When I sat down with some friends for lunch recently I didn’t expect to spend much of our time together discussing feeding therapy and Charlotte’s Day, but that is exactly what happened. I love sharing information about Charlotte’s Day and I jump at the opportunity to get in a humble brag. At first the questions ranged from how many chairs have we sent out, what are the families like that we work with, and of course, tell us about the kiddos. After a while, the conversation turned to a familiar topic. Will Charlotte grow out of this? I didn’t even know something like this was an issue. Finally, the biggest questions, the questions that I am sure every one of my problem feeding families have heard again, and again: Aren’t all kids picky? What if you just let her refuse to eat? She looks fine. Sounds like a control issue to me.
When we first began noticing issues with Charlotte’s feeding these questions would cause me to completely shut down. Overwhelmed by every meal and struggling to find answers, it was like my brain short-circuited. The best I could muster was, I don’t know. We knew something wasn’t right but no one, not family, physicians, or friends, seemed to know the answer or had even heard of this issue.
When I say we tried everything to get Charlotte to eat, I mean we tried everything. Begging, coaxing, tricking, bribing, and if all else failed, yelling. I will say now those aren’t my proudest moments.
I have some answers to those questions now. I am even somewhat surprised that I am able to explain what we learned in a way that someone can understand.
This is a short list of my go-to responses when pressed on Charlotte’s eating.
Isn’t it just a control issue?
Nope. Charlotte had underdeveloped oral motor skills. These skills that we all develop at some point made eating difficult and caused her to tire easily.
Well, she looks normal.
Charlotte does look “normal”. While she has come a long way from her first days in feeding therapy she is still somewhere around 3% on the growth chart. This is Charlotte’s normal range and has been once we were able to understand her feeding. Most likely Charlotte will always be on the smaller side, however, we have learned what works for her, how much food intake she needs and how best to have uneventful meals.
All kids are picky, aren’t they?
This is one of my favorite questions, as I could drone on forever and site multiple books, websites, and blogs. Most of the time people aren’t looking for a lecture so I try and keep it somewhat short.
The difference between a picky eater and problem feeder is well documented and a cursory search will produce a treasure trove of information. Since we went through feeding therapy at STAR Institute with Dr. Toomey, I typically use her description. Picky eaters can tolerate new foods on their plate, while problem feeders “fall apart” when new foods are presented. Problem feeders typically eat less than 20 foods, they refuse entire categories of food textures and almost always eat differently than the family. The biggest difference we noticed with Charlotte was lost foods. Foods she once loved were lost from her food list and not regained, continuing to decrease the number of foods she would tolerate. Picky eaters, on the other hand, will typically re-gain these foods after a two-week break. While I would agree that a fair number of kids are picky, there is a qualitative difference between a picky eater and a problem feeder.
For more information about the knowledge I have gained from Dr. Toomey and the team at Star Institute you can use the following link:
When will she grow out of it?
Through therapy, Charlotte fully developed her oral motor chewing abilities and improved upon her ability to engage with new foods and overcome her sensory aversions to some foods. Our current understanding is that Charlotte won’t really “grow out” of her sensory issues around food, but we can work to improve her experience around meal-time, continue to support her as she explores new foods and continue to help her develop strategies for tackling these “hard to handle” foods. While Charlotte has come a long way, we still experience trouble spots. Even foods she eats readily at home can be a problem when we are away from home. Different preparation methods, textures, or environments can cause her to push away from the table. We continue to work on exploring varieties of the same foods and adding new foods to her growing list.
What does she eat?
While it might not seem like it, this is a tricky question. As the dad of a problem feeder, I have in my mind nearly an exact list of the foods Charlotte will eat and if I were going to name them all the list would be quite extensive. When we started feeding therapy with Charlotte her list of foods was around 16, and we were at risk of losing any item on that list any day. I say it is a tricky question because now the list sounds somewhat normal. What I can’t always convey is the amount of work that went into these successes. We have worked exceptionally hard to add to Charlotte's list of foods. She enjoys a variety of foods now and we have a list of “family meals” that we can all eat together which was unheard of only a short time ago.
What if you let her refuse?
If you have a problem feeder you have probably heard, “kids won’t starve themselves.” Yes, actually, kids with feeding issues can starve themselves, unintentionally. Children that have developed the skills necessary to properly feed themselves won’t typically starve themselves. They will occasionally miss a meal, or eat less, but they will almost always fill up the next time they have a chance. Our second daughter is exactly like that. If she east a little less than normal at breakfast, lunch or dinner, she will almost always make up for it later on. Charlotte was not like this at all. Given the chance to skip a meal, she would jump on it. At the next meal, she would eat the same little portions as a normal meal, and she never seemed to make up for the skipped meal. It became much worse if she fell ill. We all have experienced a lack of appetite while sick, so consuming less is to be expected. However, Charlotte would quickly lose weight during her illness and then that lower weight would become a new starting point. Neither of us can remember Charlotte saying she was hungry until she was 4 or so. I think given the opportunity, she would have skipped as many meals as we would have tolerated. Charlotte would not have starved herself intentionally, but she very easily could have if we had adhered to that outdated feeding myth.
I frequently have to answer these questions regarding Charlotte and have for a long time. The more I learn about problem feeders, picky eaters and the spectrum that separates them, the more I am able to answer these questions.
Let us know what questions you get asked, how you answer them, and what reactions you have experienced.