Over the years, and especially since I have been dealing with more picky eaters, I've learned that it's the little things we do that add up to the bigger things/successes in the end.

When families are used to a struggle with eating at mealtimes, they naturally lose the "social" experience of the time together.  Many times, parents have tried so many different methods to get their child to eat that I see some pretty extreme things and really, who can blame them?  Having a child that won't eat, isn't gaining weight and has terrible behaviors at mealtimes is a scary, scary thing.   What I almost never see with my families though is a family mealtime.  There isn't one. Everyone is eating separately,  while running around the house or while sitting on mom's lap (but mom isn't eating).  There isn't a structured time to sit down and enjoy family time.

Often, before we ever begin to address the "food" issue I suggest the following changes for the family:

• Turn off the T.V and sit at the table as a family.
  
• Have the child help set the table. Even toddlers can help with this task and it's a great language activity to boot!
• Provide child sized, divided plates for children up to 7 years old. I don't know about you, but I don't like certain foods to touch....gravy in my watermelon? No thank you. :)
• Begin your meal with some routine. At my house, we say a prayer and then share one thing from our day. I always find it funny that if we say the prayer and "dig in" my 15 year old son is often the one who says "we forgot to share something."  He has become used to this time to share things over the years and even if it is just a time for him to vent  (more than I'd like lately) it's part of his routine and he expects it. Find what works for your family. Maybe it is a word of the day, rhyme of the day, a song...the possibilities are endless.
• Keep portion sizes in check! Did you know that a portion size for a child up to 7 years of age is 1 Tablespoon per year of age?  You are right if you think this seems like a small amount but when you realize that your child's stomach is only the size of their fist, you begin to realize how much we GROSSLY over serve ourselves. It's also much less visually intimidating to see only 1T of a food rather than 3 or 4 T of it when you are anxious about food in the first place.
  
• Don't talk about what your child is or isn't eating.  Enjoy the family time. Talk about your day, talk about the food but say things like "boy, these strawberries are so sweet tonight" and whatever you do, don't follow that up with "you should try a bite. Do you want a bite? or Take a bite." :)  Just leave it at that and move on to something else.
• End the meal with EVERYONE helping to clear the table. EVERYONE. This signals the end of the meal and helps to provide the child with a routine that will eventually help them to transition FROM the table and TO the table when it is meal or snack time. 
  

Start with these small changes, which might seem to be BIG changes for your family at first, a little at a time and see what happens.  Mealtime WILL become more relaxed and something to look forward to IF you keep the focus off of the FOOD and more on enjoying the family time together.

As always, I welcome your comments. I would love to hear about YOUR family mealtime routines. Stay tuned for more ideas.

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...