When I evaluated a child for the first time, I ask the parents what other therapies or specialists that their child has seen or are scheduled to see. Often they have been referred to a gastroenterologist. One specialist that has been a must on a team is the nutritionist/dietitian. A good one. That listens to the family and is compassionate, as well as passionate, when it comes to nutrition. No judging, just recommendations and suggests for the family. I have been fortunate to find one in Orange County in Melanie Silverman, MS, RD, IBCLC. I have not met anyone equal in her passion for nutrition but based in reality of family life.
My oldest son is turning 9 at the end of this month. He does not like to eat: sandwiches, hamburgers, broccoli, carrots, salad, potatoes (unless they are fried), anything with tomato sauce. SO when we go out to eat or eat with our extended family there is always a fight or a struggle to get something for him to eat. He will eat PRETTY much anything that is, drumroll please, beige! french fries, chicken nuggets, cheese pizza, crackers, plain noodles.
So my husband says about once a month: your a feeding therapist, fix your kid! (in jest).
Here is why I don’t worry: most of the food he rejects are mostly foods that I consider in the American style of cuisine.
Here is what he does eat: Gailan (Chinese broccoli -it is greener than american), Onchoy (Water Spinach – so wikipedia tells me), pea sprouts, and most other Asian vegetable that is green. He eats most meats stir fried in soy sauce, garlic, and ginger. He does like rice (white and brown).
He also eats sausages and potato balls that are from his German side.
Overall, he does eat a variety of foods from another culture. So, what is a true picky/limited eater? Someone that would not eat anything from ANYWHERE no matter what. Most limit eaters won’t even want to be in the same room as foods that they cannot eat or tolerate.
So try different foods with your child. See if they just need to tap into their cultural taste buds.
Majority of my clients that I see for feeding therapy have GER also know as reflux. They are on a variety of reflux medication from Reglan, Prevacid, Prilosec, to Zantac. Some are also on low grade antibiotics to help motility.
Well it has been WAY too long since I last posted. Reading my past posts I think I was trying to hard to capture a very complex process. I hope that this reboot will be better and more consistent. I am more confident in my skills and feel ready to share a different view on feeding therapy for children with feeding issues. I hope that I can put on paper what I have learned in practice. Here I go, again!
Gains in therapy, any therapy, are built on a foundation of trust. The best way I have found to build trust is to go SLOW. The majority of children I see in the clinic have little to no control over what they can do. They are limited by external (adults) or by internal (limited mobility) forces. When parents come to me, I give my speech explaining why feeding therapy is a slow process: “Your child has to trust me. I need to touch their face, go in their mouths, pull and tug. I’m going to introduce foods to them. This maybe no big deal or it may be the most negative thing in their life at the moment.”
So what have they tried. I have heard it all:
1. We don’t feed him/her until they ask. – they never do.
2. We only let him/her run around and we follow him/her around and feed them.
3. We put him/her in a high chair and just opened his/her mouth and made them eat.
4. We distract him/her with toys or T.V.
5. We just let him/her have milk.
the majority of parents will tell me these things with guilt in their voice. More than once I have hear a parent say how they are just a bad parent because they have tried one or some of these methods. I always tell parents: there are bad parents in the world…they are the ones that don’t care…you care, you try these things for your child. For THEIR best.” And that is why they are here with me.
That is the turning point in feeding therapy as a therapist. When a parent comes to the sessions less stressed. When they are less stressed they become my partner in figuring out ways to help their child. When they become that partner, it makes my life easier because it make the child and the family lives easier. There is no battle. There is listening, observing, and problem-solving. Priorities are made and parents feel that their child is a family member. Now parents are able to listen to the issues at hand, be it physical issues or sensory issues. They are more willing to try and fail and try again. Therapy in general is not a cure but a way to guide someone to their greatest potential. Stress and blame do not help in the journey.
What is important to the family? That is what I start with when I first see a family. Most of the time their child hasn’t been eating or gainng weight for quite some time. It is a constant battlefor every bit and every ounce. Why don’t they eat? You HAVE to eat…why doesn’t my child? There are multiple reasons why a child doesn’t eat. But what is important to the parents? Is it the weight gain or the types of food they eat? Is it that their child sit and eat with them at a meal. Most of the kids I see the parents have been told that their child is not gaining weight. The majority of parents feel that it is a direct reflection on their parenting. I find that it is much easier to help the parents by decreasing their stress about their child’s eating habits and concentrate on what the parents are doing right and what is normal for their child and other children. Toddlers, special needs or not, are a HANDFUL!!! But fun…
I am an occupational therapist who specializes in feeding. What does that mean? I treat children, mainly 18-24 month-olds, who: 1. don’t eat 2. don’t eat enough 3. only eat pureed or soft food, or 4. only eat certain food. Most of the children I see do not have a diagnosis. They are kids with no really history of delays other than difficulty eating. Some do have other delays or a diagnosis.
Why feeding? I have no idea. Occupational therapy is using a person’s occupation to assist in the rehabiliation. With children it is more habilitation. As an occupational therapist (OT), I look at the whole child and what a child should be doing at their age – playing, sleeping, and eating. Part of playing and eating is socializing and being part of a family. I find that when eating is not going well, the whole family unit falls apart. Eating is what sustains us. It is how we fuel our body. Without food in out system and sleep – we cannot function. When feeding goes wrong it takes away from living.
My philosophy is being positive. Not happy but enjoying all the small steps towards the goal. Life is a journey of many paths. I’m honored to be part of the journey that my families take.