Episode 44: They Are NOT Just A “Picky Eater”

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. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses. Let's get started. Hi and welcome to episode 44 of the Untethered Podcast. Today we are talking about one of the things that I hear so often but that I want to dispel. A myth if you will. Kids are not just picky eaters, right? And we'll talk about when maybe they are, but most of the time they are not. So it is time to stop giving kids a complex over their eating. But first I want to remind you that if you are listening to this live on March 23rd, doors to our course feed. The peds is closing at 12 noon EDT today, so the middle of the day, 12 noon EDT. So if you want to get in, if you forgot to sign up, go ahead and grab your seat now. We still have a few left. And there is also a bonus for people who join in the last 24 hours that we're going to give you because we were begged and asked if we would share the case study that we gave to everybody who signed up in the first 24 hours. So we're going to do that. You're going to get that bonus as well. But you have to. That's a close cart bonus if you sign up in the last 20, 24 hours. And we are coming down to the wire there, so be sure you jump in feedthepedes.com if you want to get more information about our 12 week course. All right, so back on our topic of Kids are not just picky eaters. I hear it all the time. I hear parents when they call and they talk to us, they say, you know, maybe if you are a parent you feel this way too because you don't really know any differently. And this is just what it seems like. They're so picky, they're so stubborn. Oh, they're just lazy when it comes to eating or they just don't Want to do it. Eating. Their eating is just. It's behavioral. I need a therapist who does behavioral feeding. You know, you guys don't sound like you do behavioral feeding. You sound like you're doing what we don't need. I've heard people say, like, actually, I heard one person say that to me, and they said they were going to go with somebody else because they were more behaviorally based on. To break it to you. But every therapist is behaviorally based in the sense that we have to work through behaviors before we can get a goal achieved or addressed. I should say to then achieve it. But also, I've also heard kids be called mean names. I've heard parents make up nicknames or mean names surrounding their children not eating. And so what I want to encourage is that we realize that something greater could be going on and step away from that so that we are not giving our kids a complex and so that those people who are working with your child are able to better address the issues without extra barriers or layers of the onion, if you will. So you know it. These names are being. These names are not so nice, right? And they're being assigned to a child because parents are thinking they're lazy or stubborn or picky or behavioral or whatever. And this is all over selecting eating. And that is what it is. It's selective eating. They're selective in the foods they will eat. And there's a reason for that, right? There's an underlying reason for their selective eating. And a lot of people, especially parents who are not familiar with eating challenges, are not aware of this. So that's what I'm hoping to educate on a little bit today. Because I can promise you your child is not being picky to piss you off. They're not being picky to make you have to make them a peanut butter sandwich to carry around in your purse to every restaurant you go to. They're not being picky so that you can't go to family meals at someone else's house with friends or family. They're not being picky so that you can't enjoy your holiday meal on Thanksgiving or whatever. You know, there's a reason that they're responding this way. Okay. And I can personally count on one hand the number of kids that I've treated where behavior was the primary driver. It is rare, and I believe it was Dr. Toomey who cited a study. I'll see if I can find it. That demonstrated less than 5% of kids are truly behavioral feeding cases. And if anybody has that study and you want to go ahead and send it to me. That would be super helpful, too, because trying to locate things from the past can be challenging sometimes. But let's break this down further. So first, please realize that children are inherently good. They aim to please. Like, they don't want you to be upset with them. So let that sink in for a moment. Really, like, let, like, stop and think about that. Your child actually wants to be good. They actually want to please you, right? So let's pick apart the behavior question first. Is it really a feeding problem or is it just behavior? Is it just behavioral? Children crave attention, right? And so they'll respond to whatever gets them the most attention, whether it's a positive thing or a negative thing. Like, even if you're punishing them and putting them in timeout, but that's the only way for them to get your attention and get you off your phone or get you away from your work or get you away from whatever you're doing to give them attention. Guess what they're going to repeat? They're going to keep repeating the thing that gets them into timeout, right? So they don't differentiate between positive and negative types of reinforcement. It's still reinforcement. They are still getting reinforced for that behavior, whether it's good or bad. And so the behavior is serving a purpose, right? This behavior is communicating that they want attention in this scenario that I gave you. So that's what I mean when I say, you know, we have to figure out, like, what is going on? Why is this child craving attention? Or why are they doing what they're doing? Is there an underlying reason? Is it that they're seeking something? And if they're seeking something, it's likely probably not just attention. It could be seeking input in the oral cavity. Like, they could be seeking more taste, maybe a different temperature, a different feel. And this is more directly related to the feeding. But I want you to flip this question, and you can do this in anything that you're doing. You can always ask, no matter what your child's doing, whether they're melting down or they're skipping around the room singing, you can say, what is this behavior telling me? Or what is the root cause of the behavior right now? Because even happy singing, skipping is still a behavior, right? We tend to say behavior and behavioral as though it's a bad thing. But behavior is basically whatever they're currently doing as a result of something else, right? They're skipping around the room because they're happy or because, you know, maybe they're Running around the house because they have a lot of energy to expel or they're melting down because they just can't handle one more piece of input into their tiny little system right now and they've hit rock bottom for the day, you know, or they kind of like the straw that broke the camel's back. Analogy or metaphor. So, you know, always look at. And you can even do this as a practice while you're stuck at home with your kids the next few weeks for those of you who have kids, or even while you're, you know, maybe doing therapy over telepractice during these interesting times with the coronavirus going around. Just the point is pay attention to the behavior and pay attention to what that behavior is communicating to you, you know, and look, honestly, we may not always know. There may be situations where you're like, I have no clue why they're doing that or why they're having a meltdown right now or why they literally went from being happy when heckle and jive. Listen to me Chuckle and Hyde, it's been a week, you guys, so we might not always know, right? But you know, and I wish I had a magic wand for my own kids, but I don't. So what I do know, though, is that many of the kids that I work with, they have digestive issues like severe discomfort or gas or constipation or they may be refluxing milk as babies and refluxing acid once they're, you know, no longer just pure milk or breast milk formula or breast milk feeders. Allergies, intolerances, sensitivities to food, you know, and when our body is reacting, because when you have anything that I just mentioned, your body is in a reactive state. It takes more energy to deal with that. Right? And we also don't feel 100%. And if we don't feel good, we either want comfort food. A lot of us adults could relate to that, which honestly usually actually makes us feel worse, or we just don't want to eat. Ok, so stop for a minute and hear what I am saying. When we don't feel well, we often don't want to eat. Like if you have the flu, do you want to eat? No. Your body's exhausted. It's trying to fight something off. So these kids who are constantly living in a state of allergies or airway issues or, you know, sensitivities to foods, reflux, you know, intolerances, discomfort, gas, digestive issues, all the things I mentioned. Right? And of course, this is not an Exhaustive list. But if you have a kid who's constantly living in that place, are they going to want to eat? Probably not. So it makes our job like 100 times harder, right? So and if there's other health issues, right, if you have a patient or a child who's constantly combating something else health wise, and that's causing more fatigue, you know, they're truly exhausted, they may not have the desire to eat because they don't have the energy and maybe they don't feel good, right? So this all makes sense, right? So now let's add on any like more severe medical issues. I kind of alluded to this a minute ago, but some specific ones could be like heart disease or heart issues, because heart issues, like congestive heart issues are very challenging because it causes so much fatigue in a child and an adult too. But you know, imagine the little one with that or something as severe as. So you've got the heart condition or maybe an airway issue, right? Because we've talked about this before, if you can't breathe, you know, it kind of complicates everything else. So you could have that going on, but you could have something as simple as some congestion from a cold and maybe that impacts your taste buds, right? We just don't want to eat when we don't feel well, okay? Even when people have sinus infections sometimes and you can't taste your food and things are swollen and you don't feel, feel good, you don't want to chew and swallow foods like you may just want liquids. So who wants to eat when they don't feel well? Guys, when you have no energy, you can't taste the food well, if at all. I mean, I don't know, but I know I don't. And neither do most of the kids that I treat. So this is like why, if you have been in feeding therapy, you will see dips and peaks in feeding therapy. Like for example, we might see a dip or, or a loss of skills when they've had like recently have developed a cold or bacterial infection and maybe now they're overcoming it. And sometimes it takes a few weeks, even sometimes a month to regain previously learned skills that they seem to have down before they got hit with that respiratory infection. So it's just something really, really important to understand because you need to know this. It's important to know because oftentimes it just so quickly gets written off the behavior as if there's nothing underlying the said behavior. And this is just not how it works, folks. So I Want people to realize that, especially if you're someone who does feeding therapy. All right, so let's also consider sleep, right? If you can't breathe. Well, we've talked about this before, either due to congestion or restrictive airway or other medical issues, it makes it more effortful to breathe. And so this is also going to impact the quality and sometimes the quantity of sleep. And if you're tired and you also have oral motor delays or challenges, are you going to want to work through those? Are you going to want to prefer to just eat the foods that are more easily break down in your mouth? Right. This is where we get into seeing kiddos who have, we say like the bland food diet or the white and brown food diet, or, you know, they're eating things that they literally can put in their mouth and they can mash it with their tongue up against their palate, very little chewing needed, if any. And they can swallow it back after it's mixed with their saliva to break it down a little bit softer. This is the kind of thing that we're talking about here. So, you know, they're not going to want to work on chewing and trying to expend extra energy when they're already fatigued. Right? So we need to consider that because clinically I do see that they prefer foods that are easier to break down, that require less chewing or management in their oral cavity, or that they can suck through a straw or eat very easily off a spot spoon without chewing. And this is where we get into a lot of kids who prefer pouches, who prefer to suck their food, who prefer, like I mentioned, you know, the other soft foods we already alluded to. So what I did was I went online and I googled picky eater. And I wanted to see, like, what comes up, like, what is the first thing that a parent or a professional might see when they Google picky eater? And the first thing I saw was the first one on Google said picky eating, also known as fussy, fatty or choosy eating. I haven't heard fatty or choosy before, but that's interesting. I have heard of fussy is usually classified as part of a spectrum of feeding difficulties. It is characterized by an unwillingness to eat familiar foods or to try new foods, as well as strong food preferences. The consequences may include poor dietary variety during early childhood. So, yes and no. And I don't even remember what the source of this was. I would have to like, pull it up on Google. Let me see if I do this. So I put in, I'm sitting at my computer, picky eating. Let's see who that source was so I can give them due credit. Of course I'm not gonna be able to pick it up, so it's not coming up. But it's when I googled it, that was the first thing that I found. And interestingly enough, when you do this, the top resource that comes up is something from NBC News. So here's a reminder to check your resources when you source them because just because it's the first thing you see on Google, it might not be the best thing. So let's, you know, remember where we're sourcing things from. Okay. But anyways, what I want to share is that true picky eating doesn't usually last more than a couple of months in toddlers. Like two months, maybe beyond that, like beyond two, maybe three months. Now we're really getting into selective eating and there's something going on if they're selective eaters beyond that point, beyond the two to three months. And I'm being generous by saying three months because it should be a short stint. It should be a short phase that they work through pretty quickly. I was trying to pull up some research around this and to share a couple things with you. Not too much on this, but you know, we will be going over the these kinds of things in the feed the peds course. So if it does interest you and you want to be a pediatric feeding therapist, either an OT or an SLP or somebody in a related field who just wants to learn more and understand when to refer, you're welcome to join us too. Feedthepedes.com but what I want to share is that they There was one study by Jacoby and others who shared that children later classified as pick eaters have been shown to have a different sex sucking pattern at age 2 and 4 weeks with fewer sucks per session. And this was an article that was published in 2003 and I will make sure that we link to that in the show notes. In another one, another article that I will link as well, they shared that picky eaters ate fewer foods and were especially more likely to and I think actually this was either the same Jacoby article or it was a different one by them. But I have two linked here so I will share those with you. Picky eaters are ate fewer foods and were especially more likely to avoid vegetables. Picky girls decrease their caloric intake between ages three and a half and five and a half years, whereas all other children increase their caloric intake. None of the included Parental precursors were significantly related to pickiness. Picky eaters demonstrated a different sucking pattern with fewer sex per feeding sessions at weeks two and four, like I just mentioned before. And finally, picky children displayed more parent reported negative affect than non picky children. So the conclusion here, right, is parentally reported picky eating is associated with a consistent pattern of inhibited and selective eating beginning in infancy. Okay, so for any of you who are like, what was that mumbo jumbo? Like, that was to. I didn't follow all that. Basically what they're saying is that any of this, they're calling it picky eating. I don't love that term. I prefer selective eaters. I think picky is just very negative. And I think it does mess with your child's mind in a sense like psyche, to constantly have some kind of a label like that attached to them. But basically the conclusion here is that these parents who are reporting that their children are picky eaters at the age of three and a half, five and a half, you know, later down the road, that is connected to. Right. A consistent pattern of inhibited selective eating beginning in infancy. And what was that inhibited selective eating? That was them having fewer sucks per feeding session between two and four weeks of life. This is present as a newborn. Okay, so this, these babies who I actually see and who we will talk about in the feed the peds course, these babies who are coming to us, that have significantly fewer sucks per feeding, right, they are not feeding as much. This is something going on early in infancy. And can I tell you that most of these babies now, some may have some greater medical things going on. And not every baby is tongue tied. I'm not saying that. But the ones I see in my office, a majority of them are, they do have tethered oral tissues, tongue, lip, cheek. You know, they've got a variety of them sometimes. And it definitely impacts how they feed. So I just want everybody to realize, like, this is kind of what this ties back into, you know, with Lily. And we've been. I shared her and we did a case study with her and learned how to use a pediatric feeding screener that we've created for you in the Feed the Peeds Facebook, Facebook group, the free one. And what we did there was we looked at Lily and we looked at. Well, when she was a newborn, she had trouble. Like, she latched, but she didn't pull much and her latch was shallow. It was awful. It never got better. And she was definitely a kid who fatigued and fell asleep and did not she had fewer sex per session, not just at two to four weeks, but at birth at 13 months. So I have experienced this firsthand. So this really resonates with me. And it's impacted her entire sensory motor system from developing properly. And that's something that we're working on now because she is more sensitive to temperatures and she's become a little bit less because we worked on that. So now she used to only want her food freezing cold out of the fridge or room temperature, but she prefer freezing cold out of the fridge. It could be like leftover Mac and cheese. That's just not, I don't know, I like leftover pizza cold, but leftover Mac and cheese, not so much my thing. So anyways, now she wants things warmed up, right? So we've been able to work through some of the things that she had struggled with. But she'll taste something that has a lot of flavors to it and she'll say, this is too spicy. And I'll taste it and I'll be like, this is really bland, but for her it's too spicy. So. And she doesn't mean spicy like hot heat. She means spicy like there's just too much of a flavor profile to this food you just gave me. Like, whoa, pump the brakes. So she's got a hypersensitive response to certain foods, right? So what she tastes and she'll sit next to me and I'll have had coffee and she'll be like, oh, mama, your breath is disgusting. And it's happened the past two days now that she's been home with me more in the morning because I don't usually drink it in the afternoon. And I've never really stopped to think about this. But now that she's home and she's around me in the mornings during this self quarantine she keeps commenting on, you know, it's like she cannot, you know, most kids might smell the coffee and be like, whoa, like, interesting smell. She's like, whoa, I can't be in the same room as you. So you know, the smell, the taste, you know, she's fine touching foods. She doesn't mind you that she will be. She will try things. Now she tries more foods than she has in the past. Getting her to try them again is the current challenge if she feels like it's too alarming and alerting to her system. But you know, just be aware that kids are not inherently picky because they want to make you angry or make you a short order cook who makes five different meals for every Meal time. Because I get it. That's not fun. And that's not our goal either. And we do also talk about how we can help families, you know, with that. You know, in, in the feed the peds group, there's lots of people asking questions and we've been answering lots of them too. So there's a free group, it's Facebook backslash facebook.com groups backslash feed the Peds. And you can join us in that group at any time. That's the free one. And that it probably says like feed the peds. I want to be a pediatric feeding therapist is the title of the group. The other thing I want people to think about is for these kids, if your tongue is stuck at the bottom of your mouth and it can't move side to side, right, you can't lateralize food properly, you can't form a bolus, meaning you can't pull the food onto the middle of your tongue, formed into a ball on your tongue to swallow it back properly, right? You're probably not going to want to eat certain things if you can't chew them, move them around properly. You're not going to be eating steak and grilled chicken. Those are some of the hardest foods to chew. You're going to want to eat chicken nuggets or things that are. I call it pre chewed food. Right. Sounds really gross. Sorry for that image. But it's basically broken down and then formed back together and covered up with some breading. Okay. So that's what a chicken nugget is. Sorry to break it to you. And that's why kids prefer these foods when they have sensory, motor or oral motor things going on. The other thing that they can't do is more of a dental thing. I'm not a dentist, but I'll throw this out there, right? If your tongue is restricted and they, they also won't be able to clear their gums. They can't. You know, that could lead to dental issues. But from a feeding standpoint, if you can't clear your cheeks, you can't clear the gum areas, you can't clear. Push something out of your, you know, out from between your teeth with your tongue. If your tongue's not mobile enough or strong enough or whatever to, you know, it's not used to doing these things or it restricted and it just physically can't. It's not functioning properly is probably the way I should say it. You're not going to want to eat certain foods that get stuck between your teeth really easily, like broccoli. Or something that breaks into a lot of pieces that you can't manage, like broccoli or, you know, other foods that I'm sure that people can think of that, you know, even like quinoa are like tiny little pieces. And that's why some people, some kids might not prefer, like a quinoa to a larger noodle. Right. Because it's just harder to manage. So. So you have to really look at the profile of what we're trying to feed kids, what we're trying to get them to eat and understand that they're not inherently being a picky eater just to upset you. It's probably more selective eating and there's probably more that we need to look into if it's gone beyond two to three months. So I hope this is helpful. If you're a parent listening, you can always feel free to reach out. I'm always happy to connect you with a provider in your area. We're in the D.C. metro area, D.C. maryland and Virginia, and we are doing virtual sessions right now. So give us a ring if you'd like to. But just a reminder, guys, that if you're listening to this and you do want to hop into our Feed the peeds course, it's FeedThePedes.com and we have a couple last announcements about that one. As I mentioned in the beginning, we've got a fast. I'm sorry, we've got a closing cart bonus that we're going to give you. We brought back the fast cart bonus from the beginning because we wanted to. We know that things have just been crazy this week and everybody's begging for it. So, yes, you can have it back. You can have a chance to achieve it, too. You just have to get in by today at 12 noon EDT. That's when we close the doors for this first round of Feed the Peas. There will be future rounds, but we're not committing to the dates as of yet. The other thing that we wanted to mention, which I'm now blanking on, what was the other thing I wanted to mention? Feed the Peeds. I don't know. So we'll just leave it at that. All right, everybody, I hope that you have a wonderful day. This is Hallie signing off.