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Picky Eating or Something More?

Parents often find figuring out how to feed their children one of the most stressful aspects of raising babies and young children. It is certainly not uncommon for parents to struggle with decisions around breastfeeding vs bottle-feeding. As children get older, parents often worry that their picky toddlers are subsisting on bread and pasta alone and will never eat a green vegetable. Frequently, as children develop and mature, and when parents stay calm at mealtimes and model their own healthy eating-habits, kids will grow into healthy, nourished people who eat a wide-range of nutritious foods.

Mother and daughter eating

For too many families, however, children who struggle with eating are more than just just “picky”: They may have an undiagnosed Pediatric Feeding Disorder. A child who meets the criteria for Pediatric Feeding Disorder cannot eat the types of food or the quantities of food that other kids their age can eat. They may have a medical issue that is interfering with their ability to eat. Children may have difficulties with choking, gagging, or swallowing while eating, may complain of pain, or may vomit following meals. Some children may have feeding-skills challenges. They may have difficulty processing the sensory aspects of food (so food may taste too strong, too bitter, too spicy, or feel too chunky or slimy for example). Other children may have motor coordination difficulties which may get in their way of being able to suck, swallow, bite and chew successfully. Some children feel anxious by the experience of eating. They may throw tantrums during mealtimes or refuse to eat unless certain conditions are met.

Caregivers understandably feel stressed and overwhelmed when trying to ensure their child stays healthy and they are not able to meet their child’s nutritional needs. Too often caregivers are told to use “tough love”- simply don’t accommodate the child and she will eat when she is hungry. For children with a Pediatric Feeding Disorder- that is absolutely untrue. These kids require specialized treatment and parents need to use individualized, positive behavioral strategies to support their children.

Father and son eatingIt is estimated that anywhere from 1 in 23 to 1 in 37 children in the US have a Pediatric Feeding Disorder. This is higher than other well-known conditions such as autism (1 in 54) or cerebral palsy (1 in 323).1 Despite the high frequency of this condition, there is not enough evidence-based treatment available nor enough therapists who feel comfortable treating food-related-issues appropriately.

To support children who are extremely selective eaters or who have a Pediatric Feeding Disorder, Arbor Psychology Group has a multidisciplinary team of specialists available to work with the entire family. Our occupational therapists work directly with children while our psychologists support parents/caregivers to learn how to carry over the strategies learned in the clinic into the home setting. During occupational therapy sessions, children engage in sensory play as they learn to accept the look, feel, smell, and taste of foods. Children learn about the science of food, the reasons for hunger and eating, and why nutrition matters all while exploring foods in a comfortable way and while cooking. Parents learn how to create calm, predictable structure and maintain a positive parent-child relationship while supporting their child’s ability to eat. Our team collaborates with pediatricians, dieticians, and other medical providers for a comprehensive, holistic approach. Our overall goal is to make feeding- and eating- a rewarding, joyful experience! It doesn’t need to be a struggle.


Differentiating the Past from the Present: The Ice Storm as a Traumatic Reminder

Ice storm tree damage

Through-out last week, as I met with parents for therapy sessions, I heard a common theme. The recent ice storms- and subsequent power outages and school closures- had many parents experiencing flashbacks to early pandemic shut-down days. Many parents described being triggered by the school cancellations- and subsequent feelings of isolation- with immediate panicked thoughts of “How long will this last?” “My kids are already driving me crazy.” “How can I get any work done?” “I can’t handle this.”

To be sure, it was a rough time. Anticipated plans were canceled abruptly. Kids, once again, lost out on fun experiences they’d been looking forward to. In addition, many families were struggling to deal with their freezing cold homes and basic survival needs due to the lack of power. Many parents’ intense responses, though, were less about the current hardship and more about all the feelings being stirred up by memories of the past. As a result, these parents felt more than just inconvenienced: they felt more stressed, more hopeless, and more scared about their family’s functioning.

In reflecting back on the repeated comments I was hearing, I realized there may be value in recognizing trauma-triggers from the COVID-19 pandemic and learning ways of managing the present moment.

A trauma is an event or experience that overwhelms our coping capacities. When trauma occurs, memories are encoded in the brain differently than typical memories. Memories of traumatic events are stored as fragments; they are non-linear and disjointed; often comprised of sensations and emotions rather than a clear, coherent narrative.

When our bodies perceive something that unconsciously- or consciously- is connected to a traumatic event- our brains may have difficulty differentiating between the past and present. For example, a person who was in a car accident on a bridge may become anxious or panicky every time they drive near a bridge (even one that looks completely different) in the future.

How does this relate to the recent ice-storm and the pandemic? The COVID-19 pandemic has been experienced vastly differently by various people. Specific communities have been disproportionately impacted. For some individuals, there may be specific, identifiable events that were experienced as traumatic such as the sudden death of a loved one. For many of the parents I work with, it was not one specific event but rather- a series of ongoing, chronic stressors combined with the never-ending uncertainty about the future that had a cumulative negative impact upon their brains.

If your brain perceived chronic threat and was therefore in a perpetual state of feeling endangered- then any reminders of that time period may bring up stress responses that are disproportionate to the current stressor.

This is relevant because it may make the present moment more challenging if your brain can’t distinguish between the past and present. While it was certainly very difficult to have kids home from school multiple days in a row and to not be able to leave the house due to ice on the roads- the challenge was magnified for those whose brain perceived they were in a state of threat and danger.

For some parents- the reminders of no-school, the forced-isolation, and the experience of struggling to get work done while simultaneously providing childcare- signaled to their brains and bodies- “you are at risk,” “you won’t be able to handle this.” Being triggered in this way may have caused a range of trauma responses.

If this was your experience, you may have spent time feeling frozen or foggy, which would have made it difficult to think clearly. You may have experienced a strong desire to run away. You may have been particularly amped up and engaged in more conflict than you do typically. You may have felt your heart pounding or your muscles tense and aching.

In the future, how can you cope when you are triggered by the past?

  • Be curious. When you notice yourself in an aroused state or a shut-down/hopeless/ foggy state- ask yourself, “Am I responding to the current moment or is this about the past?”
  • Be compassionate. Respond to yourself as you would a friend. “Of course it makes sense that you are upset. It is understandable this is hard right now.”
  • Self-soothe. Use a strategy to bring some calm and healing to the present moment. Have a cup of tea, snuggle up in a cozy blanket, light a scented candle, or go take a hot shower.
  • Differentiate the past and the present. Remind yourself how this is different than the past experience. “We are going to be out of school for a few days; not months. This experience has a known/understandable cause and we know how to fix it.”
  • Find hope. Recognize the current moment is limited and look forward to the future. “This moment will not last forever. In a few days things will go back to normal and I am looking forward to _____ over the weekend.”

Being able to differentiate present stressors from past experiences will allow you to respond more calmly and effectively going forward.

Thinking about Inside Out, Our Children’s Emotions, & the New School Year

School Anxiety Pic

My family has gone through a lot of changes this summer. A lot. While many of us don’t like change (it’s hard, uncomfortable, unpredictable) at least as adults we are somewhat prepared for them. We know that the unsettling feeling is temporary. Adjusting takes time. Things will get easier. Etc. My almost four year-old daughter knows none of these things. We have totally uprooted her world by moving across country, leaving beloved friends, her first preschool, and the only home she has ever known.

My daughter is certainly letting us know how she feels. Sometimes it has come through from her behavior (extra tantrums or increased bossiness- “You MUST do as I command!”) but she is verbally expressive, too. Frequently, while we are driving around our new town, I hear her little voice from her car seat in the back. “Momma, I’m sad.” “Momma, I miss California.” Even though I know these words were inevitable (even a good thing- she feels comfortable sharing these feelings with me) – they break my heart. I don’t want her to be sad. I want to fix everything and make it all better. NOW. No parent wants to see their child in pain. We have an innate, instinctual tendency to protect. It is what keeps our species alive. (more…)

Trigger Questions

I’ve been thinking and talking and reading and listening a lot about “trigger questions” lately. I think of trigger questions as questions that probably seem innocuous to the asker but that trigger some feeling in us that makes us feel hurt or offended or defensive.

“Is he sleeping through the night?”

“Is she walking yet?”

“When will you go back to work?”

“When’s the next baby coming along?”

“Do you rent or own your home?”