Via US News: What Sensory Therapists Can Teach Us About Feeding Picky Kids

Parents of young children commonly commiserate about their kids’ eating habits. Complaints often relate to a child’s exceedingly limited “kid food” diet, rejection of anything green, refusal to try anything new or the explosive mealtime battles that make dinnertime stressful for everyone. I frequently encounter exasperated parents who – convinced they’ve tried everything – come to the conclusion that their child is constitutionally a “picky eater” who is incapable of expanding his horizons.

So I decided to roast-test this hypothesis with two experts in the field of feeding challenging eaters: Jessica Piatak, a pioneering occupational therapist, and Kristina Carraccia, an innovative speech therapist, both at The Center for Discovery, based in New York. Piatak and Carraccia specialize in working with children with severe developmental disabilities, autism spectrum disorders and medical frailties and have developed an approach dubbed “Food Exploration and Discovery,” or “FED” for short. This approach has been used to successfully transition children with severe sensory and behavioral disorders from extremely limited diets comprised of two or three processed foods to varied, nutritious, whole foods-based diets. While some children take longer to transition than others, the duo has yet to meet a “picky eater” whose diet couldn’t be broadened with their gradual, personalized and flexible approach.

Piatak and Carraccia’s FED approach is grounded in a single, fundamental principle: The goal is not to simply get food into a child at any given meal, but rather to reach a point where a child eats because she or he is intrinsically motivated to do so. This is a long-term goal for lifelong behavior change, and as such, may take a long period of time to achieve. Progress is gradual and taken in very incremental steps.

Within two weeks, new residential clients are typically already eating whole food-based versions of their preferred foods, but it can take closer to three to six months until more variety has been added successfully. For clients living at home and attending outpatient feeding therapy, the process often takes longer, as the home environment is less controlled than at the center. There have been cases on both ends of the extreme as well. One client took just ten days to go from 10 foods to 35; another client took closer to two years. But to date, every child has eventually gotten there.

Think the eating habits of your little neophobe – who fears trying anything new – are hopelessly unsalvageable? Piatak and Carraccia beg to differ. With a flexible approach, the right mindset and a lot of patience, you can turn things around at the dinner table. Here are some of their tips to get you started:

Never force a child to touch, taste or eat a food.

Many schools and families employ tactics like having a child take a “no thank you bite” – just a taste, with the promise that if they don’t like it they can say no thank you – or withholding rewards unless a child eats certain dinner foods. These approaches undermine the goal of helping children become comfortable enough to try – and accept – new foods, by placing pressure on them and making mealtimes stressful. Think about how you might feel if, while visiting a foreign country, you were forced to take a no thank you bite of fried insects or calf’s brain! That’s what confronting a plate of unfamiliar greens can feel like to some children – particularly to those on the autism spectrum.

If you’re committed to raising a more varied eater and having harmonious mealtimes, then creating a pressure-free mealtime is essential. To do so, commit to staying on your side of the division of feeding responsibility and resist the urge to force, coerce, bribe or cajole food into your child’s mouth. As the world’s foremost authority on childhood feeding practices, Ellyn Satter, teaches: You decide what to serve and when. Your child gets to decide whether to eat it, and if so, how much.

Set guidelines and expectations for mealtime.

Children can become anxious when they don’t know what to expect, and often do best when routines are predictable. Dinnertime is no different. Kids may worry that there won’t be something they want to eat, or perhaps that they’ll be forced to try something scary. Piatak and Carraccia use various mantras tailored for such situations to help place children at ease. An example of such a mealtime mantra, according to Carraccia, might resemble this: “We sit with our family. If there’s something on your plate you don’t like, you may put it on another plate. You can eat it if you want to, but you don’t have to. Everyone helps clear the table when we’re finished eating.” Repeating these ditties help make mealtime comfortable, and reduces the pressure that can lead to dysfunctional mealtime dynamics.

Encourage children to play with food … away from the table.

Most of the feeding therapy at The Center for Discovery happens nowhere near the dinner table, according to Piatak. Success at the dinner table starts with a variety of play-based desensitization techniques that allow children to become comfortable with the sights, scents, textures and eventually, tastes, of an unfamiliar food in a fun, low-stakes environment. Food play encourages kids to interact with new foods in a non- threatening way with no expectations. As they learn more about the properties of a food, however, they will often get more comfortable licking or even tasting it.

Says Piatak: “We’ll stick food in a toy dump truck. Or we might put shredded veggies on our faces as a beard or mustache and make funny faces in the mirror. Water play is also a favorite – we’ll play with foods in the water and sometimes add bubbles. We’ll teach the kids how to spit food into a bowl, which they usually think is so funny. And once they know they’re allowed to spit out a food, they might be willing to taste it. I might wonder aloud what this food sounds like and let the kids guess; then I’ll challenge Kristina [Carraccia] to crunch louder than me.” Improvisation, adds Carraccia, is key.

Transition gradually and incrementally.

Rome was not built in the day, and it’s unrealistic to expect that your exclusive Goldfish and chicken finger-eating child will transition to quinoa and kale if you go cold turkey. The FED approach meets a new client where he or she is, by learning about his or her preferred foods and brands and trying to replicate them in very subtly modified ways. “We start by presenting other versions of their favorite foods – like maybe organic chicken nuggets or hot dogs – to try and replicate their preferred brand. Or we might mix some different rice into the usual type they accept at home, or switch our cheese for their usual type of cheese on a grilled cheese sandwich,” explains Piatak.

Slowly, the therapists begin incorporating new foods by continuing to make small changes to preferred foods. Perhaps it’s adding a different spice to pizza to change the flavor. Then, pizza on crust becomes pizza on bread, pizza without sauce, pizza with a half teaspoon of protein or vegetables on it. Over time, they might take the bread part out entirely and swap in a turkey burger covered with sauce and cheese. Then the sauce is gone. Then the turkey burger transitions to a veggie burger, or shredded vegetables are incorporated into homemade patties. In the population that Piatak and Carraccia serve, this process is intentionally and often painstakingly slow in order to help desensitize children with strong sensory aversions to new foods. In your home, you may be able to skip a step or two in the process.

Offer the familiar when introducing the new.

Many moms I’ve spoken with are of the opinion that offering a favorite food, such as fries or hot dogs, when trying to introduce a new, healthier food will undermine their chances of success. Surely, if there’s a preferred food offered, then a child has no incentive to try the new food, right? In fact, the opposite is likely true.

Anxiety levels can be high when a child encounters a table full of unfamiliar foods, and the stress may make them retreat into a defiant refusal to try anything. But a child who is assured that there is at least something on the table that she or he can comfortably eat may find the stakes are lower for trying something new. So hot dog night is a great time to introduce a complement like split pea soup, and pizza night is an opportunity to offer a buffet of topping options – from mushrooms and olives to basil and artichokes – that a child can encounter and consider.

Piatak and Carraccia use the familiar to springboard into new foods. If a child loves yogurt, for example, they might dip a broccoli floret in the yogurt and just let him feel the bumps of the floret with his tongue as he licks off the yogurt. Importantly, they counsel patience with the transition. Just because a child doesn’t put the food in his mouth, that doesn’t mean progress isn’t being made simply through the exposure. Each additional encounter desensitizes a child that much more, and as comfort grows, so does willingness to try new foods.

Never trick children into eating something.

Trust is the basis of a feeding relationship – as with any relationship – and you’re violating that trust by, say, sneaking pureed spinach into their brownies or beets into their smoothies. Furthermore, since the goal is to have children eat because they are intrinsically motivated to do so, you achieve nothing by tricking a piece of spinach into their bodies that they didn’t choose to consume on their own volition. What’s that old adage about winning a battle but losing the war? Carraccia explains that they never hide what’s different about the food from a child. “We say: ‘This is pizza with a little bit of broccoli,’ and we never try to deceive. We’re always honest, and we don’t try to mix things in so the child doesn’t know, because this entire process is built on trust.”