Dear Mom & Dad…Don’t Comment on Your Child’s Weight

I recently encountered a children’s book called “Maggie Goes on a Diet.” It honestly made my skin crawl. Children are sponges that soak up and internalize messages all around them. From a dietitian’s perspective (and an empathetic human’s!), sending messages concerning dieting and children is not only unethical, it is dangerous.  

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The ‘ultra thin’ ideal is already heavily promoted by the media. In addition, kids will also hear more than enough from their peers on the need to be thin. So, Mom, Dad, Aunt, Uncle, Brother, Sister, and those who love children, let’s not contribute to this mess. Instead, let’s work on creating an environment where children feel supported in their current bodies. Let’s create a world where the perception of health is not dictated by your body size, but by…your actual health!

Here are few things that you can do to help your child build the resilience that will be needed to live in our diet obsessed world:

  • Don’t promote dieting behavior. We surrounded by the thin ideal. We constantly see messages that dieting is the way to be thin and thin is the way to health and happiness. A study in the International Journal of Eating Disorders followed 111 girls and found that by age 5, half of the girls has internalized the thin ideal. The American Academy of Pediatrics actually advises against putting children on a diet. Instead of dieting, focus on health. No matter what size a person is, adopting healthy behaviors is beneficial.
  • Don’t use exercise as a form of punishment for something you ate. You ate a cupcake/brownie/pasta/potatoes so now you must do run/do aerobics/attend barre class to burn off the calories that you ate. While I 100% support physical activity as part of a healthy lifestyle, I do not think that exercise should be used to punish yourself for something that you ate. Show your child that exercise is fun and that exercise is something that we do because our bodies can and should move.
  • Don’t comment on other people’s weight. Focus on weight as an aspect of diversity. Teach children that people come in all shapes and sizes. Teach them that people come in different heights and weights and teach them that a person’s size cannot tell you how healthy that person is.
  • Enjoy ALL foods…and I do mean ALL foods. Live the example. A healthy eating pattern can include carrots and cupcakes. Teach your child to focus on variety and to pay attention to how food makes their body feel. This way they’ll learn that a diet that includes fruits, veggies, protein, whole grains, and the occasional cupcake makes them feel better than a diet that consists primarily of cupcakes.
  • Keep everything in perspective. Kids’ bodies are weird at times. It’s part of pediatric growth patterns. Before a growth spurt, a child can appear pudgy. Remember, children’s bodies grow and change quickly. Their size at any particular moment in time does not necessarily mean that the child is in poor health.

 


The SOS Approach to Feeding – Food Jags

Welcome to part 4 of my series on the Sensory Oral Sequential (SOS) Approach to Feeding. Today, we’ll cover a strategy that I implement when when working with picky eaters and problem feeders – preventing food jags.

Without warning, a picky eater or problem feeder may drop food that they were previously willing to eat. How frustrating! This may be the result of a food jag. A food jag is when a child will only eat the same food prepared the same way over and over again. The key issue with food jags is that they lead to boredom or burn out, which in turn results in the food being dropped from the list of foods that the child will eat.

picky eater

We know that picky eaters and problem feeders typically have a limited list of what they will eat. If a food jag causes that list to grow smaller, parents often become increasingly concerned that they have little left to work with. This is why we need to prevent food jags.

How do we prevent food jags?

A strategy that I use with families to prevent food jags is called a preferred foods menu. The purpose of a preferred foods menu is to not repeat the same food item over a two day time period. There are two types of preferred foods menu that I use – (1) full preferred foods meal plan or (2) one preferred food at every meal and snack. Which menu I use is based on severity of the picky eating.

To get started, I begin by working with the parent to make a list of every food that the child will eat. We get very specific with this list. For example, if the child eats crackers, we will list every single type of cracker that the child will eat and we will treat every type of cracker as a completely separate food item. Once that list is created, I will separate the foods into three different categories – protein, starch, and fruit/vegetables.

Let’s look at an example of a full preferred foods meal plan with 3 meals and 2 snacks per day.

Here are the foods that the child will eat.

Goldfish. Peanut butter. Saltine crackers. Wheat crackers. Cheez-its. Cooked carrots. Baby carrots. Sliced apples. Cheddar cheese. Strawberry yogurt. Sliced turkey. Whole wheat breaded chicken nuggets. Dinosaur shaped chicken nuggets. Spaghetti noodles. Pears in fruit cup. Bananas. Peas. Tostitos. Wheat tortillas. Graham crackers. Strawberry pop tarts. Cherry pop tarts.

Here are the foods that the child will eat split into the categories of protein, starch, and fruit/vegetable.

Protein Starch Fruit/Vegetables
Peanut butter
Cheddar cheese
Strawberry yogurt
Sliced turkey
WW breaded chicken nuggets
Dinosaur shaped chicken nuggets
Goldfish
Saltine crackers
Wheat crackers
Cheez-its
Spaghetti noodles
Tostitos
Wheat tortillas
Graham Crackers
Strawberry pop tarts
Cherry poptarts
Cooked carrots
Baby carrots
Slice apples
Pears (fruit cup)
Bananas
Peas

There are a different number of foods in each category and that’s okay. Now, that I’ve got the foods separated into categories, I’ll start building the menu. My goal is to have a protein, a starch, and a fruit/vegetable at each meal and snack while making sure not to repeat the same food item over a two day period. If I’m not able to do that, I’ll notate that I’m missing a food category.

Day 1 Day 2 Day 3
Breakfast Peanut Butter
Wheat Crackers
Canned Pears
MISSING PROTEIN
Strawberry Pop Tart
Sliced Apples
Sliced Turkey
Snack Strawberry Yogurt
Graham Crackers
MISSING FRUIT/VEG
MISSING PROTEIN
Saltine Crackers
Banana
Lunch Sliced Turkey
Cherry Pop Tart
Peas
Chicken Nuggets (Dinosaur)
Cheez-its
MISSING FRUIT/VEG
Peanut Butter
Snack Cheddar Cheese
Wheat Tortilla
MISSING FRUIT/VEG
MISSING PROTEIN
Tostitos
Baby Carrots
Dinner Chicken Nuggets (WW)
Spaghetti Noodles
Cooked Carrots
MISSING PROTEIN
Goldfish
MISSING FRUIT/VEG

Day 1 and Day 2 are done but there are several spots where I’m missing a food category. To fill in these spots, I’ll add a food item that is similar to a food item that the child will eat or I’ll provide a food item prepared in a different way.

Example – the child likes cheddar cheese so on day 1 at snack #2, I’ll specify that cheese to be sliced cheddar cheese and make one of the missing proteins cheddar cheese cubes.

Another example – the child likes sliced turkey and there are several other versions of sliced meat so make one of the missing proteins sliced chicken.

Once I get the missing food items filled in for those 2 days, I can begin working on day 3.

Here’s the same menu as above but completed. (The items that were marked as missing before have been bolded and if I edited an item to be prepared differently, I italicized that item).

Day 1 Day 2 Day 3
Breakfast Peanut Butter
Wheat Crackers
Pears (fruit cup)
Banana Yogurt
Strawberry Pop Tart
Sliced Apples
Sliced Turkey
Graham Crackers
Applesauce
Snack Strawberry Yogurt
Graham Crackers
Applesauce
Cheddar Cheese Cubes
Saltine Crackers
Whole Banana
Plain Yogurt
Wheat Crackers
Cooked Carrots
Lunch Sliced Turkey
Cherry Pop Tart
Peas
Chicken Nuggets (Dinosaur)
Cheez-its
Strawberries
Peanut Butter
Blueberry Pop Tart
Sliced Banana
Snack Sliced Cheddar Cheese
Wheat Tortilla
Sliced Banana
Sliced Chicken
Tostitos
Baby Carrots
Chicken Nuggets (WW)
Wheat Tortilla
Pears (fruit cup)
Dinner Chicken Nuggets (WW)
Spaghetti Noodles
Cooked Carrots
Diced Turkey
Goldfish
Peaches (fruit cup)
White Cheddar Cheese
Linguine Noodles
Peas

This menu can be intimidating and time consuming to create but if you’ve got a problem feeder it can help your child to not experience a food jag and drop a food while we work through things in feeding therapy.

The second type of menu, one preferred food at each meal and snack, is a little easier to create and is one that I commonly use with children who are picky eaters but are not problem feeders. The goal of this type of menu is to make sure that there is at least one food at every meal and snack that the child will eat. This food can be part of the meal that everyone else is getting or it can be in addition to the meal.

Let’s look at a meal plan for a family. The foods that the child likes will be from the same list that we used in the above example and they will be in bold type in the below menu.

Day 1 Day 2
Breakfast Oatmeal
Banana
Strawberry yogurt
Granola
Snack Goldfish
Sliced Apples
Pears (fruit cup)
Sliced bell pepper
Lunch Peanut Butter & Jelly Sandwich
Strawberries
Turkey (sliced) sandwich
Salad
Snack Baby carrots
Hummus
Graham Crackers
Applesauce
Dinner Lasagna
Roasted vegetables
Cheez-its
Tacos

  • Hard taco shells
  • Wheat tortillas
  • Ground turkey
  • Shredded cheddar cheese
  • Salsa
  • Shredded lettuce

In this menu, I took the foods that the child likes and made sure that there was at least one at every meal and snack. For the most part, there was one liked food at each meal and I didn’t have to add an extra item for the child. With dinner on day 1, I added cheez-its to ensure that there was something that the child would eat at that meal.

Picky eaters and problem feeders can be mind boggling, frustrating, and challenging. In addition to having the challenge of getting food into the child, we also have the challenge of good nutrition for the child. Having a trained pediatric feeding therapist who is a registered dietitian can help make sure that we are maximizing the child’s nutrition for what the child will eat.

Nutrition is a piece in all of this that I also look at when working with a child in feeding therapy. I examine the menu and the child’s food likes to see where there are nutritional deficiencies and how I can decrease those deficiencies. I look at what needs to be added and how it can best be added to the child’s intake…more on this to come in a future post!

As always, if you have any questions, please feel free to reach out.


The SOS Approach to Feeding – Mealtime Myths

In part 3 of my series on the Sensory Oral Sequential (SOS) Approach to Feeding, we are going to explore some mealtime myths.

Eating is a challenging sensory skill that a child must master as part of normal development. Over time, several myths have emerged about how, when, and why a child should eat. Our acceptance of these myths causes us to place pressure on children to eat, which causes the child to feel anxious about eating, which then causes the body to produce adrenaline and adrenaline suppresses the child’s appetite. It’s a vicious cycle. The SOS Approach to Feeding debunks these myths and teaches that believing in these myths can do more harm than good to a child’s feeding development. Let’s take a closer look at 10 mealtime myths and why they are a myth.

three toddler eating on white table

Myth #1 – Eating is the body’s top priority.

Not exactly. Breathing is the body’s top priority. Postural stability (i.e. not falling on your head!) is priority #2. Eating is priority #3. Eating requires the ability to safely shut off our airways for a brief second while we swallow. If a child cannot manage shutting of his or her airway or if a child cannot manage to swallow a food safely, that child will not eat because that child wants to keep breathing.

Myth #2 – Eating is instinctive.

This is partially true. Eating is an instinct but only for the first little bit of life. From birth to around 3 or 4 months old, our primitive motor reflexes (rooting, sucking, swallowing) help us create pathways in our brains that lay down the motor patterns necessary for eating. After about 6 months of life, eating is a learned motor behavior.

Myth #3 – Eating is easy.

Eating is actually quite complex. Eating involves every single sensory system – taste, smell touch, sight, hearing. The task of eating requires most of your organ systems – digestive, nervous, endocrine, muscular, respiratory – and eating requires that they each be functioning properly.

Myth #4 – Eating is a 2-step process. Step 1: you sit down. Step 2: you eat.

Not at all. There are many steps to eating. The SOS Approach to Feeding has identified that there are 25 steps to eating for typically developing children and that children with feeding difficulties may have 32 or more steps in the process of learning to eat.

Myth #5 – It is not appropriate to touch or play with your food.

No, no, no! It is completely appropriate to touch or play with your food. This is how you learn about the food that is in front of you. Playing with and touching food is part of the process of learning to eat.

Myth #6 – If a child is hungry enough, he/she will eat.

Sort of. This is true for most of pediatric population. For children with feeding difficulties, they will not eat if they are hungry enough and they will starve themselves. For these children, eating hurts or it doesn’t work so they are protecting themselves. It’s pretty simple for these kids – if it hurts, don’t do it; if it doesn’t work, get away from it.

Myth #7 – Children only need to eat 3 times per day.

Not at all. Kids are growing so they have significant nutrition needs. With 3 meals per day, they would need 3 adult sized meals to meet their nutrition requirements. They’re stomachs aren’t meant to hold adult sized meals. Children truly need to eat 5 to 6 times per day to meet their nutrition needs.

Myth #8 – If a child won’t eat, it’s either a behavioral or organic problem.

It’s not an either or situation. It’s both. Organic feeding disorders are the result of an organic disease or disorder such as a structural abnormality (esophageal narrowing), a metabolic dysfunction (urea cycle disorder), or a gastrointestinal disease (gastroesophageal reflux disease). Feeding issues can also start as a behavioral problem such as refusing to sit down at the table, throwing food, or vomiting to get out of a meal. If your child’s lack of eating starts as a behavioral problem, then improper nutrition will cause organic issues. If the lack of eating starts as an organic problem, the lack of enough food will cause behavioral problems.

Myth #9 – Certain foods are to only be eaten at certain times of the day and only certain foods are good for you.

Food is just food. Food is not a breakfast food or a lunch food. Food is not good or bad. Labeling foods snack foods or dinner foods is not helpful when teaching children to eat. If you eat broccoli and turkey for breakfast, that’s completely fine because you are still getting the food that your body needs. If you eat toast and scrambled eggs for dinner, that’s also fine because you are still getting the food that your body needs. Labeling foods as good or bad foods also isn’t helpful when working with a problem feeder. There are definitely some foods that are better for you because they have a better nutritional profile. However, all foods contain calories and sometimes, when working with a problem feeder, it’s just about getting some calories into the child.

Myth #10 – Mealtimes are social occasions and children are to mind their manners.

Manners are great! And important. However, they should not come at the expense of a child getting the nutrition that he or she needs. Mealtimes are excellent teaching opportunities and a child learning to eat is going to get a little messy. Talk about the food. Explore the food with you child. Model how to eat. Manners will come but let’s learn to eat first. Let’s also note that I’m NOT saying to let your little one be a complete wild thing when out at a restaurant. You can still be well behaved while getting a little messy and exploring food. Then maybe at home, we allow ourselves to get a little messier and play with our food a little more.

What questions do you have about the SOS Approach to Feeding or about pediatric feeding therapy? Feel free to comment below or reach out!


How do you know if your child is a picky eater or a problem feeder?

Welcome to part 2 of my series on the Sensory Oral Sequential (SOS) Approach to Feeding. In this post, we’re going to take a look at the differences between a picky eater and a problem feeder.

Part of being a toddler is going through a picky eating phase. This picky eating phase is part of typical child development and in most cases, it will end. However, there are times when it’s more than picky eating and you may have a child with feeding difficulties (i.e. a problem feeder).

An integral part of utilizing the SOS Approach to Feeding is understanding if the child is a picky eater or a problem feeder. The SOS approach can be utilized with both types of feeding issues, but how it is approached may be a bit different based on whether or not the child is a picky eater or a problem feeder.

The chart below describes some of the differences between a picky eater and a problem feeder.

If you have any questions or concerns about whether your child is a picky eater or a problem feeder, feel free to contact me. I’m happy to talk things through with you.

Picky Eater vs Problem Feeder


The SOS Approach to Feeding

This post is the beginning of a series on the Sensory Oral Sequential Approach to Feeding. Over the next few weeks, I’ll dive more deeply into the basic tenets of this approach and highlight some strategies for working with picky eaters and feeding issues.

A few years ago, I had the privilege of attending a 4-day Sensory Oral Sequential (SOS) Approach to Feeding Therapy workshop. This workshop was extremely enlightening and beneficial to the work that I do with picky eaters and problem feeders. The SOS Approach is the feeding therapy tactic that I use most often with children who are displaying feeding issues. Let’s take a deeper look at what the SOS Approach to Feeding Therapy is.

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The SOS Approach to Feeding Therapy was developed by a Dr. Kay Toomey, pediatric psychologist, and Dr. Erin Ross, pediatric speech and language pathologist. It is a program designed to assess and treat children with weight or growth problems and feeding difficulties.

The program has 4 basic tenets:

  1. Myths about eating. There are many myths circulating about how, why, when, and where a child should eat. These myths interfere with how we understand and treat feeding problems.
  2. Systematic desensitization. This is a treatment for phobias where a patient is exposed to anxiety provoking items or situations. The patient is taught relaxation techniques to deal with the anxiety. This approach is considered the best first treatment to feeding problems.
  3. Normal development. Eating has a normal developmental path that it should follow. This normal path gives us the best blueprint for developing a feeding therapy plan.
  4. Food hierarchies and choices. Utilizing food hierarchies and recognizing the child’s choice in eating and feeding play an important role in feeding problem treatment.

What I like about the SOS Approach to Feeding Therapy:

  • It accounts for the fact that feeding issues have a number of factors into consideration. The SOS Approach to Feeding looks at all of the aspects of feeding issues – posture, sensory, motor, behavioral, emotional, medical, and nutrition – to create an individualized feeding therapy plan.
  • Normal feeding development is key. The entire approach of SOS Feeding Therapy is based on normal developmental stages and skills of eating. By looking at normal feeding development, we can better pinpoint what is happening and create a plan to treat the feeding issue.
  • Feeding goals are based on the child’s skills. Many feeding programs are based on the need to increase the volume that a child eats, which of results in increasing the child’s anxiety around eating. By focusing on improving the skills involved in eating, the SOS Approach treats the root of the feeding issue, leading to increased volume.

Stay tuned for this series that I hope helps you better deal with your picky eater!