families, including my household, in mind when I write this and I know many of you struggle with these very same issues. 

The Facts.  You  may have read this on a gerber pamphlet or from your local pediatrician but it takes at least 10 exposures of a new food before acceptance of that food.  Where do your expectations at mealtime lie?  Do you put a new food on a plate and expect your child to take a bite because YOU love squash casserole and simply can't imagine that anyone on Earth would refuse a bite?  Is your child thinking "You have GOT to be kidding me, that tablespoon of so called squash casserole looks like something my baby brother expelled an hour ago"...is it the sight of it, the smell of it, the texture?  Know your child.  Knowing your childs fears and aversions is very helpful in the eating process!  If your child already knows that you Expect them to take a bite of that casserole no matter what then you may be setting yourself and your child up for disappointment.  Children want to feel that they can accomplish something and they generally love the acknowledgement whether it be a smile of approval, verbal praise or some kind of reward they are working toward.  I feel that knowing your child's level of anxiety can be very helpful toward building their food repertoire.  You can of course push a little and change things up accordingly, but the point I am trying to make is that we sometimes have higher expectations for a child that may have heightened anxiety in those situations.  We can't forget to praise the small steps and use our positive language to talk about the food and not ask impossible things of them.  Today they may be o.k. with helping to put the squash in the food processor, but trying that little taste of the finished product may be months, or further, away.  It does not mean that we should give up on the challenges, but learn to back away when needed and push when you see an opportunity.  If you would like more information for yourself or for others please leave a comment or email me at kris.starnes@gmail.com as I have a few links that may be of interest to you or others.

Its OK to be different!

Trying a new food or a 'tried and true' favorite with Chopsticks is fun! 

The Bigger Picture: Changing your attitude toward mealtime

I think the best practice for all of us, whether we have a child with food aversions or not, is to put ourselves in their little (or big) shoes. The Big Picture, always about the Big Picture. Our own anxieties and fears as parents feed directly into our children---how does this play out in a child with feeding complications? You want so badly for them to try a food, to eat a certain amount so they can reach a desired weight for their age, but sometimes ignore the fact that eating in itself is Not Enjoyable for them! Therefore the act of “trying a food” can be a really far-fetched idea in many instances. Not only that but it is often not one, but two or three people surrounding the dinner table coaxing the child to try the food and once again, our own anxieties set in and result in an overall stressful mealtime experience for everyone! There definitely needs to be a shift in the thinking here, and not only in the caregivers but also in many therapists treating children for feeding issues.

Here is a great example—a few years ago we had family in town to celebrate our daughter’s 3^rd birthday. We went to a great little seafood place and had some delicious food! My husband was really wishing for Adalyn to try the grilled shrimp but everything on her face said “No!”…thus the coaxing begins, “Just try it, you’ll love it” “Just one bite and then you can__(fill in blank here)” We all know this scenario, right? For a moment I found myself also wanting to appease him as well as the inlaws at the table; however, I knew I didn't expect her start stuffing shrimp into her mouth so I said “Hello? Do you not know anything about what I do for a LIVING, treating very selective eaters? Please don’t worry about her not trying the shrimp”  I said we’d just do a seafood or shrimp night one night. Which is exactly what we did! I started talking about it the night before and mentioned it a few more times the next day, took Adalyn with me to the store and started calling out for “Popcorn Shriiiimp, where are you?” We even got some hush puppies since that is always a nice addition to any seafood! We came across some yummy looking breaded butterfly shrimp in the frozen food section and went that route instead of popcorn shrimp. I showed her the tails (on the picture on box) and asked if I could take them off for her, she thought that was the most generous act and thanked me in advance right there in the store “Oh, thank you mommy!”

That night we had a great meal of baked tilapia with butter, lemon, mint from the garden, lots of parmesan cheese, a few new shrimp and some hush puppies! She immediately asked for her ranch—her favorite choice for dipping, especially with new foods, but I asked her if she would try some mango preserves for a sweet dip for our shrimp. She tried it, seemed to enjoy it, but politely declined any additional dips! Only 3 or so bites of the shrimp, but you know what? That’s ok! What a different reaction than the night in the restaurant! She was not prepared for trying shrimp, she shuddered at the thought and there was not much that was too familiar about it to her. 

I do realize that different personality types make it easier or harder to come to grips with inconsistencies in life. Especially when dealing with the health and nutrition of our children. I am considered an “Idealist” (according to the Myers-Briggs personality test anyway), and I know my ability to really empathize with another person in combination with some other ‘weird’ qualities help me help others and I have a strange knack with the pickiest of picky eaters! It is a challenge but I do love it—at times I find it harder to relate these mealtime concepts and beliefs to the parents of these children, but I do believe a shift in attitudes toward mealtime is needed. This is why I am content with a "1 bite shrimp night" and the fact that she may have eaten a third of what she did the day before. The grandparents may not agree, your friends may not agree and often the spouse may not agree...there is pressure from all around.  

We, as therapists, work with many children whose need for more careful observance of caloric intake are much more important.  I am a big believer in finding calorie packed foods that can be added to current accepted foods, I learned this from the beginning of my career and it is a perfect way to continue to allow a child to choose what they will eat and how much they will eat…it just so happens that some of their choices have more calories in them! The outlook I have in many situations is the same, “This too shall pass”, or many small steps toward the bigger picture. And like I said, it’s all about the Bigger Picture.

** I love you dear husband, just using you as a wonderful example!

Fun with Food Facebook Page

There is now an official facebook page for Pediatric Feeding Support.  Just go to Fun with Food-Pediatric Feeding Support and click "like".   Hope to see you there!