Book Excerpt from:
Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorders by Katja Rowell, MD, Jenny McGlothlin, MS CCC-SLP, and Suzanne Evans Morris, PhD.
Helping families help their children develop a positive relationship with food is what being a feeding therapist is all about. For children with extreme picky eating who demonstrate anxiety about food (EPE defined as eating that significantly affects a child’s physical, social, or emotional development or causes conflict in the family), which can include feeding disorders, improving the relationship with food is paramount. Including parents as partners in that journey to food enjoyment sets the stage for carryover of strategies, innovation during preparation of meals, and more ‘buy-in’ to therapy ideas.
As a therapist who works closely with families struggling to successfully feed their children, I find that much more progress is made at home when a parent feels competent and confident that they can have a positive impact on their child’s development. Our book was written with this partnership in mind, focusing on the parent as an extension of the feeding therapist. With increased understanding of their child’s challenges and needs, as well as how children typically learn how to eat and enjoy food, parents can make changes at home that will support the skills that you teach the child.
The excerpt below is about making “bridges”, and is found in Chapter 7, which outlines Step 4: Know What to Serve and How to Serve It, of our STEPS+ (Supportive Treatment of Eating in PartnershipS) approach. (excerpt pgs. 158-163)
Building Bridges to New Foods
Learning to like new foods is something like learning a new language. If you are immersed in a language, you learn because you have to communicate your needs and wants, and it happens in a natural way. Food immersion happens when your child sits at the table with you every day— becoming fluent in the foods your family eats. But your child will need bridges he can cross to access your family foods. Building those bridges can make all the difference.
You wouldn’t expect a child with motor delays to learn to ride a bicycle at the same age as his typically developing peers, or in one afternoon. When parents have unrealistic expectations for how long it will take for a child to eat a more typical variety of foods, it’s hard for them to see the progress that is happening. Even when your child sees foods over and over, it takes time. A sibling might branch out after two or ten exposures, but the child with EPE may need dozens or hundreds. Don’t get discouraged and give up before your child has a chance to make those first tentative steps toward the bridge.
When There Is No Bridge
If your child is only eating processed, high- flavor, or fast foods, and you only eat plain, low- fat foods such as broiled chicken or fish and steamed veggies, expecting him to make the leap to your relatively bland foods will be an obstacle. As one dad put it, “I just don’t see how he can go from eating nuggets and waffles to quinoa and broiled chicken.” Frankly, neither can we. If you eat foods solely for their perceived health benefits and taste isn’t important, your child has little motivation to branch out. There is no bridge over that gaping canyon. Children, particularly those who struggle with eating, aren’t motivated to eat for health benefits they can’t comprehend. If you yourself eat for fuel or for health, it may feel difficult or like an imposition to change the foods you serve. But your child will make progress only if she enjoys what she tries, and most people prefer foods with some fat and flavor.
Bridging by Chaining or Fading
You can help your child transition to new foods via characteristics (flavor and texture) of foods she already enjoys. This idea has been called linking or bridging, but is most often referred to as “food chaining,” a term coined by Cheri Fraker (Fraker et al. 2009). The book by the same name includes, among other helpful suggestions, lists of foods to move along, or chain. For instance, if your child likes cheese, you might cross over to a cheese-flavored cracker, put cheese sauce on broccoli, or mix cheese into scrambled eggs. If he likes crunchy and sweet, try kettle popcorn, or dehydrated pineapple slices. Even condiments can provide that bridge.
Exercise: Name two or three characteristics for each food on the list of your child’s safe foods. Is it crunchy or smooth? Savory or sweet? Salty or cheesy? Dry or wet? Hot or cold? Think of foods with similar characteristics.
A similar approach, called “fading,” makes minute changes to an accepted food, like adding a small amount of peach yogurt to vanilla yogurt and gradually increasing the peach. Think of fading as making small changes to one food, while chaining links one food to another through common properties like crunchy texture.
For the child with EPE, small differences in foods can scare him, so the goal is to help him see the similarities. Remember “chicken- steak”? Giving your child that connection to a food he is familiar with eases him into learning about a new food. You might say: “This is a cheese- cracker. It tastes like cheese but is crunchy like your other crackers.” Or “This is pasta like your spaghetti. It’s spaghetti- bowties!” Or “You know how I make those zucchini muffins? These are zucchini- carrot muffins.” Or “Did you know bunny- boo loves carrots?” The last example is a context clue that’s a little more fun: a child fixated on bunnies, for example, may be curious about carrots if she learns that bunnies like carrots. One nonverbal child with autism began eating dog food out of the dog’s bowl, exasperating his mother. Jenny suggested serving the family food from an identical dog bowl at the table. Why not? The child was eating ten new foods within a few days, and soon enough was using a regular plate. This is an example of a cognitive bridge— the visual of the bowl.
If a food doesn’t taste good, children are unlikely to come back for more. As previously stated, nutrition doesn’t motivate the vast majority of children; having a pleasurable experience is their goal. But children can learn to find more foods that taste good. Start with flavors your child enjoys: savory, salty, sweet, sour, or tart. Build a repertoire of foods with those flavors that you can rotate into eating opportunities.
Parents often express a reluctance to serve sauces and dips, worrying the child won’t learn to eat foods plain, or about the health implications of fat, sugar, or salt. Think of ketchup and dips as training wheels; you probably won’t have a teenager pouring ketchup on rice or corn on the cob (but you’ll survive if you do). Many adults prefer steak with steak sauce, or love the punch of added Tabasco, salt, pepper, or other toppings. Children should be allowed the same option. Condiments help children learn to like new foods. If a child likes chicken with ketchup, she may enjoy other meats (or potatoes) with ketchup. For tougher or dry foods like meats, dips and sauces add moisture, making them easier to manage. Have a variety of options, such as ketchup, ranch dressing, homemade honey- mustard dressing, or hot sauce, on the table at meals and snacks.
Adding some sweetness makes many foods more palatable, especially when the food is naturally bitter, like broccoli or brussels sprouts. While white sugar is fine, there are alternatives that provide sweetness along with some nutritional benefits. Honey, coconut nectar, agave nectar, and molasses are a few you can try. Applesauce is good for baking and can replace up to half the sugar in a cake recipe, or be added to complete recipes for additional sweetness, like in pancakes. A ripe banana can stand in for sugar when you’re baking at home or can sweeten a pudding. Blend frozen bananas with other ingredients into a smoothie. Sweet bridges offer opportunities to sample new flavors and textures.
Many children are less particular about liquids than solid foods. Using juices, nectars, or smoothies to introduce flavors may be easier than introducing a flavor in its whole form. Here are some ideas:
• If your child enjoys apple juice, try serving half applesauce, half apple juice in a fun cup with a straw.
• Mix apple juice with a little yogurt and freeze it in ice-cube trays with toothpicks, or a frozen pop mold, for a frozen treat.
• For the child who enjoys orange juice, make orange smoothies.
• Try a juicer so your child can see where orange juice comes from; he might suck the juice straight from the orange.
• Try soy- based fruit drinks that are the consistency of milk but come in a variety of flavors, providing more protein and nutritionally dense calories than juice.
• Serve smooth soups like tomato, potato- leek, or butternut squash in a cup—y our child may not eat soup with a spoon, but he may drink it!
• Offer Yo- J (orange juice and yogurt blend) or drinkable yogurt (mix it into milk if it is an accepted drink, and gradually increase the amount).
For the child who only drinks water or plain milk, ease into flavor using the “fading” method mentioned earlier. Changing the color may be the place you start. Introduce food coloring (natural food dye if you prefer) that your child can drip into water or milk. You can talk about the colors when you mix them. After assuring her it won’t taste different, you can see if she wants to try her green water. If your child happily drinks the colored water, next time see if she’s up for adding flavored ice cubes. Mix half water and half juice (try white grape juice if you think colored ice will upset her), make small ice cubes, and let her add one to her water. The first few sips won’t taste any different, but as the ice melts, her water will have a slightly different taste. If it’s not a positive experience, scoop out the ice cube or dump it out and get her clean water. The last thing you want is to ruin a safe drink. Be cautious with milk if it’s a major source of nutrition.
Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disordersby by Katja Rowell, MD, Jenny McGlothlin, MS CCC-SLP, and forward by Suzanne Evans Morris, PhD. can be found “anywhere books are sold”, meaning Amazon, Barnes and Noble, Indiebound, etc.