The onset of loneliness, anxiety and depression in teens and adolescents during the COVID-19 pandemic has fueled a sharp rise in reports of dangerous eating behaviors.

The National Eating Disorders Association (NEDA) helpline saw a 54% spike in calls for support and resources to treat anorexia nervosa, bulimia, binge eating and other illnesses. Experts blame the surge on factors including stress, isolation and excessive use of social media during the coronavirus lockdown beginning last year.

Health care professionals have long known that eating disorders can be brought on by major life changes. Specialists say that for some young people who already were predisposed, the disruptions from COVID-19 triggered a full-fledged illness or a relapse from their recovery.

“Eating disorders are somewhat of a secret disorder. The more isolated you are at home, the more these types of disorders thrive,” said Joy Crabtree, a licensed psychologist at Cook Children’s. “These disorders often go hand-in-hand with anxiety disorder and depression, and the pandemic has played a role in that.”

At Cook Children’s, we initiated the Joy Campaign – a weekly series of stories addressing mental health issues in children and teens – in response to an alarming rise in suicide attempts in the past year. Eating disorders carry an elevated risk of suicide, particularly in those who suffer from anorexia. One out every of five deaths among anorexics is by suicide, according to the NEDA.

But the hopeful news: Although serious and complex, eating disorders can be treated through a combination of medical, behavioral and psychological tactics. Early diagnosis and intervention lead to better outcomes, Crabtree said.

Keep in mind a few key points:

• Eating disorders cover a spectrum of mental and physical illnesses that in the most severe cases lead to death. Anorexia typically involves severely restricted calorie intake, dramatic weight loss and distorted body image. Binge eating involves rapid and often secretive consumption of large amounts of food. Bulimia causes cycles of binge eating followed by forced vomiting, misuse of laxatives and/or excessive exercise. More information and other types of eating disorders are listed here.
• Eating disorders happen more commonly in girls and women, although boys and men can struggle too. The disorders affect people regardless of age, race or body shape.
• The American Academy of Pediatrics reported the estimate that 0.5% of adolescent females in the United States have anorexia nervosa, and that 1-5% meet criteria for bulimia.

Depression often co-exists with eating disorders. When it comes to adolescents, studies cited by the National Library of Medicine recommend a strategy of aggressively treating the depression and not just the unhealthy eating behaviors alone. Studies also recommend routine monitoring for signs of suicidal ideation, which surface when someone doesn’t want to live anymore.

The reported rise in new or recurrent eating disorders remains a relevant story, even as many of the COVID-19 restrictions have ended, because these illnesses require specialized and sometimes long-term care. As one dietitian put it … eating disorders don’t go away overnight. Treatment options range from outpatient visits to residential care to hospitalization for complications from severe malnutrition (heart disease, organ failure and electrolyte imbalance in the most extreme cases). But access to treatment isn’t always available.

In the past year, inquiries about eating disorders have trended up at Cook Children’s, although the medical center’s behavioral health Intake department doesn’t keep an exact count. Crabtree sees a tie-in to the general anxiety and depression that the COVID-19 pandemic inflicted. She listed contributing factors such as last year’s school closures, cancelation of extracurricular activities and separation from friends.

What else came into play during the pandemic? Lack of routine for sleeping and meals. Poor coping skills. Messages about food hoarding. Fears about weight gain. Pressure to look thin in social media photos and on the Zoom screen.

“Seeing yourself on camera, seeing others on camera, making those comparisons has played a role” in the rise of eating disorders, Crabtree said. “It was kind of a perfect storm, all this focus on food and bodies. It was very overwhelming.”

She urged parents to watch for signs of eating disorders in kids. Red flags include preoccupation with dieting, dramatic weight loss, withdrawal from friends, fatigue, dizziness, fainting, anemia, hair loss and menstrual irregularities. Anyone with concerns should contact their child’s pediatrician or call Cook Children’s to discuss referral options or possible psychological or psychiatric treatment, Crabtree said.

Getting started on treatment

Jean Mankin, a registered dietitian with Cook Children’s Outpatient Nutrition Services, works with primary care physicians to help with food allergies, obesity, picky eating and other issues. When it comes to someone with significant weight loss, Mankin starts by trying to determine whether the patient’s weight fluctuation is intentional.

“If you feel like they’re purposefully withholding food or telling you that they’re binge eating or purging, it’s important to get help,” she said. “A lot of kids are finding themselves having issues they didn’t have prior to the pandemic.”

Mankin emphasized that adolescents need to eat a well-balanced and sufficient diet because all vital organs and bone are rapidly growing and developing at this stage. Anxiety and depression can cause a dramatic decrease in appetite for some, and for others it can lead to stress eating or binging. As long as mental health problems go unresolved, the eating behaviors won’t improve, she said.

At Cook Children’s, patients with suspected eating disorders are referred to local specialists such as Carol Ann Darwin, a registered dietitian in Fort Worth who has met over her career with clients from age 8 to age 70. In April 2020, Darwin started seeing a big increase in anorexia and bulimia mainly among the 13- to 17-year-old set. She called the pandemic a nightmare.

“I went from working three days a week to working six days a week just to get these kiddos in,” Darwin said. Some individuals with eating disorders had to be hospitalized with feeding tubes until spots opened up in residential treatment centers, she said. Dietitians, therapists and treatment centers in North Texas and nationally still have waiting lists up to a month, Darwin reported.

The pandemic caused an onslaught of maladies that Darwin’s youngest clients bring up: isolation, stressful dynamics in a quarantined household, frustration with online school, loss of control. Food became a crutch to comfort and to alleviate loneliness. The challenges that were particular to 2020 compounded the usual causes of eating disorders, such as genetic predisposition and being bullied.

There’s no quick fix; Darwin typically meets with her clients in weekly nutrition consultations for two or three years – although the time frame can be less for those whose underlying depression and anxiety are mild. She said she prefers to use “gentle nudging,” rather than scare tactics, to motivate her clients to start eating appropriately.

“I’ve had several (clients) where I thought, ‘Would this have happened if COVID hadn’t come along?’ Maybe not,” she said.

Disconnection and disappointments

Dawn Dillon, a therapist in Fort Worth who has specialized in eating disorders since 1998, characterized the current demand for mental health services as an explosion. Disordered eating can come from the instinct to take action during times of uncertainty and fear, Dillon said. She drew an analogy to the people who rushed out to buy toilet paper in the early days of the pandemic. The same instinct applies to food and body image.

“We take all these things that are messy, uncertain or scary, and we manifest it through our body,” Dillon said. “Instead of saying ‘I’m scared, I don’t know what to do,’ it gets put onto the body as ‘I’m fat. There’s something to do with that – I can lose weight. I can sculpt. Or I can tone.’”

Eating disorders can originate out of a misplaced attempt to manage distress when someone feels stuck or trapped. Dillon listed a variety of scenarios that particularly applied to life for teens and young adults during the height of the COVID shutdown: Disconnection from social support. Disappointment when prom and graduation got called off. When will colleges and dorms reopen? So many unknowns.

Additionally, refusal to eat can be a way that teens, like toddlers, exert their separate identity. “In a home with no personal space and no autonomy, a lot of times eating disorders will creep up because it’s a way to assert boundaries,” she said.

Once a patient’s medical condition and food intake have stabilized, Dillon said, the mental health piece of treatment becomes vital to get to the root of the anorexia, bulimia or binge eating. Everyone involved in treatment stays vigilant for warning signs of suicide.

No one chooses to develop an eating disorder. Dillon’s current clientele includes first-timers as well as patients with persistent struggles in and out of treatment. Some patients who were handling recovery well prior to COVID-19 had to return for more therapy.

“From the research, we know that life-stage transitions are high-risk times,” she said. “You look at this pandemic, and it was a huge transition that nobody planned for, nobody expected, and nobody knew how to do it. So it makes sense that there would be a rise” in cases.

Dillon acknowledges it can be a terrifying experience for families to go through. Don’t blame yourself or make it a power struggle, she advised. “It’s hard on parents on a fundamental level, but it’s not their fault. The goal is to be aligned with your loved one as the two of you fight against the eating disorder together rather than the two of you fighting with each other.”

It’s a common question to ask your pediatrician. "What is the daily calorie need of your infant or child?"

Here’s a chart that covers the normal daily calorie need to sustain healthy growth. Average weight and lengths are listed for reference for infants. Base the calorie needs of your growing infant more off of their weight and height, rather than their age, until age 2. Also listed is the approximate number of ounces of breastmilk or formula your infant should consume to obtain the daily necessary calories (for a solely breastfed or formula fed infant, it does not take into account the calories from pureed baby foods).

These daily calorie counts are a general guideline, but other factors such as chronic medical conditions, medications, and extreme physical activity can change what your child actually requires in a day. If you are concerned your child is not eating enough, or is eating too many calories in a day, schedule an appointment with your pediatrician.

"Heavy metals in baby foods leading to lower IQs"

You might have seen these headlines in the past few weeks as a result of the report, "What's in my baby's food?" from the Healthy Babies, Bright Futures initiative.

The report looked at a variety of foods for four different heavy metals: arsenic, lead, cadmium, and mercury. Each of these heavy metals can be linked to developmental delays and loss of IQ points over time.

But, the tricky part is that these metals are present in many different substances, foods, even the dirt that your child eats on the playground. So, it's not just the fact that the metals are there but how much and how often they are ingested that matter.

And despite what you read in the headlines, it's not possible to avoid these exposures by switching to organic or by changing to baby-led weaning or homemade purees. Because these heavy metals are present in our soil, they are taken up by plants as they grow. Even the report goes on to say, "Organic standards do not address these contaminants, and foods beyond the baby food aisle are equally affected." So, moving away from jarred baby food doesn't eliminate the risk of your baby having exposure.

While we'd love to eliminate any risk and should continue to do so, is there a real risk to your baby?

The report spends significant time discussing lead exposure and it's a risk to babies. Interestingly, many pediatric offices (including mine) run a screening lead level at age 1 and 2 but we do not see a significant number of children who test at a detectable level and even fewer who fall above the level of 5 at which a child is considered at risk for problems. We do not routinely screen for the levels of the other chemicals but, likely, those would not be present in a significant number of babies either.

The headlines and articles have spent significant time discussing the 11 million IQ points that have been lost due to exposure of heavy metals, but what does that mean to YOUR baby. Probably not much. First of all, those lost IQ points are based on the known IQ loss from excessive exposure and many other assumptions to calculate the total loss. And, while it's not clear from the reports, the assumption is those IQ points were a cumulative loss over all children from 0-24 months which when averaged out over all those children work out to a fraction of a point per child which would mean nothing to an individual baby.

So, what should we do?

Of course, the baby food and agricultural industry should continue to work to provide a sustainable source of healthy nutrition for all of us (including our babies). Subtle changes, like searching for soils that have less heavy metal exposure for root vegetables (like carrots and sweet potatoes which absorb more heavy metals from the soil) might be beneficial. The food processing industry should continue to make as many gains as possible in decreasing the steps that might lead to an increase in heavy metals in our foods.

Here are some tips for parents that you can make to minimize your child's exposure:

1. Remember that switching to organic or providing homemade purees will not reduce risk. So, if you wouldn't otherwise, there's no need to make that change now.
2. Avoid higher risk foods, especially those that contain no other nutritional benefits. Rice cereal, teething biscuits, puff snacks (rice-based) and apple juice are some of the riskiest foods and have little to no benefit.
3. Provide a variety of foods regularly. Sweet potatoes and carrots can be an important part of your baby's diet but should be given in with a mix of a variety of other foods.

Because we talk about healthy and unhealthy things at home a lot, he agreed to eat some broccoli (bear with me, folks – this green food took over 5 years to happen. It was not easy and I consider it a huge victory that will likely be short-lived).

My daughter refused all the broccoli and all the fruit. Not havin’ it.

My son ate 3 pieces of broccoli, two bites of neon orange, licked every ranch molecule off the plate, and then asked for the 4-month-old Oreos in the pantry.

Yogurt ranch for the win.

They both drank milk. Score. Protein.

Dad worked late. Two working parents. We didn’t sit at the table together today.

There was a lot of talking and distraction by: counting to 100, temporary tattoos, our cats howling, and arguing about what 6+6 equals (9, in case you didn’t know). Also someone threw a strawberry and someone cried because there was no “real dessert”.

Even your pediatrician worries about her kids’ nutrition, and even your pediatrician doesn’t follow her own rules sometimes. And this picture doesn’t represent what my kids actually got in their stomachs. And every meal looks different at my house.

I used to be that childless pediatrician who always said, “I’m never gonna have the kid that only eats a couple of things! My kid is going to eat a wide range of nutritious foods! I’m a pediatrician, for crying out loud!”

Then God and Mother Nature got together and decided I needed to be taught a lesson, and gave me my firstborn child. Cue the Uncrustables.

There is no topic I talk about more in my office than picky eating. Well, maybe poop. But seriously - you’re all worried about it. And you should know that you’re not alone.

GENERAL INFO:

• Picky eaters are often children who are sensitive to their surroundings, to tastes, and to textures. Some are anxious kids in general. Some have sensory problems and are sensitive to other things like loud noises, certain smells or how clothes or shoes feel. Some are children on the autism spectrum. These kids may have heightened awareness of these senses, thus making new foods a challenge.
• Most kids who are picky are “just normal kids” though.
• The majority of kids I see who are picky will grow up to be TOTALLY NORMAL AND FUNCTIONAL EATERS (shout-out to my sister Christina who used to only eat cereal and Fritos as a kid and who now makes quinoa and kale salads for fun.)
• Picky eating may be pre-programmed in us. Think about it. Maybe we are avoidant of bitter things (like some vegetables) in our youth in order to self-preserve? Caveman toddlers needed to know to avoid the poisonous plant or fruit, which often had a bitter taste. This might be a partial explanation for why so many kids are picky.
• It is very normal for children, especially toddlers, to only eat the same thing for awhile. My daughter lived on blueberries and yogurt for a solid two weeks once, even though other things were offered to her.
• It is very normal for small children to only eat a few bites of food some days, and eat giant meals on other days.
• Milk is a great source of protein for picky kids. An 8 ounce glass of milk has 8 grams of protein in it. Try to keep it below 20-24 ounces a day for your picky eater though. Kids who just depend solely on milk for nutrition and avoid other foods can get anemic.
• Giving your picky kiddo a multivitamin with iron daily is a great idea. It's not gonna be as good for them as the nutritionally dense veggies and fruits are, but it won't hurt.

WHEN DO I WORRY?

• If a child completely refuses an entire food group, I worry. If they shun all dairy, I worry they won’t get enough calcium for their bones. If they refuse all fruits and veggies, I worry that they’re gonna get constipated or have a nutritional deficiency (these typically only develop in the most severe cases and over the long-term).
• If a child is extremely picky and is a very small kiddo, I worry.
• If they are losing weight, I worry.

Most picky eaters are your run-of-the-mill “chicken nugget and mac and cheese” type. They gag sometimes with new foods, and often don’t want to stray from the 10-15 foods they’re “OK” with. The majority of your kids will fall in this category.

But some kids are extremely picky. These kids may have something called Avoidant Restrictive Food Intake Disorder (ARFID). The diagnostic criteria are here.

If your child meets any of these criteria, it’s best to talk to your pediatrician. Your kiddo might need therapies that can help with introducing new foods and could benefit from seeing a nutritionist as well to assure they’re getting the nutrients they need.

“Children Will Eat If They’re Hungry”

Yes, this is true. When I moved dinnertime from 5:30 to 6 p.m. in my house, there was a noticeable difference in how much they ate and how little they whined for snacks later on in the evening. But remember the other things that fill our kids up – sometimes that little handful of Goldfish crackers an hour ago was all that was needed to keep their dinner hunger cues away. Sometimes a cup of milk before the meal will cause lunch to end in a meltdown. Snacks and milk are fine if your kiddo needs them and is an easy eater, but I just wanted to open your eyes to how easily a picky kid’s hunger can be satiated so you can better understand the food refusal.

Healthy portion sizes for kids are typically much smaller than parents may think. Protein should be the size of a child’s palm (meats, fish, beans). Veggie/fruit portion – what they can grasp with two fists. Pasta or bread? One fist. This may change depending on a growth spurt or more hunger that day due to exercise. But it illustrates how little they may need sometimes. 4 green beans. 2 apple slices.

Kids are very good at knowing how much food they need to eat. In fact, they’re better than us at it. You put me in front of a box of donuts and I’m gonna eat way more than I need because…donuts. Small kids are great at stopping when they’re done with being hungry. They don’t loosen belts or overstuff themselves. In fact, I often guide older, overweight kids to watch their younger siblings when they eat – small kids usually stop eating when the hungry goes away, not when they feel really full.

Along those lines, don’t force kids to “finish your plate.” In a day and age when kids are bigger than ever, this is just antiquated and unhealthy. Give them small portions and allow for seconds if they’re having a hungry day.

Dips. Sauces. Do it. It’s fun, and different. Use Greek yogurt to make the creamy ones. Throw onion soup mix in there, or a ranch spice packet. Try hummus. Try salsa.

New illustrated plates. Fun spoons. Twirly straw for that veggie-packed smoothie. Kids love special stuff like that. And might be more willing to try something new if it’s fun.

I know it’s enticing, but try not to use dessert as a “reward” or “bribe.” It sort of sets the stage for associating sweets/treats with success. And we’re reinforcing that what was on the dinner plate isn’t as good as the dessert.

Again, remember that some kids do sit on the edge of the eating spectrum in the “severe” zone. ALWAYS talk to your pediatrician if you feel like your kiddo might be really struggling. If he’s small, eats fewer than 5-7 things, throws up and gags on a daily basis, or has very high anxiety with food, ask for help! Feeding therapy is wonderful. Our dietitian and nutritionist friends are so helpful to doctors and parents alike. We can get through it together as a team!

I barely scratched the surface here. Please speak up in the comments if you have any other advice or ideas!

Lettuce romaine calm,

Dr. Diane Arnaout

But I hear from my patient families all the time that it's anything but relaxing.

The American Academy of Pediatrics recommends doctors ask parents three questions about mealtime:

1. How anxious are you about your child’s eating?

2. How would you describe what happens during mealtime?

3. What do you do when your child won’t eat?

When offered a healthy, well balanced meal with fresh fruits, vegetables, and lean proteins, kids will stop eating when they are full. Children will naturally refuse to eat when they are not hungry. We often describe these as normal appetite slumps. We can disturb children’s natural satiety cues by either forcing them to eat or by offering foods high in added sugar or salt when they won’t eat. This results in a child who will “only eat chicken nuggets.”

Parents are most successful in feeding their children more fruits and vegetables when they model healthy eating, set appropriate limits, and have a positive attitude at mealtime. “The parent determines where, when, and what the child is fed; the child determines what to eat.” ⁽¹⁾ In other words, “parents provide and kids decide”. ⁽²⁾ 

Here are some tips on eating mindfully and encouraging your kids to eat in a manner that gives them more energy and helps them avoid chronic disease. These are easy ways to change your lifestyle that don’t involve a ton of work and expensive supplements.

1.Drink more water. Kids should not drink juice or soda except on special occasions.

2.Drink milk with meals. Children from age 1-2 should be on whole milk. After the age of 2, low fat or skim milk is recommended.

3.Vitamin supplements are not needed unless your child does not drink milk. Vitamin D is essential for bone health and immune function and may play a role in prevention of chronic disease.

4.Serve 5-9 servings of fruits and vegetables daily. Encourage your children to at least take a bite of everything you serve. Remember that children will need to taste a food 10-15 times before they decide they like it. Lean protein like fish and baked chicken might be better accepted if you add ketchup as a condiment.

5.Add healthy protein likes nuts (for older children) and legumes. Peanut butter is fine for younger children and new allergy immunology guidelines suggest that early introduction of peanut may actually decrease the risk of peanut allergy.

6.Eat more meals at home. Keep staples such as eggs, whole grain pasta, pasta sauce, yogurt, carrots, frozen vegetables, chicken breasts, and fruit stocked at all times so that in a pinch you could throw together a simple meal.

7.Double your recipes and freeze 1 meal at the same time that you cook the other meal. This will save you from making a trip to a fast food restaurant when you have that go to meal in your freezer.

8.Serve only whole grain breads and pastas.

9.Avoid buying, eating, or serving processed foods (chips, cookies, cakes).

10.Avoid fried foods and fast foods.

To read more about nutrition needs of children at different ages, I highly recommend the book “Nutrition: What Every Parent Needs to Know" available on the American Academy of Pediatrics (AAP) online bookstore.

See choosemyplate.gov for more information about how your child’s plate should look at meal time.

Realize that children’s tastes will change over time. They will sometimes refuse foods they readily accepted in the past, and they will readily accept foods that they refused in the past. Involve your children in shopping and meal planning. Let them help in the kitchen! Take them to a local farmer’s market and let them choose something new for everyone to try.

Take a matter of fact and pleasant approach to meal times and ENJOY YOUR FAMILY! Create wonderful childhood memories.

References:

1. “A Practical Approach to Classifying and Managing Feeding Difficulties” Pediatrics Volume 135, number 2, February 2015

2.Nutrition: What Every Parent Needs to Know. AAP

When I advise my 3 year old patients to wear helmets on their tricycles, then I end up with 10 year old patients who wear their helmets. It’s near impossible to convince my 10 year olds to START wearing a helmet.

Why do you think so many ED doctors end up advocating for car seat safety? They see the results of horrible car accidents that could have been prevented.

That’s how I feel about obesity prevention. Far and away, poor diet and a sedentary lifestyle wreak havoc on the mental and physical health of my patients – from young to old – those with poor lifestyle choices have a decreased quality of life. They come to see me with more illnesses, more headaches and most certainly more abdominal pain.

When I start talking to my families about diet, I try to give anticipatory guidance about offering fruits and vegetables and limiting processed foods. Toddlers and young children do two things really well – they don’t eat when they are not hungry and they stop eating when they are full.

We as parents, and grandparents, mess up their satiety cues by trying to get them to eat when they are not hungry and trying to get them to keep eating when they are full. Allowing children to control the amount of food they eat leads to a long term healthy relationship with food. Parents have control over what is offered but should not try to control how much is eaten.

Along those same lines, children are naturally conditioned to be outside and to be active. We as parents mess that up by keeping them inside in front of an iPad or video game. We have control over their media time.

I think focusing on healthy behaviors rather than BMI is a positive way to talk to parents. Most parents are doing 1 or more things right in the 5-2-1-0 recommendations. Kids are motivated to follow these recommendations, but they need their parents to create an environment at home that allows them to do so. This goes along with the thinking of the Blue Zones.

I do think there is value for using BMI as a tool. I usually show growth charts to families as an objective measurement of what is happening and then we turn to talking about healthy behaviors. But I do see a flattening of BMI with improved diet/activity choices. It is also not uncommon for me to see an increase in BMI and ask what has changed, and families are usually able to say – oh yeah, he quit playing soccer, or he doesn’t have PE this year….etc.

When you look at guidelines for treatment of obesity, the first thing you must have is motivation for change. If that is not there, you really can’t go forward. What if we don’t have to motivate people to change because they have been feeding their children correctly from the beginning?

About 3 percent of kids suffer from severe selective eating, to the extent that they can't eat out at a restaurant, said lead researcher Nancy Zucker, an eating disorders specialist at Duke University Medical Center in Durham, N.C.

Severely selective eaters are more than twice as likely to be diagnosed with depression or social anxiety, when compared with kids who'll eat anything, according to findings published online Aug. 3 in the journal Pediatrics.

Alaina Everett, a Cook Children’s licensed psychologist in Denton, says severe picky eating can be treated from a psychological/behavioral perspective as well as through oral-motor and sensory therapies and trying new foods for children who have severe selective eating can be terrifying.

“The fear is only intensified when parents make threats or express anger and frustration,” Everett said. “In our psychology department we emphasize the belief that kids do well if they can. Likewise they will eat well if they can. But there are obstacles that get in the way. Whether the original issue is a sensory processing disorder, oral-motor weakness or a gastrointestinal problem, all these kids have one thing in common, anxiety.”

From a psychological standpoint, these kids have had unpleasant experiences with food and the lingering trauma may be real. This is especially true for well-meaning moms who hide veggies in their kids’ favorite foods. If you have a seriously picky eater, Everett says this strategy will back-fire big time.

So how much anxiety can meal time actually cause?

“It is not uncommon in my practice to see children cry, scream, hide under the table, and quite literally shake at the sight of a novel food or when asked to join me at the table,” said Amanda Fyfe, a speech-language pathologist at Cook Children's in Arlington and Mansfield. “The anxiety severe picky eaters cope with is real and it can be intense. These kiddos often have months or years of negative food experiences fueling this fear, and unraveling it takes real work on everyone’s part. “

Fyfe says severely picky eaters:

• Have a significantly limited food repertoires (think 10 foods). These foods are probably similar in some way, although figuring out the rhyme or reason to what your little guy will or won’t eat can be mind boggling. It may be that his safe foods are the same color or have the same texture.
• Frustrate us with behavior that makes mealtime at home a catastrophe and eating out unheard of. He may refuse to eat with your family or cry and scream at the sight of the casserole you’ve so lovingly prepared.
• Refuse foods based on ALL sensory properties, including appearance, smell, texture, and taste. A picky eater may not even tolerate an offensive food on his plate. The sight of a non-preferred food may cause gagging, retching, and vomiting. Eating is more than simply chewing and swallowing. Interacting with, smelling, touching, and tasting are ALL important steps in the eating process. And disruption can occur at any step.
• May struggle to meet nutritional demands

“A child will not eat the broccoli and pork chops if you wait him out. He just won’t,” Fyfe said. “In fact, he may grow more and more rigid in his food selection because he IS hungry and grumpy. If a food or experience causes a child stress, discomfort, or pain, he will avoid it, plain and simple.”

Fyfe says these children are hypersensitive to foods in ways most of us might not even consider when planning our meals. Foods have to pass many tests before deemed acceptable for consumption, believe it or not, and severely picky eaters really put their meals to the test.

The first and possibly the most important test his dinner must pass? What it looks like. Children are acutely aware of the color of the food and may question why the color, shape, or size changes from bite to bite or from meal to meal. In addition, they might become overwhelmed by the smell of a particularly pungent food (think roasted broccoli, guys) and lose all ability to even consider tasting it. The texture of yogurt or pudding may cause a gag with incredible force. All of these reactions to food can lead to increased behavior disruption and meal time chaos.

“They can taste everything,” Everett said. “Zucchini pasta does not fool anyone and they are likely to stop eating pasta altogether. Presenting motivators like extra video game time can help, but it doesn’t solve the underlying anxiety. The scenario will just repeat itself when the next new food is presented.”

If your child shows signs of extreme picky eating, you will need some help. Talk to your child’s pediatrician about scheduling a feeding evaluation with a speech-language pathologist to determine the origin of the feeding woes and develop strategies to improve the eating experience for the entire family. A child psychologist may also be used if necessary.

http://www.npr.org/sections/health-shots/2015/08/03/428016725/could-your-childs-picky-eating-be-a-sign-of-depression

https://childhealthanddevelopment.files.wordpress.com/2012/03/kaytoomey.pdf

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

What are the most common causes of a runny nose? How do you treat one? When should you call a pediatrician?

Doc Smitty is back with the latest My Kid Minute. Watch the video to find out all the answers.

You may be thinking, “Am I the only parent in town dealing with dinner drama every night?”

The answer is no. It is reported 25 to 45 percent of typically developing children experience feeding and swallowing problems, while a staggering 30 to 80 percent of children with developmental delays struggle with mealtime (Arvedson, 2008).

Now for the million dollar question: what causes feeding problems? There are several factors that can impede a child’s ability to develop a happy, healthy relationship with food, including: sensory processing disorders, gastrointestional complications, prematurity, and dysphagia.

Food should be fun. And for most of us, it is just that. But children may not see eye to eye with us when it comes to mealtime, causing this to become a stressful time for the whole family. Little ones can be incredibly stubborn when it comes to food choices.

Most parents have described their children as picky eaters at least once or twice. However, it is important for parents to know the difference between “picky eaters” and true problem feeders and when to seek assistance.

Picky eating can be a typical stage in normal development. Ready for the skinny on picky eating?

A picky eater will typically:

• Accept approximately 30 foods. That may sound like a lot, but it’s really not.
• Tolerate a new food on his or her plate and may even taste it once or twice. This new food may become a new favorite. But then again, it might get tossed on the floor. This truly depends on the child’s sensory reaction to the food in question.
• Eat meals with his or her family, but requires different preferred foods.
• Eat only one food from each food texture category (puree, crunchy, solids,etc).
• Consume one preferred food consistently, and then suffers “burn out” and refuses to eat this food for a period of time (picky eaters will usually begin to accept this food again after a brief break).
• Eat new foods after frequent exposure.

So, how can you nudge your picky eater toward the leafy greens and save your sanity? Here are a few simple suggestions for success at the dinner table regardless of whether you’re serving pizza or brussel sprouts.

1.Develop a routine and stick to it. Offer meals and snacks at about the same time each day

2.Don’t force feed or bribe your child to eat. This will likely increase refusal behaviors or even worse, bring on a power struggle.

3.Offer a variety of foods, including 1 to2 of your picky pumpkin’s favorite items, at the family meal.

4.Persistence is key! Remember not to shy away when he shudders at his first taste of peas. You may need to offer those peas up to 20-25 times before he will tolerate them.

5.Explore food with your child. Talk about the way it looks, smells and feels. Invite her into the kitchen to help you prepare the foods. Bring her along to the grocery store or farmer’s market to choose a new fruit or vegetable. Star fruit? Why not?! Eggplant? Coming right up!

6.Make it fun! Serve fruits and veggies with dips. Use cookie cutters to make a Shamrock Sandwich for St. Patrick’s Day or Santa for Christmas. Eat dinner by candlelight. Serve breakfast for dinner. Better yet, have everyone put on their coziest jammies for a pancakes and PJ’s party. Get creative!

7.Practice what you preach! This means you, parents. If you want your little ones to eat salad for dinner, you will need to dive into that bowl of greens yourself and forgo the drive-thru on your way home. Our children are always watching and learning from our actions and habits.

8.Don’t become a short-order cook. If your child refuses the family meal, it can be tempting to head back to the kitchen to whip up the macaroni and cheese he is coveting. Resist! This may promote picky eating.

Now, let’s get down to business. While picky eating can be frustrating, it is a typical stage in normal development. However, problem feeding is a true disorder that requires specialized assessment and/or intervention and is downright disheartening for parents. A child that does not eat well can evoke feelings of anxiety, fear, and helplessness, leaving caregivers struggling for a solution.

A problem feeder may:

• Eat fewer than 20 foods.
• Refuse the bottle/breast or drink a small amount and then refuse during infancy.
• Refuse an entire texture category (for example, a problem feeder may refuse to eat all pureed foods).
• Not accept new foods on his plate and may cry, scream or tantrum at the sight of a new food. Problem feeders may even gag or vomit at the sight of an offensive foods.
• Be unwilling to try new foods, despite multiple exposures.
• Eat the same food over and over, but once he experiences “burn out,” he will most likely not go back to eating that food. This will cause him to slowly, but surely, shrink his group of tolerable foods.

If your child is showing symptoms of problem feeding, talk to your child’s pediatrician regarding a feeding evaluation by an occupational therapist or speech-language pathologist. A thorough evaluation is necessary to determine the best course of individualized treatment for your child.

Hang in there, parents. There IS hope! Our feeding therapists are trained to help your child with a wide array of feeding difficulties.

References:

http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934965§ion=Incidence_and_Prevalence

http://www.sosapproach-conferences.com/articles/picky-eaters-vs-problem-feeders

Resources for Parents:

www.feedingmatters.org

www.yourkidstable.com

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.