Thursday, December 15, 2011

Fruit of the week

When kids learn letters and shapes, they learn one letter/shape for the whole week.  A great way to increase your child's food repertoire is to pick a food/fruit that they don't eat and introduce it on the first day with pictures, games, crafts, etc.  On the second day, you could begin to cut the food, "explore" it with their fingers, kiss the food, etc.  Each day progress as far as how far your child will go with the exploration until he/she is eating the food.  Kids love to learn, so this approach is easy and will be fun for them to try new foods! Here are some ideas of crafts and fun things to do with foods:

- Paint with fruit (cut the fruit in half and use it as a stamper for the paint!)
- Colorful spaghetti (cook some different shaped noodles and put some paint in them, allow your child to play with them using their hands, kitchen tools, etc)
- Food towers (use their preferred foods to build towers, alternating every other layer with a non-preferred item)
- Make mom lunch (have your child help make YOU lunch using some of their non-preferred foods.  This way, your child will have to touch and smell the foods, and then can watch you eat them)

As always, although you may be stressed out because your child is having a difficult time eating, don't become so stressed that you loose focus on the fact that mealtime should be FUN!

Thursday, December 1, 2011

Finger Foods!!!

Many of my readers are wondering about finger foods to introduce.  Here is a list of all of my go-to finger foods to suggest for kids:

7-9 months:
- MumMums
- Biter Biscuits
- Small pieces of soft veggies
- Small pieces of cooked fruits
- Meltable solids: cheerios, puffs, rice krispies, graham crackers, Ritz (or any buttery cracker), etc

9-12 months:
**This is the time when you are allowing your kiddo to practice eating solids especially introducing ones similar to what you and the rest of your family is eating for dinner.

- Soft Cheeses (ie:Laughing cow)
- Meatball
- Bread with melted cheese
- Bread with nut butters/butter/jelly
- Zucchini chunks- no skin
- Cooked cauliflower
- Mashed potatoes/sweet potatoes/yams
- Quesadilla bites
- Rotisserie chicken- dark meat shredded
- Raviolis with different fillings  - butternut squash/cheese/spinach- try mini ones :)
- Pancakes/waffles with syrup/apple butter/or jelly
- Rice (try mixing your child's favorite puree as the sauce initially)
- Soft cooked pasta (try mixing your child's favorite puree as the sauce initially)
- Cracker with jelly/sunflower seed butter/cream cheese
- Tofu
- Green beans - cooked
- Peas
- Carrots - cooked
- Squash - cubed
- Potatoes - cubed or in strips (like french fries)
- Breadsticks
- Rice cakes
- Dips (hummus, refried beans, guacamole, sunbutter, soft cheese, cream cheese, etc)
- Deli meats (Nitrate-free if possible)

**Just remember: Every child develops at their own pace and therefore some of the foods on this list may not be appropriate for your child.  This is simply a guideline for suggestions... As always use your best judgement!

Wednesday, November 23, 2011

Happy Thanksgiving!!

Happy Thanksgiving to all of my blog followers.  Thank you all for reading my blog as it is my passion to help children learn to love eating and mealtime.

Thanksgiving is a great time to enjoy food with family, however to a child with sensory feeding challenges it is a nightmare.  Try these tips to help your child be most comfortable around your thanksgiving table!

1.  Try to serve the food buffet style, so that it is not on the table directly in front of your kiddo.
2.  Take your child over to the food and serve approx. 1 tsp of all the options on a smaller salad plate for visual opportunities (put that plate on the table next to his/her plate of food)
3.  Bring a food that is "preferred" to help with the smells and visual experiences of all the foods around.
4.  Tell your child before going to Thanksgiving dinner that he/she will NOT be forced to try any new foods.  (Most children become anxious when they anticipate an event with tons of non-preferred foods)
5.  Try to make it fun for you child, and allow him/her to touch and explore with the "traditional" (non-preferred) Thanksgiving foods.  Give your child an extra fork, so he/she can use it to explore the foods on the separate plate.
6.  If your child becomes anxious with the foods, or if you feel that it is sensory overload, remind him/her to take a deep breath.

Happy Thanksgiving!!

Thursday, November 10, 2011

Gagging, pocketing, and spitting out foods...

If you are experiencing any of the following with your toddler or child, you need to read this post!  Everyday, children come into my office that want to eat, but just can't figure it out, and unfortunately parents read their cues as "I do not like this food".

1.  If your child is gagging on foods, especially if they are a new texture or flavor, it might not be that he/she does not like the food.  When babies are born, their cheeks are lined with tastebuds.  When we first introduce foods, they get a BLAST of flavor (even though we perceive purees to have no flavor) and they may shiver, make a "yuck" face, or gag.  These are all signs that they are adapting to the flavors.  Do not stop trying this food with your child.

If your toddler or preschooler is gagging on foods, it could be a hypersensitivity to texture, taste, or temperature.  If you stay consistent as I mentioned in my previous posts, you will be able to desensitize your child's mouth to accept new and different textures and flavors.

2.  If your child is pocketing foods you need to consider the following:
- Is the food you are offereing a complex texture? (ie: chicken, raw veggies, etc)
- Is the food you are offering in too big of a piece for your child to chew?
- Will your child eat other foods (chew and swallow them) while they are storing the other food in their cheeks?

These are all very different scenarios.  The bottom line, if your child is pocketing foods, DO NOT let them sleep with these foods in, run around with the food in their cheeks, or get up from the table with the food in their cheeks, as it can be a safety hazard.

3.  If your child is spitting out foods.  More often than not it is a texture/taste dislike for the food.  However, a small percentage of the time it is a significant oral motor issue.  Take a look at your child, when the food goes into their mouth, are they trying to chew it? Do they repeatedly put the spit out food back in their mouth?  If your child picks up a piece of food, puts it in his/her mouth, spits it out and keeps trying that same food, chances are he/she is having a difficult time understanding how to chew it and it may not be a dislike or "picky" eater situation.

As with all feeding difficulties, it is important to assess the mealtime and gather all the facts to determine if your child is giving you cues about why he/she is exhibiting these behaviors.  When in doubt contact an occupational therapist! 


Thursday, November 3, 2011

My Turn!!


 Self-feeding is an important milestone.  Your child should be learning to use the spoon or fork by 8-10 months.  They should be self feeding AT LEAST 50% of the meal by 1 year of age.  There are a few scenarios to address if you are having difficulty with self-feeding....

1.  My child refuses to self-feed.  If your child refuses to use the spoon or fork, you need to assess the situation.  Will your child bring other food (ie: crackers, puffs, etc) to his mouth?  If the answer is yes, then  you know he/she's capable of self- feeding at this time.  My suggestion is to have your child help your hand bring the spoon to his/her mouth.  Eventually, you can put his/her hand on the spoon (with your hand further down the handle) and guide it to their mouth.

2.  My child refuses to take food from a spoon.  If this is the case, have you tried giving your child a spoon or fork and teaching them to do it by themselves?  25% of the cases I see are children who have been labeled as "picky eaters" or "refusing to take purees", but once I give them control of mealtime (give them a utensil and teach them how to use it) they begin to eat because they have a sense of accomplishment and independence.

3.  My child uses a spoon, but spills and so I just do it for him/her.  The only way to teach your child to not spill, is to let him/her practice feeding.  I always suggest forks, because they are MUCH easier (the food stays on!!).  Or, you can use a spoon with something like yogurt and just dip it instead of scooping so much onto the base of the spoon.

As with all feeding concerns, it is best to rule out bigger issues.  If your child is not self-feeding, check his/her fine motor milestones and make sure he/she is on track.  That way you will be able to tell if it is an "I don't want to" or an "I can't" situation.



Friday, October 21, 2011

If you eat this.. then I'll give you...

When is it appropriate to bribe kids to eat non-preferred foods?  Parents ask me this question on a daily basis.  Generally I suggest to CAREFULLY use reinforcements.  Some general tips:

1.  Don't use preferred foods as a reinforcer.  When children have very few preferred foods, we need to be careful about using these select foods to reinforce tastes of non-preferred foods at the risk of loosing the preferred food completely.

2.  Generally it is better to set a routine than to "bribe" your children to eat.  (ie: At the beginning of each meal, help your children explore the non-preferred foods, even if they don't eat them.  Do this consistently, and soon your children will become used to the smell, sight and taste of these non-preferred foods.  Then, offer them their meal.  This way you are not bribing them, but simply adding a step to your mealtime routine.)

** Remember that it takes OVER 15 CONSECUTIVE presentations before your child will consistently chew and swallow a new/non-preferred food**

3.  As always, avoid distractions while eating.  If your child will only eat while walking around, with the TV on, or with toys on the highchair, then you will need to gradually reduce the dependence of these supports because this is not a functional way to eat.  Often children use distractions to avoid taking part in mealtime. 

4.  Don't get in a power struggle.  The main problem with reinforcing children for eating non-preferred foods, is that if they refuse even after you "bribe" them, then they have begun a power struggle, which is what you want to avoid with all children, but especially picky eaters.  

Occasionally, it is necessary to use a preferred item or food as a reinforcer for trying a new food, however do not make this a habit.  Most children will continue to try/eat a new food if they like the taste of that food, so a reinforcer each time is not always needed.

Seek help from an OT or Physician if you still have questions regarding reinforcements.


Tuesday, October 18, 2011

Mouse Bites

The most common thing I hear in my clinic is, "My child only eats 3 foods, and I've tried EVERYTHING".  Most of the time not only have the parents not tried slow, gradual introduction of new foods, but the other common mistake parents make is that they try new foods in a sporadic and uncontrolled way.  Some things to remember when trying to introduce new foods to your toddler/picky eater:

1.  SMALL QUANTITIES.  Children are more likely to try new foods when the serving size provided is very small.  Usually, during my feeding sessions I will take a dime sized amount of whatever the parent has provided and present this on a separate plate for the child to "explore".

2.  LET THEM "EXPLORE".  Children are messy, and they enjoy touching their food.  In addition, they learn about the food presented and are more likely to try it when they are allowed to touch it.

3.  "MOUSE" BITES.  Animals are a fun topic when it comes to children and toddlers, and therefore referring to their bite sizes in terms of animals makes it fun and exciting for them.  A "mouse bite" is the smallest bite a child can take to experience how the food feels on their teeth and in their mouth.  One of my patients told me, "Ms. Liz I'm not going to take a mouse bite, but I will nibble."  So, if this is the case, let your child "nibble" and at least begin to bring new foods to their mouth, lips and teeth.

4.  PRACTICE, PRACTICE, PRACTICE.  If you want your child to eat a new food, you need to present multiple opportunities for them to touch, like, kiss, and take mouse bites of that food, before you expect your child to pick up the food and eat it.  It is a very slow process, and every child goes at their own pace.

**Most important tip:  If your child is underweight, has not gained weight, or is loosing weight, it is essential that you contact your pediatrician and get a referral for a feeding therapist.  The longer the feeding aversions have a chance to develop, the harder it is to desensitize and get children to eat new foods.***

If you have special tips that have worked for you and your family, please share a comment with other blog followers, so they can learn from you and your experiences with picky eaters :)


Thursday, October 6, 2011

When to introduce...

Well as new parents, everyone always reads books and surfs the web for the most recent posts by parents, magazines, authors, etc, on when to introduce new things to your baby.  The reality is, trust your instinct.

1.  When to introduce... PUREES :  There is a lot of debate about this topic, however infants should not be eating purees until they can hold their head up and sit up independently (6 months).  Recently, parents have been coming into my office with the advice from outside sources to feed purees at 4 months.  This may work, although it does have the potential to create more aversions, tactile defensiveness, and negative mealtime environment.  Bottom line- Between 4 months- 10 months (or 12 months), your babies PRIMARY nutrition should be from formula and/or breast milk.

2.  When to introduce...CUPS:  An open/sippy cup should be introduced when you are beginning to introduce purees (so ideally at 6 months).  Cup drinking is an important milestone to teach your child jaw stability, tongue lateralization (moving tongue side-to-side), lip closure, etc.  Your child will not be successful with this, but try to spend some time teaching them how to do this.

**Helpful tip:  Use a dixie cup filled with an inch or less of water/formula/breastmilk to begin.  These are small and easy to manage if your little one decides to spill it all over the place.

3.  When to introduce...UTENSILS:  I can't tell you how many times a 2-year-old walks into my office and their parent tells me that they have not introduced utensils yet.  It is so important that you begin to offer a spoon (for exploration purposes) at 6 months (or when purees start).  It can be messy, so if you want to only do this one meal a day, then that's fine as well.  By the age of 12 months, children should be feeding themselves 100% of a meal (with exceptions of course), using fingers AND utensils.

4.  When to introduce... MELTABLE SOLIDS:  The first question you might have is, "what are meltable solids"?  This is a "solid" that melts with moisture:  graham crackers, Cheerios, Gerber puffs, Saltine crackers, Biter biscuits, yogurt melts, Mum Mums, Rice cakes, etc.  These are GREAT first finger foods to introduce because they will melt in your child's mouth.  These should be introduced (provided your child has had all kinds of purees and is moving them in his/her mouth without spitting them out with their tongue), by 8-10 months of age.

**As always please post questions and comments below**

Friday, September 23, 2011

These are a few of my favorite things... right now

1.  The First Years - take and toss spoons/forks are the best.  They are lightweight so babies and toddlers can use them easily.  In addition, the spoons have bowls that are just the right blend of deep and shallow to make it successful for your child.

** Liz's tip: Introduce a fork when chunky foods are introduced (9-11 months).  They are much easier for kids to use and there is no reason why your child can't start with a fork!

2.  Daiya Cheese- So many kids are on special diets.  I found this amazing cheese at Sprouts (also found at Henry's and Whole foods), and it is Gluten Free, Casein Free, and Soy Free! The best part is.. it actually MELTS!!

3.  Sunbutter- Looks/tastes very similar to peanut butter without the risk of allergies.  Look for the "smooth" version to avoid sunflower seed chunks.  This is a great "first dip" for your baby/toddler.

4.  Cooking for Baby-  If you are planning on making your own baby food, or even if you just want information on how/when to start, you MUST get this cookbook.  It is by far the best one I've seen and it even tells you what spices/herbs you can give with your babies purees!!

5.  Mini Massager- If your child has tactile sensitivity (does not like textures, foods in/ around his/her mouth) you can try vibration to the lips, cheeks and tongue several times throughout the day to desensitize the area. 

** Liz's tip: Slowly introduce this by allowing your child to put it on your hand first, then ask permission to put it on your child's face.  If they don't know what's coming it can be very startling at first.

If any of you have cool feeding gadgets, cookbooks, or food to share, please do so that other readers can learn from your experiences!!

Wednesday, September 21, 2011

Top 10 things to remember when feeding your child


1.    Be Consistent! Children and infants learn best when the skill is repeated several times.  When you are just beginning to introduce purees, be consistent with consistency of food, type of food, time you are presenting the food, and where you are feeding.  

2.    Eating is a LEARNED behavior.  Most people think that every child is born with the ability to eat.  This is not true.  Children learn from their parents modeling how to chew and swallow.  It is important that you teach your child how to eat by over exaggerating your mouth movements and eating with your child.  

3.    DO NOT force feed!  Developing a healthy relationship with food and mealtime is a very important skill to learn.  At times, it is very frustrating when your baby won’t eat, but you have to remember not to force anything into his/her mouth, as this will make problems worse.   

4.    Listen to your gut.  You are the parent, and therefore you know your child better than anyone.  If you feel that your child is not eating efficiently or if mealtimes are stressful for you or your child, it is important that you seek out professional help, even if your pediatrician does not agree.  Early intervention is best.

5.    Watch for cues. Feeding is like a dance, you need to watch your infant and begin to read their cues for when they need another bite, have had too much, or are done with mealtime.  If your infant turns their head away from the spoon you may need to give them a moment to swallow.  Other signs to watch for are pursing lips tightly, closing their eyes, placing head on tray, hiccups, or crying.  These signs may let you know that your infant needs a break or that it is time to end mealtime all together.

6.    Get Messy! Your child should be able to touch and manipulate his/her food.  It is typical for infants/toddlers to be messy when feeding especially when they are just learning.  Often it is the parent that places significant restrictions on the infant/toddler’s active participation in mealtime, making the infant less likely to join in an enjoy mealtime.

7.    Encourage self-feeding.  It is so important that you allow your child to be independent from the very beginning.  Often times this is the key to allowing “picky eaters” to advance their diets because they are in control.  
8.    Watch liquid intake.  “Picky eaters” often drink all their calories because it is easier.  Ask your pediatrician how much milk is appropriate for your child’s age, and stick to that amount.  For this reason, I usually don’t recommend fruit juices until after 2 years of age or in moderation.  DO NOT give an infant juice.  It is full of sugar and will give them a false sense of fullness.  

9.    Good fats are essential for brain growth and development.  It is important to offer your child “good” fats (ie: avocado, oils, butter, milk fats, etc) in order to help promote brain growth and development.

10. HAVE FUN!!! Mealtime and eating are supposed to be fun.  Traditions, memories, and relationships are built around meals.  Allow your children to enjoy mealtimes even if they are having a difficult time with one or two aspects of mealtime.  


Monday, September 19, 2011

What is Feeding Therapy?

First I should say that this blog is not just for parent's with children with feeding difficulties.  All infants/toddlers go through a "picky" stage, and it is important to understand what this means, products that are helpful, tricks, tips and support to get you through this time!

Everyday I get the question, "What is an OT?" followed by "How are YOU going to get my child to eat?"  Most parents come to my office and tell me that they have tried EVERYTHING.  What they usually have not tried, is feeding therapy with a certified occupational therapist.

Occupational Therapists can help people of all ages and abilities.  We usually assist people/children with daily life tasks (ie: eating, sleeping, playing, cooking, getting dressed, hygiene, community activities, social skills, etc.)  An OT can be found in schools, hospitals, rehabilitation centers, skilled nursing facilities, NICUs, private practice, and community centers.  As a pediatric occupational therapist, I help children and their families with any difficulties they are facing that are interfering with their daily routines.

Feeding therapy is tricky business, and the most difficult part is connecting with the child.  If you are concerned with your child's quirks with regards to eating and are wondering if you need to seek out an OTs assistance, the best action plan would be to get an EVALUATION. 

Feeding is an essential part of life, and when you are a parent, feeding is usually your MAIN purpose especially when your child is too young to self-feed.  What happens when your child just wont eat?!  This brings feelings of defeat, failure, frustration, and often times anger.  You begin to dread mealtimes, and all your friends/family say, "Give him/her to me for a week, and I'll get him to eat!"  With feeding therapy, you can overcome these hurdles and begin to "see the light at the end of the tunnel".  It is a slow process with baby steps and lots of "mouse bites", but as long as you are consistent and strong, your child will learn to eat new foods, more nutritious foods, self-feed, and sit at the table/highchair without tantrums. 

Stay tuned for tips, tricks and knowledge that you will not find on WebMD!!!

Sunday, September 18, 2011

Parent Support

I recently held a parent support group for families going through my feeding therapy program. Most of these parents have children with profound aversions to all types of foods, and as a result these children are underweight and undernourished. Through these parents' stories I hope to assist and resolve major issues in regards to picky eating, special diets, failure to thrive, oral motor weakness, inability to transition to more mature textures, and any other feeding concerns out there. I hope this blog helps parents struggling for answers. I welcome any questions and/or comments!!