The Problem Eater: Picky Eating, Oral Sensory Issues and Behavior Modification

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>> Amy: Welcome to SpeechPathology.com’s e-learning seminar entitled “The Problem Eater:  Picky Eating, Oral Sensory Issues and Behavior Modification” presented by Jennifer Dahms.  I'm very pleased to introduce Jennifer Dahms this afternoon.  Jennifer is a pediatric speech pathologist in Boise, Idaho.  She received her bachelor’s and master's degrees from the University of Wisconsin-Milwaukee.  She has worked in pediatric outpatient clinics and Birth-to-Three programs in both Wisconsin and Idaho and currently has her own private practice, Valley Pediatric Feeding LLC.  Jennifer has dedicated her continuing education and professional focus on pediatrician dysphagia and she has presented on pediatric feeding disorders at the Idaho Speech and Hearing Association Annual Convention as well as at the Intermountain Area Speech and Hearing Convention in 2008.  Jennifer also presented in pediatric feeding disorders in the schools at the Idaho State University Winter Symposium in 2009.  She received ASHA's ACE award in 2010.  So, welcome Jennifer and thank you for sharing your expertise with us today.

>> Jennifer: Thank you so much.  I feel privileged to share this information with all of our listeners today.  I think this is probably the largest growing population of children who have feeding difficulties, at least that is what I have seen in the last few years.  So it seems that this information is becoming more pertinent to our practice as therapists.  Let's go over course objectives.  Course objectives today include listing the developmental milestones of feeding related to problem eating and identifying medical diagnoses that can lead to problem eating behaviors.  We will look at the symptoms related to problem eating and we're going to look at the strategies available to assist with introducing new foods and ultimately adding those foods to a child's diet.

Since we're talking about eating today, let's start eating.  I have a number of pictures up here with foods that I like and a couple of them that I don't like.  Now, without knowing me you're not going to know exactly which ones are going to be my favorites, so I wanted to make this same point when you're working with children. You really need to get the full background information and a child's current diet so you can actually see what kinds of patterns you see with the child's eating and then figure out from there what are the next best foods to eat.

(If anyone is interested, my favorites are avocado, banana and mac and cheese.)

Developmental Milestones for Food Textures

The first topic we will discuss today is the developmental milestones for textures.  This isn't really related to oral motor skills it’s related to the actual food textures children at different ages are taking.  For the newborn to four/six month old they are primarily getting formula and breast milk, and this is not bottle versus breastfeeding.  We're looking at the specific food item that they're getting, which is formula or breast milk.  Formula fed babies are not exposed to a variety of flavors because they're just getting that one formula.  However, breastfed babies have a wide variety of taste that they're exposed to based on what the mom is eating for that particular day or particular week.

The four to 6-month level is a critical period in terms of feeding development for children.  This is their first exposure to another texture.  I'm going to usually begin with baby cereal, and this is a huge window of opportunity when we are making that transition to texture.  Typically, we are going to introduce baby cereal to formula fed babies about the 4-month age level and to breastfeed about the sixth month level.  The reason there is a discrepancy is there is that breastfed babies have already had some exposure to different tastes so they can wait longer because they have already had flavors they have been exposed to.  What we typically see if this window is missed for whatever reason - development, medical - there's a greater chance the baby will be a picky eater later on in life.  The easiest transition for this level is to mix cereal with either the formula the baby is familiar with or the breast milk because then you are only changing one feature at the time; which is the texture.  When baby cereal is usually introduced there is some initial gagging, and that's normal for a baby receiving baby cereal the first time.

At the 6-10 month age-level is when we present stage one and stage two foods; fruits, vegetables, some of the dinners.  Again, puree is going to be easier, moving to a thicker.  There is also on the market stage three foods.  I typically recommend to parents to just skip these foods.  They're often very confusing sensory-wise, especially the ones with lumps of vegetable or potato.  I think it is very confusing to the child because they don't know whether to swallow it because it is smooth or how to chew it because there's lumps in it.  There is too much sensory information there.  Again you will see gagging at this level because it is a change in texture slightly from the baby cereal.