Yesterday I shared Part One of my interview with Katja Rowell, MD and Jenny McGlothlin, MS, CCC-SLP, co-authors of the excellent Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorders. We talked about how to distinguish a child’s normal eating behaviors from truly problematic ones, as well as the ways in which parental pressure at the dinner table can easily backfire.
Today, in Part Two of our interview, we discuss what parents can do to reduce their anxiety about a child’s selective eating, the importance of family meals, and when – and how – to get the right professional help.
TLT: Yesterday we talked about why parents shouldn’t pressure kids to eat, but when a child isn’t eating well, parents often feel helpless and want to do something to help kids along. So why is using subtle pressure, like the use of praise or rewards, such a bad thing?
KR & JM: First, we would ask parents to reflect– why isn’t the child eating well? What is the definition of “eating well?” Is it amount? Variety? Are there challenges that need to be addressed? Has there been inadvertent pressure that may be contributing to the child’s resistance? Are there realistic expectations? For example, many small children are satisfied at some meals with a bite or two (self-regulating by eating more at other times) but parents would like the child to eat more, parents may expect unrealistic behavior, or want a child to be tuned in to the pleasure of food the way that they are…
Then, observe, think about your child. What have you been trying? Has it worked? How is your child responding? If praise and rewards seem to encourage your child and help him expand his variety, by all means, continue. That just isn’t the reality for the parents we work with, many of whom have already been trying these tactics on their own and with formal therapies for months and years with worsening struggles.
You’ll know if something you are doing is helping your child or not by how he responds. In our experience, and the literature supports this, the more parents worry and pressure, the less children eat. For many children, even the attention, the praise, the eyes watching, is enough to make them feel like they will disappoint their parents, and can really dampen appetite. Allow children to be participants at mealtimes, not the focus. (Watch this video from the University of Idaho to see how the attention can feel.)
TLT: If parents shouldn’t use pressure, how can they reduce their anxiety about their child’s eating patterns?
KR & JM: It is important to really dig into what the worry is. Growth? Protein? Nutrition? Have a talk with the child’s doctor (or read our book or another resource) to get an idea, “Do I really need to worry about this?” If so, address it, if not, what a relief! If growth is slow, but steady, that’s reassuring. Most parents also greatly overestimate how much protein a child needs, or are so worried about sugar or processed foods that the anxiety has become toxic.
Understanding WHY your child might not be eating well is critical. If parents can empathize that their child may be reluctant because of a history of reflux and pain, or sensory challenges, or that he is sensitive to pressure and why it backfires, that understanding can help parents trust the process of feeding children well and supporting them with eating. Understanding is empowering. Also, when parents’ observations are reinforced and acknowledged, that is hugely affirming.
A lot of anxiety around eating is about getting good nutrition. With this worry, perfect can be the enemy of the good. In other words, pushing for better or best can make right-now nutrition even worse and put the long term goal of raising a competent eater even farther out of reach. There is not a whole lot parents can do to get children to eat more variety or amounts, but there is a lot parents can do that slows the process down. Particularly for children with more extreme picky eating, it may take a long time, and initial progress is not about what is going in their mouths. Initial progress is about decreased anxiety and having a child who is comfortable at mealtimes and around new foods. Parents can do a lot to set the stage for progress. Like tending a garden, you pick a sunny spot, but not too sunny, water, weed, mulch and compost. Then, when the first shoots start to grow, resisting the impulse to try to pry open the leaves and buds can be hard!
TLT: Why do you think family meals are so important in helping children along in their eating?
Watching parents and the people children love and trust enjoy the foods they are expected to grow up and learn to enjoy eating is critical. If parents feed children separately, and then eat later, there is a lost opportunity. Pleasant meals together are a chance to connect and share.
When there are no more battles about picky eating, mealtimes become that protected space to enjoy your family.
Mealtimes give children pleasant opportunities to get exposures to the foods they are expected to grow up and learn to enjoy eating. They see the food, smell it, pass it, maybe even help prepare the foods. Again, it’s about the environment so that the child’s innate curiosity has a place to blossom. One father of a child with extreme picky eating related his own experience. Most of his childhood his parents talked about good nutrition and pressured him at meals to eat more vegetables and the “healthy” food. He resisted. When he was ten, he remembers that his parents “gave up” pressuring and talking about food, but still ate together. After a while he started getting sick of his sandwiches, and remembers the meal where his parents had Chinese food, and he suddenly discovered that it smelled good and looked better than what he had! He reported that that summer he tried more new foods than he had in years and grew up to be an adventurous eater. He identifies that once there was nothing to resist, his own curiosity had a place at the table. Critically though, there was a table where he was newly able to relax and enjoy mealtimes and where he was exposed to new foods.
TLT: When do you recommend parents seek professional help for picky eating?
KR & JM: If there has always been a struggle, or if an infant is resistant or appears unhappy or in pain while eating, getting help early is critical. The neural pathways and anxiety around all of this is harder to undo the longer problems persist. A good evaluation by an experienced feeding therapist is paramount when parents (and physicians) aren’t able to figure out why the child doesn’t eat well. The feeding therapist is a detective, wading through a child’s history, evaluating skills, and getting a feel for how feeding is going at home. Discerning if there is a problem with oral motor skills, sensory differences or needs, or structural issues is hugely important because these can go undetected and can be the root problem causing picky eating.
But, finding the RIGHT help is important. Bad therapy is worse than no therapy. We help parents learn about options, and learn to trust their gut. Many children, even with more than typical picky eating, or who have had challenges in the past, don’t need intensive formal therapy, or may just need one or two visits and then the parent needs to be taught how to help the child at home, perhaps through ongoing consultation. Jenny finds that partnering with the parents and teaching them to be the child’s “therapist” is the most effective approach. Being a model, coach, and guide (but not doing it for them) gives them the confidence they need to put strategies into place and the results are quicker and more enduring than if a parent relies on a therapist to “fix” their child’s eating.
TLT: Is there anything else you’d like to tell Lunch Tray readers about the book or picky eating generally?
KR & JM: Take a deep breath. For most children, picky eating is a stage. Learn how to not make it worse, and how to support your child’s curiosity and internal drive and skills with eating. Learn as much as you can, and if you struggle, find support. (A great resource for parents of children with extreme picky eating is Mealtime Hostage blog and Facebook private support group.) Find help if your child is struggling with anxiety.
Nutrition is important, but so is avoiding unnecessary struggle and anxiety. The good news is that having pleasant mealtimes and a relaxed child at the table will ultimately support good nutrition.
There is help and hope.
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I want to thank Rowell and McGlothlin for taking the time to respond so thoroughly and thoughtfully to my interview questions. As I said in Part One of our interview, I highly recommend their book and am pleased to offer TLT readers a chance to win their own free copy of Extreme Picky Eating. To enter the drawing, just leave a comment below by Monday, January 18, 2016 at 6pm CST. You can share your own experiences with your child’s picky eating or you can just say hi. I’ll use a random number generator after the comment period closes to select one lucky winner and if you comment twice (e.g., to respond to another reader’s comment), I’ll use the number of your first comment to enter you in the drawing. I’ll email you directly if you win and announce the winner on TLT’s Facebook page, too. This offer is open to U.S. residents only.
[Blogger disclosure: I received a free copy of Extreme Picky Eating for review. However, I never accept any other form of compensation for the book reviews or author interviews you see on The Lunch Tray.]
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