As I sit here waiting to return to a week of work (had a nice week off with my kids), I am reviewing several conversations that I have had over the past week and find myself coming back to the same conclusion about our picky and problem eaters. That conclusion is that it seems, no matter the cause (medical, structural, sensory), Neophobia plays a HUGE part in the development of picky or problem eating. I think sometimes, as clinicians, we forget to look at the big picture. We are so busy with treating the symptoms that we forget the cause and for me, that sometimes is the key to excellent treatment outcomes.
When I meet a new client for a feeding evaluation, invariably one or more of the following things will be mentioned as we discuss the case history; difficulty with bottle feedings, frequent ear infections or URI's, REFLUX/GERD, food allergies, sensitivity with getting hands dirty(tactile sensitivity), prematurity, difficulty with table food or lumpy purees when an infant, "grazing", sensory delays, sleep problems, distress at mealtimes, ONE choking episode, breathing problems, trouble gaining weight...the list goes on and on and on but these, for me, are some of the most common things I hear. When you look at the list, you realize that some are medical, some are behavioral, some are functional but the result is the same...the child or adult doesn't want to eat.
Let's explore this for a moment. When you eat something and several minutes later your chest burns, you feel nauseous or you can taste a "sourness" in your mouth does it make you want to eat the food again? Before you would choose to eat that food again would you remember how you felt the last time you ate it and would you want to recreate that feeling? How about if you took a BIG bite of a new food and it was difficult to move around and keep together in your mouth? Some of it stayed on the middle of your tongue but some of it slid back toward your throat and you gagged and it felt like you were going to choke. Would you choose that food again? Would you say you had a positive experience with the food? Do you see where I'm going here? No matter the "source" of the picky or problem eating the outcome in my opinion, is the same....Neophobia....being fearful or anxious about food.
I believe that one of the MAJOR pieces of the puzzle that most feeding therapists and feeding programs miss is the underlying issue of Neophobia. We can, in most cases, treat the oral/motor, functional or medical issues but STILL our children stay picky or problem eaters. We stand scratching our heads. Why are they not eating? Their tongue moves fine now..etc...etc...the reason is that we never addressed the ANXIETY that resulted from the condition that was treated.
I am exited that my "light bulb" moment came about a year ago when I attended a course entitled Food Chaining. It just made sense to me. I like that the program moved slowly and respected the client's feelings (no matter how young or old). I LOVED that it was FUN and clients seemed to "magically" try new foods once they realized no one was going to ask them to "take a bite" or "try it." I LOVED that it dealt with ALL of the issues surrounding food..most importantly the Neophobia.
Stay tuned for my next blog post for some ideas on how to deal with Neophobia. As always, please feel free to leave your comments and please visit our website and check out our new Skype consultation services for feeding AND speech/language issues.
Until next time...