Say What?

I love talking with my son, Josh. He has such interesting perspectives and the way he verbally expresses himself gives me insight into how he thinks and processes information. When he was young, Josh had some difficulty remembering words so he would use descriptions to get his point across. He once described his ankle as "you know, that part that's like the wrist of your leg". He tended to use vague words such as "thing" and "that" rather than specific word labels. Despite the circumlocutions, I could always tell what Josh was talking about. Since Josh struggled to recognize many nonverbal signals and had to be taught how to use appropriate body language when he interacted, I could never take it for granted that Josh would just pick up on social cues and be able to express himself adequately. He could learn how to interact with other people, but he had to be taught specific discrete skills for social interactions. For my daughters, social skills came naturally and they just seemed to intuitively know how to relate to others. For Josh, it was like being in a foreign land where everyone else seemed to know the language but he struggled to learn basic communication and was vulnerable to being frequently misunderstood. I did speech therapy with Josh to work on conversational turn-taking, topic maintenance, and nonverbal ways to let a listener know he was interested. Unfortunately, Josh often was not interested in what others wanted to talk about, so then I had to teach him about being polite and a good friend by sometimes letting someone else take the conversational lead. Once Josh had some of the basic skills for social interaction and was able to express himself more effectively, he continued to practice and fine tune his communication exchanges. I noticed that Josh often did not respond when given a compliment. Outside of the family, Josh didn't get many positive comments so he didn't really know how to respond when it happened. I talked to Josh about possible responses and we role-played several situations together. After our practice session I reminded Josh that he had lots of strengths worthy of compliments so it was good that he was learning how to respond to them. Josh informed me that "Vanity was never my strongest weakness." Say what? After some probing (they don't call me the Momster for nothing) I was able to help Josh expand his message so that I could understand what he meant. His intention was to indicate that although he was aware that he had many significant challenges, being vain was not one of them. Therefore, he needed some help in learning how to respond to compliments. Even today, Josh comes up with some unique responses that catch me by surprise. Just this morning our dogs were playing and one of them ran over and stood next to me. I said, "Look, Josh, she's on base." After a brief pause, Josh jokingly said, "Then I'll be lead guitar." Say what? Translation: "base" sounds like "bass" as in a type of guitar. What's a band without both bass and lead guitars? Josh was making a play on words, and at least now he understands what I say and makes a deliberate choice to joke and say funny things.

Picky Eaters

If you have a picky eater, you’ve probably heard comments such as “Don’t worry, she’ll eat when she’s hungry” or “All young children are picky eaters.” While these statements may be true of most typically-developing children, some kids take picky eating to the extreme and mealtimes are miserable for all involved. There are some children who can refuse foods indefinitely, long past the point when most would respond to hunger signals. Others eat such a limited number of food items that their diet is extremely restricted to just a few accepted foods. Some children insist on using the same plate and cup each time they eat. Many children with feeding aversions often resist even a change in the brand of foods they will eat. Is picky eating just a normal part of childhood? For some, it is far more than a developmental stage and can become a serious concern for the family.

A friend of mine went into a panic when she learned that the only brand of frozen waffles that her son would eat was being discontinued by the manufacturer. In desperation, she went to several stores to stock up on that particular brand of waffles while feeling anxious about what her son would eat when one of his regular, accepted foods was no longer available. This little guy had multiple allergies and would only eat a few different foods. His parents were obviously very worried about his nutrition, and the more they pushed their son to eat, the stronger the resistance they encountered. Mealtimes, which his parents had hoped would be an enjoyable time of togetherness, instead became a battleground fraught with stressful interactions.

Feeding aversions and extreme picky eating can have a number of underlying physical causes. A child who has been on a feeding tube may not have developed the muscle coordination needed for eating. They may have to be taught how to bite and chew foods. Without adequate feeding skills, children may resist foods that seem too challenging to them. Some children stuff their mouths with food or just mash food using the tongue instead of moving the food to the molars to chew. These children may experience gagging and choking, which can lead to avoidance of foods in the future. Swallowing large pieces of food can also lead to physical discomfort after meals.

Prematurity, allergies, aspiration, reflux, and other physical issues can all contribute to extreme food selectivity in children. Many children, such as those with autism spectrum disorders (ASD) or attention deficit hyperactivity disorder (ADHD), have difficulties processing and regulating input, including the taste and textures of a variety of foods. Sensory processing dysfunction (SPD) can cause a child to become squeamish just at the sight or smell of certain foods. Some children will only tolerate foods with specific textures. Children with feeding aversions may eat chicken nuggets from a certain fast food restaurant but refuse chicken nuggets prepared at home. It is puzzling and frustrating when children refuse to eat or have strong reactions just at the mere sight of a food that they don’t typically consume.

One mother told me that her son’s feeding aversions made it difficult to go out to a restaurant or another family’s home for a meal. His limited repertoire of accepted foods left his devoted mother trying to explain to others about her son’s strong reactions to smells and textures of foods. She worried about his nutrition and was baffled by his refusal to try new foods. She tried strategies that worked with other children, but her son seemed impervious to them all.

When is it time to seek help for a picky eater? One indication is when a child consistently refuses food or only eats a limited number of foods. For example, a child who eats no fruits or vegetables is missing entire food groups and may have difficulty getting adequate nutrition. Some children do not drink enough fluids and are poorly hydrated. A child with repeated respiratory infections may be at risk for aspiration, with food or liquid entering the lungs. Over time, a child with feeding challenges may develop behavior problems related to eating such as crying and gagging when offered a meal or snack. When eating problems are interfering with a child’s health and family activities, it can be helpful to consult with a feeding specialist or feeding team.

A feeding team consists of a group of professionals with expertise in the various aspects of feeding and nutrition. It may include some or all of the following: primary care physician, dietitian, gastroenterologist, psychologist, speech/language pathologist, and occupational therapist. At a feeding clinic, the initial evaluation will gather information through parent interview and observation of the child when presented with a variety of foods and drinks. These professionals work with the child and family to determine ways to meet nutritional needs and expand the child’s diet to include a greater variety of foods.

Feeding aversions and extreme picky eating are far more complicated than mere childhood whimsy. Feeding problems can interfere with a child’s health and affects the entire family. When every meal becomes an ordeal, there’s a problem. Treatment usually progresses slowly, but over time feeding aversions can be lessened, diet expanded, and health improved.