by Tanya Barber | Jul 2, 2020
If you’re concerned about the variety of foods your child is eating, one of the best tools you can use when you meet with your pediatrician to discuss the issue is a food inventory. And, if you’re referred on for a feeding evaluation, having a completed food inventory ahead of time will really help the therapist to get some insight into possible challenge areas and causes. First let me jump into how to create a really useful food inventory and then I’ll share a couple of the things it can reveal about a child’s food preferences.
You can’t be too specific
When we think of inventory, it’s an easy analogy to imagine the owner of a craft shop taking an inventory of her merchandise. We wouldn’t expect her to list, “Paint, quantity: 87” because this doesn’t provide enough detail about what is on the shelves. Instead, we might expect something like, “Crafty brand acrylic paint, 2 oz, crimson, quantity: 4.” The good news is that you don’t have to be quite as specific as the shop owner when taking your inventory, but you do have to be specific enough. An entry like “crackers” is really not specific enough because Triscuits and Ritz are both crackers but are very different in a lot of ways. Canned green beans are also a big leap from lightly steamed fresh from the garden beans. Is the yogurt perfectly smooth cotton candy flavored yogurt from a tube or a type with pieces of fruit in it? The differences between these varieties of foods can be very telling about why your child eats one and not the other. You generally don’t have to list specific brands, unless your child will only eat one specific brand of each particular food; in that case, definitely do tell!
When you’re taking your inventory, it’s often helpful to have a template with categories or food groups listed that you keep somewhere handy in the kitchen and can jot down items as your child eats over the course of several days. You can easily create this yourself, or download and print a template like the one below. Here I’ve left a column for foods that don’t easily fit into one of the standard categories and another for dishes that contain a mix of foods.
Bring the completed inventory to your appointment(s)
It’s true that many children go through stages of “pickier” eating during toddlerhood and the preschool years. Some “grow out of it” (I don’t really love this phrase, but it serves the purpose for now) and some continue down a road of more and more selective eating. Because many kids do go on to have an acceptable variety of foods after a period of time, your medical provider might reassure you that your child’s picky eating is normal. Even a great doctor who really cares about your child has a lot of ground to cover during a routine well visit and might not be very concerned, especially if your little one is keeping to his growth curve. But, if you bring in your food inventory and entire categories of food are absent or nearly absent, that’s more likely to raise a red flag that you’re dealing with more than “typical picky eating” and result in a referral for more help.
This inventory will also provide valuable information to your feeding therapist. From looking at the example above, I can see that there are no foods on this inventory that require mature chewing skills. This doesn’t necessarily mean that the child has impaired chewing skills, but it will definitely be something to consider. Everything listed also has a relatively uniform and cohesive texture which tells me that there could be sensory and/or motor reasons for such a preference. Finally, when working with the family to determine goal foods to introduce in therapy, we have a good idea of which categories we might want to target and what might be good stepping stones to help reach those goals.
Sometimes when I ask parents to make a food inventory they are actually surprised by how many different foods their child does eat. Sometimes they’re surprised by how few. No matter what, it’s usually an informative and worthwhile activity.
Have you made a food inventory for your little eater? Was there anything that surprised you? Have you used a food inventory to talk to a doctor about your child’s eating? Please share in the comments! I have a printable version of my food inventory available for my newsletter subscribers! I’d love to give you a copy; just get in touch using my contact form.
by Tanya Barber | Jun 26, 2020
When I arrive to work with a new baby, I’m almost always the recipient of a puzzled expression when I introduce myself as “Tanya from Speech Therapy.” What in the world is someone from speech therapy going to do with this little one who obviously won’t be speaking for months?? Many people, especially in the pediatrics realm, don’t know that speech-language pathologists (SLPs) are the professionals with advanced skills and training to evaluate and treat dysphagia (dis-FAY-juh) or in everyday terms “swallowing problems.” Even when folks are aware of dysphagia and the SLP’s role, they’re usually thinking of Uncle Joe who had a stroke and was told to drink thickened liquids. And while strokes are a major cause of dysphagia, babies and kids experience dysphagia too! In fact, “It is reported that the prevalence of pediatric dysphagia is increasing due to improved survival rates of children born prematurely, with low birth weight and with complex medical conditions.” (Arvedson, 2008). There are often many factors affecting a baby or child’s ability to swallow safely and efficiently and treatment needs to be individualized to the person’s specific problems. We often think of coughing as a primary sign of dysphagia, but this is actually not a common sign in babies. Instead we are more likely to observe things like
- Frequently falling asleep at the breast or with a bottle
- Behavioral stress cues like widened eyes, raised or furrowed eyebrows, extended arms with splayed fingers
- Milk spilling out of the mouth
- Gulping or hard swallows
- Gurgling or rattling sounds in the nose or throat during feeding
In older infants and kids we might also observe excessive drooling, gagging or choking, a preference for easy to eat foods, and we may be able to look at the medical history and see more sick visits for respiratory infections than would be expected.
The good news is that dysphagia can be treated and that treatment can result in improved health and quality of life! If you have concerns about your little one’s swallowing, talk to your pediatrician about a referral to a speech-language pathologist and once you’ve been referred, make sure to ask if the therapist you will be seeing has experience in this specialty area. Training in pediatric dysphagia was not common in many speech-language pathology graduate programs until recently, but many SLP’s like myself have pursued advanced training and keep up with the latest evidence to provide the best possible care.
Has your family been affected by dysphagia? I’d love for you to share about your experience in the comments!
Reference: Arvedson, Joan C. “Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches.” Developmental disabilities research reviews 14.2 (2008): 118-127.
by Tanya Barber | Jun 18, 2020
How is a feeding problem like an ogre?
In the wise words of Shrek, “Ogres are like onions. They have layers.” I’ve never met a feeding problem that didn’t also have layers… at least as many layers as an onion! And as we begin to peel away the layers we often discover some early events that may have been forgotten or brushed off as “no big deal”. How those events were responded to, usually out of great compassion and a desire to do the right thing, may have actually gotten you stuck in what I like to call a Slippery Cycle.
A slippery cycle occurs when your reaction to an event results in an effect that causes that event to happen more often or in a more dramatic way in the future.
Let me break this down using a common example that I discuss with parents in feeding therapy: too much milk. In this example, the initiating event is a toddler not eating “enough” at one or a few meals. Maybe the little one wasn’t very hungry or maybe he was cutting a tooth or just didn’t love what was being offered. The reaction was that mom (or dad or grandma), who is concerned about nutrition and growth, gave greater access to delicious, easy to consume, filling milk between meals. And the result is that our toddler isn’t very hungry the next time he comes to the table. He also knows that if the food being offered isn’t his favorite he can fill up on milk later. Almost before you know it we can have a little one drinking large amounts of milk and eating a shrinking variety of foods AND parents who are afraid to cut back on the milk because it’s now perceived as one of the only sources of nutrition. I call this a slippery cycle because it’s so easy to slip into and also hard to get your footing and walk out of. Slippery cycles are common in many aspects of parenting (and life in general) and I’ll be featuring more of those common to feeding as we go along. Getting stuck in one doesn’t mean you’ve done a bad job! You might just need someone to give you a hand with getting out.
Have you gotten caught in any Slippery Cycles that have to do with feeding or something else? I’d love to hear how you got out or be that helping hand you need! Just leave a comment below.
by Tanya Barber | Jun 9, 2020
When the whole casserole is scarier than the sum of its parts
This topic comes up all the time in feeding therapy: My child won’t eat mixed foods!
Mixed foods are a challenge for many kids (and adults if we get right down to it). But why? For those of us that are comfortable eating mixed foods it might feel like a bit of a mystery but when we do a little digging we can find the answers that make those combinations foods such a problem area for many of our kids.
I always like to start out by framing these things from my own perspective. There are many mixed foods that I do like, but others that I’m not as comfortable with. In general, I’m wary of foods that are going to surprise me in some way. For example, I’m probably going to be more reluctant to order a combined food dish at a restaurant that is serving a type of ethnic food I’m not familiar with. I’m going to want to see each and every item on the plate and decide whether I like it before you start hiding things under a sauce. And if I bite into something that has an unexpected texture (hard, chewy, something with juice that’s going to squirt into my mouth) I’m going to be even more likely to call it quits.
Now think about our learning eaters…almost everything we serve can be like that first meal in the Thai restaurant (speaking of, mmm, Spicy Veggie you’re calling my name!). They aren’t sure what to expect and that can lead to refusal to try. And all of our cajoling with, “Just try it! You’ll like it!” is unlikely to change a mind. In fact it’s likely to backfire and result in more prolonged refusal.
Another factor that can lead to refusal or reluctance to try mixed foods is immature oral motor skills. Each different component of our delicious chicken pot pie likely has slightly different characteristics that affect the way we have to manage it in our mouth. Crisp crust, creamy gravy, soft vegetables, a bit more firm chicken. As a mature eater it comes naturally to make slight adjustments to how firmly or gently you chew even within the same forkful of food. You can (likely) recover when that pea goes POP or a slippery piece of carrot slides over toward your cheek. For a kiddo with immature skills this can be a challenge at best and downright scary at worst. For most these skills develop with practice. If you’re concerned that your child’s skills aren’t improving over time it might be time to talk with your pediatrician about a referral to a therapist who specializes in feeding and swallowing difficulties in children (usually a speech-language pathologist or occupational therapist).
So do you just need to stop serving mixed foods to your reluctant eater? DEFINITELY NOT! If you stop serving a food you can’t expect your child to learn to eat it. But there are some compassionate ways to help the learning process.
Continue to serve a SMALL portion of the mixed food every time you serve it to the rest of the family. Aim for about a teaspoon full. This is a small enough amount that it’s minimally threatening and it also isn’t going to create much food waste when it doesn’t get eaten. (Did you notice that I said “when” and not “if it doesn’t get eaten”? This is a nice mom mindset to decrease your stress level. Don’t expect or worry about it getting eaten! That’s not the point right now.)
Serve a deconstructed version of the mixed food. Using our pot pie example, a few pieces each of diced chicken, carrots, potatoes, peas and a tiny container of gravy for dipping. Now I know this isn’t possible with all foods, especially if you’re out at a restaurant or potluck but it is possible in many instances when you’re cooking at home. Just leave out a little bit of each ingredient when you’re putting the recipe together. Super easy if you’re making that pot pie with a leftover rotisserie chicken and a bag of frozen mixed vegetables…a bit trickier if you’re doing a one-pot type meal where you’re throwing in raw meat and everything else, but still possible. Then at the table you might encourage your child to use his fork to search around in the mixed food to see if she can find a match for each individual item. You can model dipping the component foods into the gravy and talk about how it changes the taste or the texture. We might work up to spearing a piece of chicken and carrot on our fork and trying them together. You can comment on what you notice, for example, “Hmm, I have to chew a bit longer on the chicken than the potato. What did you notice?” Through all of this the emphasis is on exploration and learning.
You might get tired of hearing me say this, but have your child help you cook! This is a great opportunity to learn about the ingredients without the pressure to eat them and also provides ownership of the final product. Having kids help you bake cookies is awesome but having them help you cook the foods they don’t readily eat is even more AWESOME!
Do I expect these strategies to get your reluctant eater to gobble up a whole serving of a mixed food after one try? Unlikely. As with everything in feeding, this is a process. But using these strategies will give you a map for moving forward. Celebrate the small wins every step along the way!
I’ve created this graphic and a printable worksheet to help you along. The worksheet has the right hand column left blank for you to make a plan for your own goal food. Printables are a special treat for my newsletter subscribers, so make sure you sign up to get access to new materials as soon as they’re available! (If you’re looking for a printable that was published before you subscribed just send me an email and I’ll get it out to you.)
I’d love to know what’s working and what roadblocks you’re coming up against as you focus on feeding. I plan my content around what you tell me you need. Just drop me an email or reach out on Facebook or Instagram. And as always, if you know someone who might benefit from this info please share the post on your social media.