Ep 326: Overcoming ARFID and Pediatric Feeding Issues with Melanie Potock, MA, CCC-SLP

Hi and welcome to episode 326 of the Untethered Podcast. Today we have Melanie Potok joining us. Melanie is a pediatric feeding therapist, international speaker and certified speech language pathologist with over two decades of experience helping children and families establish healthy relationships with food. Known as coachmel on Instagram ymunchbugmelannie Potok, she is the author of six books including the award winning Raising a Healthy Happy Eater and Responsive Feeding. A sought after expert in both typical and complex feeding development, Melannie combines evidence based strategies with real life parenting insights. Her guidance has been featured on over 50 media outlets including CNN and the New York Times. Certified by ASHA and The recipient of Asha's 2024 State Clinical Achievement Award, Melania has also received eight ACE Awards for Excellence in continuing Education and provides training for healthcare professionals worldwide.

Welcome to the Untethered Podcast. I am your host, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collab with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, airway tether, dural tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest posture.

Tongue up, lips closed, teeth apart, breathe through your nose. Let's get started.

Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider.

Hi Melanie. Welcome back to the podcast.

Thank you. Hi.

I'm excited to have you back on. It's always a pleasure.

Thank you. And likewise, I was excited to get that nice email from you saying you want to do this again. Yes. Yeah, let's do it again. I love it.

I love it. So I am excited to chat today because I feel like I am not an ARFID expert and I know we're going to dive into that topic today. But first, before we even get there, I would love for you, as an expert in this space, to talk to us a bit about this interplay that exists between anxiety and picky eating. Can we start there?

Absolutely. Absolutely. And this is the way I explain it to parents who come to me who have children with avoidant restrictive food intake disorder or arfid, and that they will often just search on the term picky eating. Yet we know as professionals that ARFID is not picky eating. But what's easier to visualize, I think, especially for someone who is in the trenches trying to help a child with extreme picky eating or arfid, is to think about picky eating as if it were a spectrum. So all of us, I would imagine you with your kids and me with my two girls, even though we are pediatric feeding specialists, we run into that picky eating stage. It is a natural phase that a lot of kids go through between about 18 months to age 3 and it is almost to be expected a few kids skirt right by it. But the majority of kids do have a picky eating phase. When you think about those kids, I want you to think about those on the very left hand side of this spectrum that I'm going to try to describe to your listeners. And then on the very, very, very far right hand reaches of that spectrum would be avoidant restrictive food intake disorder. Again, full disclaimer, it's not picky eating, but we're talking about the spectrum of anxiety as well here. So I, Hallie, I have never met, in my 25 plus years of doing this, I've never met a garden variety picky eater who didn't at least have some element of anxiety. Because when you're hesitant to do anything, naturally there's going to be a smidge of anxiety there. But the strategies that we use for those, as I say, garden variety picky eaters that we see so often in the preschool years are not the same as the strategies that we'll be using for a child with ARFID or even with pediatric feeding disorder at first. And I know we're going to chat more about that. So getting back to our spectrum of anxiety, our spectrum of picky eating, on the left hand side, you've got garden variety picky eating. We've all seen it. They don't need feeding therapy, they're just picky. Right? They need some strategies to just move through that natural phase of hesitancy. But they are a tiny, tiny, tiny bit anxious in the same way that I'm anxious to ski down a really steep hill right in the Colorado snowstorm. Even if you're a really good skier, you're a little bit hesitant. Think you've got the idea now, as we start to move toward the right hand side, not only does the child become more picky and we start to morph into pediatric feeding disorder, which you're an expert in. But then if we keep going, we move into arfid. And the difference between everything on the left hand side of the spectrum and what's happening at the far right is that with arfid, anxiety is the major culprit. Is there maybe a little bit of challenge around chewing certain foods? Sure, because they've only had five foods in their life because they're scared to death to try a new one. But it's not to the same degree that we might see in pediatric feeding disorder, where it's a true oral motor dysfunction. So I guess if I were going to ask your listeners to think about the term avoidant restrictive food intake disorder, there's one word I want them to remember and that's avoidant. These kids have such extreme anxiety that they are experts at avoiding what they think makes them feel anxious. And that's the challenge helping these kids.

It's fascinating too. I mean, I've seen, there's this one little girl, this account that I've seen where she tries new foods and she does it on video and yeah, you.

Know, I know who, you know, know her mom really well. Yeah.

And it's, you know, you, you watch her and you're like, I mean, it's very interesting to see all the emotions that she goes through and how truly stressful it is to try something new, but also how brave she can be in trying something new too. Was very eye opening to me because, you know, sometimes she almost is physically ill over trying certain things. And so can you speak a little bit just to maybe some of the presentation that, you know, you might see with a child because, and I say this because I think sometimes we will have children come in and sometimes they may not like something. Occasionally they may gag, maybe even vomit. But that's more extreme than, you know, than usual. Usually we'll get a lot of these kids with these sensory, oral motor challenges where a lot of times they don't have the motor skills and they haven't built the sensory profile needed maybe to support, you know, their experience with a certain food. But I just thought it was her experience because it didn't appear to be, like you said, it didn't appear to be motor based. It really appeared to be more anxiety, maybe even sensory, I don't know, like. So I'm just curious to know, like, what you see as some of the more key characteristics, if you will, aside from the avoidance factor and the anxiety.

Yeah, no, I'm glad you're asking that because I think it'll surprise you, you know? Yes. Extreme anxiety can look like tears. Crying, shaking, really, really, really scared. We all know what that looks like in a kiddo. But anxiety can also look like acting distracted. Great example is on telehealth. The other day, I was doing a telehealth treatment session with an older kiddo, and I said, so how did food homework go this week? You know, the big smile and he just looks up at the ceiling and he goes, mom, how did my food homework go this week? And he isn't even looking in the camera. That can be anxiety.

Yeah.

I don't want to look at you because I didn't do my food homework. And if I have to think about the fact that you wanted me to try cheese this week, I think I might just gag right here on screen. Like, those are the thoughts that are going through their head. Those. Those very anxious. What if. What if she asked me to try that now and I didn't really practice it all week? What if I have to talk about that food and it literally makes me break out in hive to just talk about it? Yeah. So it can look like distraction. It can also look like angry outbursts. You know, we all know that kids tend to shout at their parents or their loved one because that's a safe place, place to let those emotions out.

Yes.

And they will sometimes do that with me. But they often try very hard to be that. That good kid in the classroom who just seems like the perfect kid, but then loses it when they get home because they've been holding it all together. That's an anxious kid. But I do also want to take it one more step further to say one of the things that I see in my clients with avoidant restrictive food intake disorder are true anxiety disorders. Now, keep in mind, ARFID is not an anxiety disorder. It's a feeding or eating disturbance in the DSM 5. But up to this is the numbers we have so far. Up to 50% of children with ARFID or also have a concomitant anxiety disorder. And in general, the ones that I see are generalized anxiety disorder. Just overall feelings of what if all the time, those worried, worried thoughts. Although panic disorder is its own thing in the DSM 5, I do see it's not unusual for me to see kids with panic disorder. And in that case, that's where those kids are having trouble breathing. They're feeling like they're going to choke. They start to shake. They can't breathe. They honestly feel like they Might die. So if food is put in front of them and that tends to trigger a panic attack. Think about it. If you were a parent of a child like that, I wouldn't be serving new foods to them. Yeah, I'd be scared to death they're gonna have a panic attack.

Yeah.

So we get into this sort of vicious cycle of not only the child's anxiety that you're asking about, but also the parents anxiety around what the child might encounter and experience if everything doesn't go well. So those are just a few examples. But yeah, anxiety is the biggest culprit and, and that often will spread to the parents as well. Because I know I'd be anxious if I had a kiddo who was in that level of discomfort over anxiety around food.

Yeah, you mentioned the parents a couple of times and my brain just started going. Right. Because I know when we're talking about like anxiety and maybe pediatric feeding disorders. Right. It's complex. Right. They're all complex. But there's definitely that child focused anxiety like that you've talked about where maybe there's some fear based responses or you know, food refusals, maybe they're choking, vomiting, gagging, maybe sometimes some kids will get headaches or stomach aches or something. Right. But then there's that parent focused anxiety too. And that's where I think, you know, I spend more of my time. I think educating is on the parent focused anxiety as, as it relates to pediatric feeding disorders, to pfd. So because, you know, I think that sometimes we'll get parents who are overly anxious and rightly so, but then maybe they're trying to force feed, they're trying to control the situation more and it's just not, honestly, it's just not helping. Right. Maybe they didn't cause the issue, but they don't really know how to help their child either. And so with that increased tension and stress and everything, I think that, that we spend a lot of time just trying to educate so we can help everybody kind of have a, have more central. Not central, but more a calmer nervous system. So everybody's set up for success. So I guess I'm curious to know, you know, are there certain ways or certain conversations that you have with parents, certain ways that you work with them with children with arfid, especially when there is a also concomitant anxiety disorder at play? Because this just sounds very complex.

It is very complex. And especially for my, well, definitely with my kids with arfid, we want to have a psychologist or a social worker involved at Some level. And if I possibly can, I'd like the parents to be really active in those treatment sessions with that health professional. But you know, you and I know that parents are so busy, they often have trouble finding time to take care of themselves.

Yeah.

And so two, two answers to your question. When I'm mentoring other therapists, one of the ones, one of the things I want them to remember because I didn't think of this when I was a younger, less experienced therapist, is we really need to support the caregiver as well. And as we start to gain their trust through building a relationship, finding out do they have someone that they can talk to and maybe that person they talk to honestly is the other moms at the bus stop after the kids get on the bus. And you know how we all stand there drinking our coffee for an hour, we all done that. Maybe that's their release. Maybe it's the pastor at their church, maybe it's a professional who is in the realm of psychology, a social worker, etc. But trying to find out, do they have someone who supports them in that way? And if not, is there a way that we can help them find that person, even via telehealth? However, there's also the role that you and I play in helping them learn what they do to decrease their anxiety that may be impacting their child's journey to more adventurous eating. So you brought up great example. It's not unusual for us to see a parent, I hate to use the word force because they don't mean it in a forceful way, but like getting food into that kid's mouth any way they can because that kid's got to eat. Yeah. But also when that food goes in that child's mouth, you know what it does? It decreases the parents anxiety. So it's very reinforcing. Not only is that kid getting nutrition in their belly, but every time they see that kid swallow, their anxiety goes down. The parents anxiety goes down a little bit.

Yeah.

And so it's very tempting to keep doing it because it makes them feel better.

Right.

And when we get to the stage where even a child in pediatric feet with pediatric feeding disorder, but especially in Arfid, when that child is to a place where they are able to make the decision to fork that food and put it in their mouth on their own, you gotta sit on your hands, gotta look the other way and talk to your husband about the weather. Yeah. You can't, you can't project your own anxiety. Are they going to do it onto that child? And that Takes your best Academy Award performance. You know, like, you gotta. You're gonna win an Oscar here. Model calm. Make sure you have a pleasant look on your face, even if the pit of your stomach is in knots. Are they gonna eat it or not? And just exude that energy that it's their decision if they eat it. And, man, is that hard because that makes your anxiety go up instead of when the food goes in their mouth, making the anxiety go down for the parent. So you're right. It's very, very complex. And there have been some. A little bit of research around parents who have kids with special needs, with arfid, et cetera, different studies where their level of anxiety is. And of course, it's just kind of common sense. But of course they have a higher rate of anxiety and anxiety disorders, I should say. Of course they do. This is really challenging.

Yeah, yeah. No, as. And as you were saying that, I was thinking about, you know, children who are autistic. Right. So autistic individuals sometimes will talk about their experiences with foods and this. But it's interesting to listen to adults talk about it and older children, too. But you can see it. You can see it in the younger ones and how that sensory. Whether it's sensory, motor, or whatever's going on, there's generally a lot of anxiety around food expansion beyond our safe foods. And these children are actually why I got into feeding the way that I did, because I saw patterns and I was like, oh, okay, this is fascinating. This child is not available for speech language today because he's constipated. He's withholding a bowel movement, and he also tends to eat these beige foods that don't have a ton of fiber and they don't have a lot of nutrients. And no wonder you're constantly uncomfortable, gassy, constipated and uncomfortable.

Right.

And who feels.

I. I wouldn't want to eat either.

Right. It's like, who wants to eat then? And who wants to participate in educational activities when you don't feel good? And that really kind of threw me through a loop because I started to learn about the gut brain connection and the GAPS diet and all these other things. And this was, you know, a while back now, but it really just opened my eyes to a lot of what was going on with them. And I think a lot of these kids also were demonstrating some anxiety sometimes. And, you know, sometimes if we. If we get down on the floor and we spin something, it calms our nervous system and we feel regulated. And I would get down on the floor And I would do that with them. And they kind of look over at me and make a connection and go, oh, like, she gets me. Okay.

Right.

And so I think that really turned my brain on in a very different way than I was ever taught in grad school, where just kind of went, like, meet these kids where they are, you know, and if we can apply that across any of the therapy that we're doing, like, yes, we're going to provide some challenges. That's why you're here. But you have to feel safe. Right? And so, you know, teachers do.

Yeah.

You know, and so I just, I just, my brain just goes back to, how do we help you feel safe? So you can take those, you know, those next steps. You can take a fear based, you can move into something that feels more challenging and then have the energy within you and the, the tools within you to even make the decision to do that and to maybe successfully or to be successful at it. Right.

I, I, I really, really want your audience to hear what you just said. That that is everything right there. That, that yes, we always want to look at the whole child and frankly the whole family and be respectful of where they are. Not even in that day of therapy, but maybe even that moment of therapy. But they are there with our love and support to be challenged. Or they wouldn't, they would just do it on their own. And they're scared. They're really scared. But that doesn't mean that we wait for them not to be scared to go to the next step. What we do is we help them regulate and get to a mental place, an emotional place where they're still scared, but they can do it. I can do this. I got this. I'm scared. I might even be tearing up a little bit. Again, I'm going to use my skiing analogy. It's same way that if I've never been helliskiing before, so if I went hell skiing the first time, and I'm a really good skier, I might get a little scared, you know, But I still, like, I can do it with someone to guide me through it. That's the kind of relationship that we're trying to build here, that we can freely talk about our anxiety, we can freely talk about how hard this is for us, but we can also do it anyway. And so when I'm talking to parents, what I want them to understand is I'm never going to shove your kid into doing this. That would just be A, wrong and B, cruel. But what I am going to do is help them feel the feeling and do it anyway. And it might just be touching that carrot today. I don't know if we're going to get to eating it. I'm going to try to listen to your child and read their cues, see how much they can do during this particular lesson and then we'll build from there. But usually what happens is, is they're really scared. They do a little bit. We hang out in that happy place for a very, very short time. And then I nudge again. And every time they are scared and then have this moment of I did it, that builds and they get more and more confident until they get to a place where they say, you know what? My anxiety is really high today. But that's just my anxiety. It's not the food. And I love that. I love it. When we get to that moment, we all have anxiety. It's there to keep us safe. But when you have arfid, anxiety doesn't tell you the truth. That's the issue. The anxiety has gotten so loud and opinionated that it rarely tells you the truth. And it gets loud and opinionated and stronger and stronger every time we avoid what scares us. That's why it's called avoidant restrictive food intake disorder. It's more about treating avoidance than it is anxiety.

Yeah, well, and I love that you were like, this is the key. When we talked about like kind of the interplay. We talked about how anxiety interplays with picky eating and with pediatric feeding disorders and now even like with arfid. And I like that you highlighted that whole like avoidance we are avoiding because I think that is a really, I mean, obviously it's in the name, so that's helpful. But I think that's such a key thing for people who maybe are either new to this or who just really haven't grasp the difference between like ARFID versus a pediatric feeding disorder or a severe, you know, it's more severe chronic type of feeding disorder. But I think that really helps to highlight major differences between.

Yeah. And also just recognizing that, you know, if you're working with a 6 year old, 6 year olds sometimes tear up. Yeah, I mean, I tear up over stuff really easily. And it's okay to be a little scared about this. It doesn't mean we're necessarily still going do it. I'm not saying we're going to make a kid do anything. We're not. But I think we all have to get used to the fact that this truly is scary for these kids and therapy is not about making sure they Never tear up. Therapy is about holding their hand and loving them through it in a compassionate manner so that when they feel those big feelings, they recognize it's okay to feel this way. It's okay to be scared about this. And Melanie is never going to make me do anything. But she also is here, right here with me when I'm ready to take that next step. That's what, you know, I think we spend too much time making sure that kids don't seem upset. And it's like they're allowed to be upset. This is scary for them. And every time we back off too much. And it's an art. It's an art we're actually helping them avoid and only making them more scared because anxiety feeds on avoidance. So that's, you know, that's one of the reasons I teach so many courses in this is it. Again, it's an art. And I do make mistakes. We all do in therapy. But I think what makes a really good therapist is being able to reflect on what worked for that individual child and what didn't work and where you should make the shift. Yeah, absolutely. You know, you mentioned kids with autism.

Yeah.

And I think it's so easy. I heard this for so many years from very well meaning pediatricians. Well, all kids with autism are picky. Like it just goes with it. And then I don't get those kids to like nine or 10, and then they're diagnosed with ARFID because it's seen more as an anxiety disorder. But maybe they actually had pediatric feeding disorder and they missed that little window of time and early intervention where we should have addressed it. Yeah. And you know, now they are only drinking from a bottle and eating some meltable foods. So it looks like arfid, but in actuality it's pediatric feeding disorder. Yeah. And I want to make it really clear to everyone that don't get too stressed out if you have kids on your caseload or parents if you have a kiddo who you just love so much in your family. And it turns out they get the PFD diagnosis from an OT or an SLP and they get the ARFID diagnosis from a psychologist because they. We diagnose in different manuals from different manuals. Excuse me, that's going to happen for a while till we tease all this out. But it's okay as long as we understand the spectrum of anxiety. And kids with arfid. Excuse me, Kids with. Well, yes, with arfid, but also kids with autism, the research shows they have a higher, a higher risk of developing an anxiety disorder.

Makes sense. I think I saw like, it's as high as 40 to 60% of children and adolescents on the spectrum have occurring.

Anxiety because they're sensory challenges which are higher than the world in such a different way. So. And we are still learning about how to support them in a world that is designed for you and me, right?

Yeah, absolutely. So are there. Do you find that you use different strategies when talking about, like, anxiety in a child who is. Well, we talked about picky eating, and that's usually more of a phase, but like a child with PFD versus ARFID versus autism. Right. Are you finding that you use different strategies or do you feel like there's a lot of overlap between your approach and, you know, I see you nodding your head.

Well, there's a lot of overlap, yeah. But, you know, in my experience, I see more kids with PFD in the younger years, like for four and under and with those kids or even for anyone listening, if you happen to have a picky eater who's in that preschool stage of picky eating, what I really focus on there is exposures and exposures that are fun. You know, the best math teachers exposed kids to math in a variety of ways. It's not just worksheets. They make math fun and they make it very real life and practical. So kids are like, yeah, this is cool. And they learn to love math. I think feeding therapy should be the same way that it's still about exposures. But it's not that we're necessarily going to start with new foods on the plate. We might start with gardening. We might start with a trip to the grocery store. We might start with food play. We might jump right to new foods on the plate. Depends on where the kid is in terms of their skill and their anxiety. But no matter where we are on that ladder of exposures, we keep them very small. I always say think tiny, tiny, tiny little plastic tasting spoons so that when you're cooking together, you get the tiniest taste on your tongue. Tiny little tools for tiny little hands. Also tiny responses. You know, we talked about the role of the parent. Such an important thing to share with the parent. I don't want to see a lot of, yay, you ate it. The kids hate that. I want to see tiny responses. I know. Cool. It's kind of salty. Ridiculously calm, right? Love it. But with my kids with more significant anxiety, whether it's with PFD or whether it's with autism or whether it's with arfid, I still start tiny, for sure, even with my teenage kids. But the difference is I probably nudge them a little more often than I do the younger kids. And that's because I can talk about it with them and we can talk about anxiety and we can talk about why we still need to do this. And even though it's hard. And I love that part of this because they can teach me so much, especially when they're involved with a psychologist or a social worker who specializes in pediatric anxiety. See, their role is to address the anxiety. My role is to help them get through the process, the developmental process of learning to love a bunch of new foods. But then we overlap and we teach each other. I teach the psychologist, the social worker, why starting with an apple is maybe not a good idea. Let's start with applesauce, right? Or a little matchstick slice of apple that not every kid could bite right into an apple if he's never experienced an apple. But they may not know that because they don't get that education. You and I know about feeding and swallowing. But I firmly believe, and Hallie, I know you've heard me say this before, I firmly believe that every SLP and OT has a responsibility to learn as much as they can about anxiety and the role it plays in feeding development. Because we still have to recognize and know how to support, yes, challenges around anxiety, even if we aren't the primary person that treats it. When people tell me that this is like my pet peeve. When people tell me that SLPs and OTs don't treat ARFID, that is just an overgeneralization. That's like saying a psychologist doesn't treat pediatric feeding disorder. There are plenty of psychologists who are pulled in to help with family. Who's having challenges with a child who has pediatric feeding disorder. Maybe they don't treat that diagnosis per se, but they're part of the transdisciplinary treatment team, as are we. And I think we should be there from the start until the very end.

Well, I mean, I love what you're saying.

I really feel strongly about that.

Yeah, no, I love what you're saying because I think I'm a very root cause practitioner. Right. And so this really gets to the fact that there is an emotional root. Right. And so if we're putting the anxiety first and we're not just writing it off to behaviors, which I really, I really hate when people say, oh, there's these behaviors. Well, the behaviors are secondary to something else. There is a root behind. Right. There's an antecedent to the behavior. If you ever learn the ABCs of this. Right, we know that. So, okay, great. There's a behavior that's a communication to us that we need to dig deeper. And so, you know, I see these children with pediatric feeding disorders that have these food related anxieties and sometimes, you know, to your point, it might come from past trauma, medical issues they've had. Maybe there's a sensory overwhelm, like, who knows? But we can't ignore that. Otherwise we're not, we're not engaging in pediatric feeding treatment. It's, you know, you can't ignore that.

I literally have goosebumps because you have brought up such a good point. You know, I work with so many kids with ARFID now and you've known me for a long time. Started out more in the pediatrician feeding disorder realm, but definitely heavy into arfit. And you're absolutely right and that it ARFID didn't exist. We would be doing those families and those kids a disservice if we didn't educate ourselves around the anxiety piece because that's how we started out this conversation. Is that even just a garden variety hesitant eater has a smidge of anxiety. And you've got to know what is typical adaptive anxiety that we all ought to have to keep ourselves safe and what's disordered anxiety. Just like SLPs need to know about sensory processing. Like we still learn about that, but the OTs are the captains of the ship around that. Right. So we absolutely treat kids with arfid.

Yeah, yeah. And I think, you know, and anything we do, I think we're constantly talking to the child too. So a lot of us may, maybe we just need to look at what we're already doing because I think some of us may be like, hey, this might feel a little scary. That's okay. It's okay to have that feeling. Right. And kind of reinforcing acknowledging that they're having this fear of this feeling. And I think we do that a lot as therapists and I'm not sure if people recognize that that's actually a strategy that we can use to acknowledge. Right. And I've seen people use different emotion scales in therapy and I think that can be applied and, and then to the parent piece.

Deep breathing is another strategy that we've used for years. And yet it's also about anxiety. We read books with children about feelings and emotions and there's so many books that are about the, what I call the anxiety monster, you know, and how to tackle the anxiety monster that has that appropriate language for kids. We've been doing that kind of stuff for years. But that's all part of this same treatment around anxiety. Yeah. So, yeah, fully recognize that a psychologist or a social worker, they are the people who are going to diagnose arfid. Yes. But I, I have so many psychologists and social workers and mental health professionals who take my ARFID masterclass. It's a four hour course. And what I stress to them is you need an SLP and an OT there from the very beginning so that you work together. And what I stress to the SLPs and OTs and the feeding specialists is do your very best to get a psychologist or social worker on board. They may not have to be involved weekly, but they should be a part of the team. And it does take time to get on their caseload. We know that. But that doesn't mean that you can't get started with some of these basics that you and I have just been talking about.

Yeah. And I mean, I think it's, you know, back to kind of what we were saying too. One of the big things I think I've done in therapy, regardless of whether we're using food or not and whatever it is, it's helping parents co regulate with the child or removing them from the situation until they can. At times we've had moms step out of the room and so she can see the child have success. And then it feels a little bit easier to learn how to co regulate. But really just I talk. And this came from, I think my myo, like my deep dive into the myofunctional therapy world and airway. You were talking about breathing, but regulating our nervous system, which helps us to kind of lower the threshold. Right. For whatever thing. We may have some. We may be going. I got a little bit of an intolerance to whatever this thing is that you're putting in front of me. Whether it's a game, it's working on speech, it's a food. You know, as soon as we enter that fight or flight, we shut down. And so if we can stay in what like I know Autumn and I like to call rest and digest. Right. If we can kind of stay in this rest and digest or bring them back to this like rest and digest. This calm state of being. It just really helps everybody go like, oh, absolutely, I'm more ready for this. Yeah.

And breathing, you mentioned breathing, partner, what we do, Such a big part of what we do. Yeah, absolutely.

Yeah. And sometimes we'll use calming mantras too. With some kids, you know, I can do hard things or I can try new things. I am safe. Right. And it's, you know, almost like talking to your subconscious self. And, and until you believe it, until the breath matches what we're saying, until we feel like, okay, I really can do this. So I love this because I just, I think it's such a uncommon conversation, but one that we need to be having more of to be giving strategies to therapists. Regardless of, you know, who you're working with, it's really helpful to know how to help any child or adult regulate.

Their nervous system a hundred percent. Yeah. Yeah. Wow.

I know, I know. So obviously, and I don't know, you tell me if there's anything else we haven't covered that you want to dive into. But I wanted to give you a moment to share with us, you know, your resources because you've mentioned your courses. So if they're like, okay, Melanie, where, where are these courses? Tell them where they can find you.

Thank you. Well, my website and I know you'll have it in the show notes too, but it's my munched up, excuse me. Mymunchbug.com or melaniepotok.com same thing. And under all my on demand courses there are 10 of them. The one I think I'd like to point out to everyone I've mentioned my ARFID masterclass, but my the one I think that this audience will find most helpful because I it's really on topic for all of the great points that you brought up that I didn't know you were going to bring up those points. I'm just sitting here grinning because it's like I just every time I talk to you, we think so much alike. It's so fun. I have a brand new course that's called Arid Autism and anxiety. The triad that's not just picky eating and it's a lot of what we've been talking about and three and a half hours more. But what is a especially important for me to share with your audience is that it also includes an SLP who I think so highly of and she is a parenting expert and certified in parenting effectiveness training and she often speaks with me when I do bigger events. She graciously included an hour, hour and a half of her wisdom in this three hour course so that parents do get these strategies about not feeding in to the anxiety monster and how to support their child and what anxiety looks like and how we can be compassionate yet loving guides through all of this. So I would say that if there were one course that fits beautifully into our conversation, it's my arfid. Anxiety. Excuse me? Arfid, Autism and anxiety. The triad that's not picky eating. So I hope your audience will find that one helpful.

Oh, for sure. I mean, it's when you really start to talk about it and the interplay between these things. You know, I think people kind of, as many of us are taught, we silo these topics, right? There's arfid.

Yeah.

There's pfd, there's autism, there's anxiety. And I don't think that people really realize how much of an interplay there is amongst, you know, interwoven into all of these diagnoses. And so I love that you're kind of pulling it together for everybody because I think one, it's totally needed to, you know, I've also, collaboration is a big, big thing that I'm always preaching. And so anytime we can bring other professionals in that are going to be supportive to that child and that family that we're working with, I think it's so critical for people to understand who needs to be on that team and who's going to best serve this child based on their presentation. So again, I love that you're, you're highlighting that as well because, you know, I can't tell you how many times people come to me and go, well, who else should we be talking to? Or who else do I need to reach out to? Or where else should we refer this child? And so just, you know, hearing from.

Other professionals and recognizing that that list could be 10 more professionals long, 20 long, that we've only mentioned a few here, sort of the key players. But naturally there's registered dietitians who are just invaluable. There are gastroenterologists, ENTs, airway centric dentists. I mean, the list could go on and on. So I want to make sure that your audience recognizes that we fully see that this transdisciplinary treatment can involve a lot of different professionals with a lot of different overlap. But for the sake of this conversation today, the mental health worker and the SLP or OT are the key players for what we talked about right now. Yeah.

Well, this has been amazing, Melanie. I know we could talk all day long, but we're going to direct them to your course. So thank you so much for joining me. As always. Thank you. This is so much fun.

It's so, I, I, I love talking to you. And you're right. Could we just keep going for the next three hours. Let me grab a glass of wine. Totally.

I'm sure everybody would love that.

But I think we probably have to say goodbye. Thank you Hallie.

Thank you Mel.

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