Food Therapy

My son is a picky eater. I know what you are thinking – all little kids are picky. This is beyond that. He eats 3 meals: spaghetti with marinara, eggo blueberry waffles, and dominos cheese pizza. That’s it. Everything else he eats are sides – cheese, frozen gogurts, fruit, cucumbers, crackers, etc. It had become a problem. He wasn’t getting the nutrients he needed, even with vitamin supplements. I grind meat up in his spaghetti sauce with the Cuisinart and make special cookies that have beans and nuts pureed in them to help with iron and protein. I read every parenting magazine that claimed to be able to “help you feed your picky child.” And those magazines made me feel like a failure. These people were talking about edamame and humus. I can’t even get my child to eat pancakes.

My in laws made me feel like a failure. Their toddlers were walking around eating dried fish with bones in it at barbeques. My son wouldn’t eat the cucumbers if they weren’t cut right. Most of them force feed their child as a toddler. I don’t agree with that – I am not going to sit and hold my son down and force feed him. In fact, when we were in Russia I got very angry with my MIL for doing that. I don’t think it’s healthy. But still, my son wasn’t eating anything and I didn’t know what to do. I knew what I didn’t want to do, but I couldn’t fix this problem.

I was at my wit’s end and I didn’t know what else to do. Now, my son has sensory issues – his main problem with foods is texture, smell, and taste. (I know – that’s all of it.) I had read about food therapy and decided we needed to ask his doctor. At his last well check I asked about it. She referred us to the children’s hospital, they did an evaluation on him, and we got into the food therapy clinic. In food therapy an OT helps figure out what the issues are, and how to fix them.

He has always kind of had feeding issues. He had a hard time learning to nurse, and then I had to stop breastfeeding due to cancer treatments and he had a hard time with any nipples except a certain type. He never got past the newborn nipple – he would gag and spit up and cry with the nipples with more flow. He ate baby food pretty well. But I was really sick and couldn’t make fresh food most of the time, so we just used jar foods and while those are healthy, they weren’t the same flavors as what we normally eat. I wish I had just ground up our food for him. Getting him off baby food to solid food was very stressful for him. At one point he really ate well – pretty much every thing I gave him, but then he started eliminating foods and it became a struggle I couldn’t deal with. In fact, I got so frustrated with meal times that I just gave up. I stopped making family meals since my husband came home late (and later his mom came and she makes the foods he prefers). I stopped eating at the table with him, we just ate in front of the TV. I stopped trying to get him to eat other foods. I just couldn’t handle the frustration. We adapted to him instead of continuing to challenge him and get him to eat more things.

So, food therapy – I have had some questions from friends about what we do. I am not an OT, and having someone to go work with, having someplace that isn’t home to do this work has helped a lot. He fights less with her than he does with me. But I will share what we do, what we have changed, and what our techniques are at home.

First the new rules: 1. we eat at the table as a family. Right now that usually just means me and my son except when his dad is off. His grandparents eat on their own schedule after work and such. 2. I choose what to serve, he chooses what to eat. I don’t force him or struggle too much with him about what he eats. Every meal has SOMETHING he prefers so he doesn’t go hungry. 3. We put the food on the table and pass it around (or in our case serve ourselves from the bowls) – “family style”. We both put some of everything on the table on our plates. It can just sit there if he doesn’t want to eat it, but I try to have him spear it with a toothpick or something. He at least looks at it and smells it. I have gone back to divided plates for him (like toddler plates with dividers) because that makes it much easier for him – not such bad anxiety over foods contaminating “his” food. 4. Eat on a schedule. He isn’t allowed to graze. I always just gave him a snack when he wanted one. He isn’t allowed to just eat when he wants. He eats breakfast, snack, lunch, snack, dinner, and a snack if he needs it. He has adapted well to that and I rarely have to say “you need to wait for snack” anymore. If it’s within half an hour and he is starving I am flexible with the time, as long as he isn’t just walking around eating small snacks all day.  5. change the way you talk about food. Correct statements like “that’s yucky” or “I don’t like that” to “I am still learning about this food.” And even with you, don’t turn up your nose to something at a restaurant, or at a friend’s house. Be positive about food. If it is something completely new, we use the phrase “that surprised our tongue. Remember, our tongue has to try a new food 10 times before it knows if it likes it or not.” Also when anxiety arises, saying “you don’t have to try it, we are just LEARNING about it.” Eventually you get to the point where you have to push more and then we stop just learning about it.These types of phrases helps disperse the anxiety.We also say “I think your eyes are tricking you” if he doesn’t want to eat it when he just looks at it. Our biggest rule is “you don’t have to eat it, but we are going to learn about it.”

Desensitization: Kids like my son need some help to get over the struggle with foods. He has so much anxiety around foods. So we do it in steps, we let him get to know the foods before he actually tastes them, and we take it slow.

Some of the things we do for him to get used to food was hard for me at first. It’s messy. It’s not pretty. It’s everything you don’t want in table manners. The therapist said some families just play with food at snack and say dinner is time to practice being polite and using our manners. I use the techniques at every meal because it makes it easier for him to interact with different kinds of food. The order of desensitization is: sight, smell, touch, in depth touch (like pulling it apart, crumbling it, squishing it), touch on the face or head, kiss, lick, bite, chew, swallow. Those are all separate steps.
Our therapist said that kids need to step up slowly to eating new foods. We start with what it looks like – if I serve something new he might not even want it on his plate, but we are getting past that. We put a little on his plate. We will talk about what it looks like. What color, what textures, do we think it might be crunchy or soft or gooey? Then we have him smell it. At first even that made him so upset. Now he will smell anything. We will compare the smells to other foods we know. Then we start with touch. We do a lot of messy projects with food. Pudding finger paints, crunching up cheetos or veggie sticks (like potato chips kind of, but made with more veggies, different colored, and stick shaped – less fat too), putting goldfish crackers in our jello or fruit, chopping, mixing, feeling, crumbling, getting totally messy with the food. Just exploring the textures and smells and stuff. She said they need this – they need to feel what the food will be like in their mouth before it gets to their mouth. It’s messy. And it’s hard for me to let go of that sometimes. But we do it. I bought some of those sword toothpicks, some fun bowls and utensils, etc for him to play with – and I have him help me cook which he likes – this all desensitizes him to the foods before it ever gets close to his mouth.
Next step at first was touching it to his face or head. He didn’t want it near his mouth, and we were mostly doing things like crackers or veggies sticks, nothing extremely messy. He would bounce it on the top of his head, or tap it on his ears to a song, etc. Eventually she would have him tap his lips or teeth. This was much more fun and less threatening than “try it.” We have eliminated this step for the most part. He has gotten to the point where he will put the food to his lips without freaking out.
So now we start putting it to his mouth by kissing it, then licking it, then finally biting it and allow him to spit it out if it’s too strong. After he has been exposed to a certain food in several of our “sessions” at home or in therapy, we move on to “take 3 bites with chewing and swallowing. This is still difficult for him. This is still a struggle. But I remind him that he KNOWS this food, I remind him that this food isn’t scary. And he has gotten to where with most things he will do it without too much of a struggle.

An important thing to remember is to try to branch out from foods your child already eats. If it’s somewhat similar it will be easier to make that transition. They call this “food chaining”. For example – if your child will eat spaghetti with marinara sauce, start trying differently shaped noodles. Then you can try different sauces. We are trying this right now with mac n cheese. He will eat macaroni noodles with marinara on them, but not cheese sauce. We have let him put some marinara on the mac n cheese and it helps him tolerate it more. If your child likes waffles you can try pancakes, blueberry muffins, french toast, etc – other bready breakfast foods.

Some of the best things I have learned:

Kids think that they only like ONE KIND of thing by sight. Like he will only eat square graham crackers and not any teddy grahams or grahams shaped like spider man, etc. So we take that one food he likes, and put 3 different “types” out to taste test, play with, explore all at the same time. He eats eggo blueberry waffles. We have tried plain, strawberry and are now going to try chocolate chip. We did different flavors of applesauce. He only liked one kind of string cheese. I got him to try another after a lot of work and playing with it and looking and touching it, and he liked it. He would only try it after we had done several of these types of activities – because he thought if it looked a little different or had a different package he wouldn’t like it. We talk about how these things are the same. With the cheese: it’s the same color, it’s the same shape and size, it feels the same… etc. We tried different colors of jello, kix cereal now has a couple different flavors, cheerio shaped cereal like Fruit Loops or Apple Jacks. She said even different types of fruit snacks, etc. Just to desensitize. Different types of ice cream, different types of cookies – she said don’t worry about how healthy stuff is at this point – i mean, still try to get a balanced diet over all – but let him try different snacks, deserts, etc – just to show him not all new foods are scary.

We mix foods we already know with new foods to make them less scary. One example: when we tried new flavors of applesauce he used graham crackers to dip in it and eat off the cracker. He already knows graham crackers. And it was less applesauce at once mixed with something that isn’t scary. Right now we are trying for mac n cheese. He eats most kinds of noodles (macaroni, spirals, spaghetti) with marinara sauce. But won’t try cheese sauce or alfredo sauce or anything. Right now he is helping me make mac n cheese, which I eat, and he puts marinara ON TOP of the cheese sauce on his plate and mixes it in good and then he can eat it. If it doesn’t have marinara he gags. I don’t know why. We have used one of those nut chopper things that you put the food under and hit the top of to chop up crunchier items and mix them in with the food that was new. He loved the chopping. He likes to peel and cut veggies up too. I was amazed he would do this mix in activity because he hates his food to touch. But he did – he crunched up veggie sticks and put them on noodles, today he made crumbs out of cheetos and put them on his mac n cheese. He crunched up the veggie sticks and crunched cheetos into them when the cheetos was new. It was more veggie sticks than cheetos and then they did “puppy dog licks” where they lick their finger, dip it in the pile of crumbs, and lick the crumbs off their fingers. It helped with the taste, texture, etc.

Change the shape of foods. Since he was so worried about packaging, what color or shape things were, since he had such a set idea about what “his” food “looks like”, I started changing the way his foods look. I would cut the waffles with cookie cutters to change the shape – I cut pizza into squares or stars or different shapes. I did different colors of a similar food, I did bigger sizes, smaller sizes. I used fruit cutters to make balls or differently shaped slices out of our fruits. I mixed cut up strawberries and bananas in the same bowl. There are lots and lots of ways to change how food looks.

Another fun thing the therapist did (and kind of gross) is she had like a medium sized mixing bowl and when he put something in his mouth at first they “blow rockets” with them. Like put them in their lips and them blow them (spit them) into the bowl. And call it blowing rockets. Then he is tasting it, touching it, getting it to his mouth for fun. I have done it at home with a few things he was really worried over.
Also just playing with it. Like the mac and cheese, we made smiley faces with it. Because he hates those stickier textures. It helps him to touch them. We did frosting on graham crackers with our fingers, we did jello to squish in our fingers. We did painting with those cheese and pretzel packs you get at the store (the ones where you dip the pretzel or tiny bread sticks into a cheese sauce).

We give him “choices” like do you want to take an ant bite or a birdy bite? Then we move up to a bigger bite – the biggest is a t-rex bite and it’s huge. I will also say “are you going to lick it or kiss it?” or “are you going to take 3 bites or 4?” He feels more in control. If your child has a problem with getting her fingers in the food, or getting their fingers messy, keep a wet washcloth beside her – that helps us too. He doesn’t like the juices or crumbs or whatever on his hands.

We have several things we say when the anxiety starts to get bad. We say things like “what’s going to happen if the taste “surprises” you?” (we never say “if you don’t like it”) I will say things like “is it going to bite your nose? Are you going to explode? Is it going to hurt you somehow?” and he laughs and says no and then it breaks the concern and he feels better about it. Important- if you seem frustrated and anxious (which I always was about food) he will get frustrated and anxious. He has to see that it’s just food. It isn’t a big deal. It’s just fuel for our bodies. Help your child take the control factor out of it without you being in control – that can lead to more issues later on – anorexia and stuff. It’s JUST FOOD. It’s no big deal. That’s how we approach it now.

My goal is to have him eating something he can take for lunch next year. We aren’t there yet. I mean, he could take stuff. I have plenty of “meals” I have made up over the past couple years – crackers, cheese, cucumbers, a fruit. And at camp for a few weeks this summer he took spaghetti and ate it cold. But a sandwich or a wrap would be awesome. He won’t be buying hot lunch for a while, I guess. Maybe on pizza day if it’s the right brand

It sounds like a lot of work. At first I was like ????? After our first appointment I was so stressed out. It felt like something I just couldn’t do. Changing the way I have been doing things for the last couple years? How would I manage. I think most families probably eat more meals together and haven’t given up cooking family meals like I did. So some of the work is already done for you. It will be the playing, the steps, the waiting until he/she is comfortable with the food to actually have them taste it. That part is the work. But it’s worth it. Yesterday my son ate meat at food therapy. Real meat. That wasn’t pureed into his marinara sauce. I am going to start pushing him a little more, start really trying new things. Soon, he will be eating stuff I never imagined he would eat. Then this morning when he went to give his dad a hug and his dad had been eating a piece of cheese on toast, he freaked out that his dad’s fingers were dirty and getting “that yucky food” on him. We still have work to do. LOL

Remember, this might not seem like it needs to be so anxiety ridden to you. You may not understand WHY your child can’t just eat normal foods. You may not understand why one food is just fine and another is not. But you don’t have to understand. Just try to be kind, don’t force, and remind them it’s JUST FOOD.

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