Learning to find new favorite foods

Who says children don't like to eat spinach? This is one of Ewan's favorite foods--after many years of cinnamon waffles and glass after glass of milk. Proof that Food Chaining definitely takes you places!

A child's advice...

A little advice from my son on trying new foods. Ewan has struggled for many years with eating and expanding his diet. Through a lot of work and Food Chaining principles, Ewan is much more willing to open his mind to trying new things.

Bad Foods or Bad Behaviors?

This past month I have been bombarded with the notion of 'bad foods' and I don't mean 'past the expiration date kind of bad.' My daughter is in dance and at competitions they are banned from bringing 'junk food' with them and can only bring 'healthy' foods. While in theory this looks like a good idea, in practice it falls apart and here's why:

The world will always be full of Twinkies, Ho-Hoes, Ding Dongs, candy bars, pop, and even spam. Unless a nuclear holocaust occurs, we are stuck with some of these ultra tasty and not-so-great food choices. Children growing up today are faced with a plethora of choices that we never had and decisions we were never confronted with. Some of those choices are going to involve food. Rather than banning 'bad foods' entirely, it's our responsibility to teach our children how and when to make which food choices.

A healthy diet is a BALANCED diet, one that will invariably include fruits, vegetables, dairy, meat, grains, and yes, the inevitable and discretionary, Twinkie. A balanced diet also includes exercise--hence the new look to the Food Pyramid today. I encourage everyone to take a look at the MyPyramid website at www.mypyramid.gov and utilize the activities and information there in teaching what a balanced diet really is.

Is it the end of the world if you eat a Twinkie? I've yet to see anyone struck by lightning simply by opening the Twinkie package. Is it wrong to eat a Twinkie 4 times a day? I'm gonna go with yes on that one. So in reality, the food itself isn't 'bad' but rather they way we live with this food can lead to some bad behaviors with food.

If we don't teach our children self-control with the junk food, they won't learn how to live as an adult with it. Because you can restrict every junk food in the world while they are children, but once they hit that independent, college or adult bound life--suddenly the supermarket is filled with temptation. It's like Girls Gone Wild but with food instead of instead of alcohol and flashers.

The task for adults is not to label foods bad or good but rather teach our children how to live with food and teach better behaviors related to food. Learning to balance and control impulsivity for anything in life is a monumental and developmental task for children and young adults. All that good 'frontal lobe' executive functioning activity and decision making ability takes time to develop--and really isn't fully developed till around the age 25. Learning to live a life with food takes time to develop and our job is to guide children and young adults toward independent choices.

I would hope Dance teams and others in the world would learn to say 'Balanced Snacks or Foods' rather than healthy or junk food decisions. Because in reality, we have to learn to live with both. In reality, there are no bad foods, only bad behaviors.

Hunger

I picked up a book today that I find absolutely interesting. The book is Hunger: An Unnatural History by Sharman Apt Russell. I think this quote will speak for the whole of this post:

"Appetite can intertwine with hunger and then separate. You have an appetite for ice cream although you are not really hungry. You may be hungry for food without the appetite for anything specific. Appetite is desire, born of biology, molded by experience and culture.... When appetite and satiety conflict, appetite often wins. We know this whenever we leave the table after that stomach-distending holiday meal. We recognize it in most banana splits. We see it in patients being fed nutrients through a tube; their hunger is abated but their appetite remains, and they will secretly eat solid food even at the risk of pain or vomiting.

Appetite's alter ego is aversion. When aversion and hunger conflict, aversion often wins. We won't eat a breakfast that doesn't appeal to us. We lose weight traveling in a country with unfamiliar food. We pass up the appetizer that has a strange texture or smell...

Like many emotions, aversion can go straight to the stomach. If you once suffered food poisoning after a tuna sandwich, you may reject tuna for a long time. You may feel sick eating something you define as disgusting or morally wrong....Cannibalism is not a common response to hunger or famine. The majority of us will die before we eat human flesh. People with anorexia nervosa are paying more attention to their emotional needs than their body's hunger. Although they may feel hunger acutely, their appetite, their aversion is more important....

To be hungry is to be uncomfortable, and most of us experience hunger in the same ways we experience pain, as a signal to do something" (pgs 24-26).

Now here's the point to ponder: what happens for those that don't feel hunger the same way? What happens for those that don't connect the gnawing pain in the stomach with eating? What happens with those that have no feeling of hunger at all? What of those who cannot understand satiety signals from the body? Do we take into account the child or adult with an eosinophilic disorder that has tasted food, that has an appetite for pizza and ice cream yet those foods can no longer pass their lips? What of the psychological impact?

NASPHGAN 2008

Here is the very talented Cheri Fraker, Mark Fishbein, MD, and Laura Walbert at NASPHGAN talking about their new article:

The Prevalence of Dysphagia in Infantile GERD
Mark Fishbein, MD, Christina Branham, MD, Laura Walbert, CCC/SLP, CLC, Sibyl Cox, RD, LD, CLC, Jenny Mollerud, CCC/SLP, Cheri Fraker, CCC/SLP, CLC

Congrats on a job well done!

What is the child telling us?

Watch the video and think about what the child is telling us about drinking!

Treat with your eyes, heart, and mind

As you can see with the Anew logo, part of what we stand for is looking differently at the complex child. So often, parents, providers, physicians, teachers, and families get stuck on the one track mind. You have a diagnosis for a child and all the sudden that diagnosis begins to explain every facet of the child's life and behavior. Unfortunately, it is rarely that easy to explain anything in life and certainly one word, one diagnosis, cannot explain something so complex as the human child. One of my biggest pet peeves is when someone, anyone, says, "Well you know this child has ___". It is easy, too easy, to lay the blame of every aspect of what you cannot understand or control at the doorstep of the diagnosis. If you find yourself saying this about a child in your care, stop and evaluate the situation. Stop and question. As Cheri Fraker mentioned in the last conference, "Question everything, even what we tell you."

Questioning and digging into the issue is all about complex problem solving. We are all investigators, we are all anthropologists studying and learning from the children we treat and live with. One of my favorite quotes comes from Dr. Oliver Sacks, "So while a single glance may suffice for a clinical diagnosis, if we hope to understand the autistic individual, nothing less than a total biography will do." This of course, applies to all children, not just the autistic child. Truly understanding the child in front of you may take time, may take many conversations with parents and caregivers, may require you to research and network with other professionals and parents, may push you in more ways than you were prepared for in school but you will never regret looking at the child in front of you with your eyes, heart, and mind.

Use your eyes to see what the child sees, get a second set of eyes (or a third and a fourth) by videotaping; use your heart to guide your decisions and be compassionate to the family and their needs; and use your mind to think, question, research, learn more, problem solve, keep an open mind, and know when to ask for help. As Dr. Mark Fishbein stated in our last conference, "Educating our families, our colleagues, and ourselves is the first step." Work as a team, no one person can solve all the problems. Be suspicious of gurus and experts, we all have something to learn--one person cannot know everything. One final word of advice, remember that the person who can teach you the most is the child sitting right in front of you.

I'll leave you with a quote from Kedesdy & Budd (1998): "Many of the issues that complicate research on pediatric feeding problems also make clinical work in the area challenging. The influence of multiple, interacting, etiological variables can produce unique, often puzzling, constellations of clinical features in different children, rendering feeding disorders both intellectually stimulating and humbling to clinicians. Clinical wisdom in this field depends on the continued pursuit of a scientist-practitioner approach, informed by the diverse perspectives of colleagues in multiple disciplines, the personal experience of parents, and mindful observation of the evolving intricacies of child behavior" (382).