Book SummaryHelping Your Child with Extreme Picky Eating, by Katja Rowell and Jenny McGlothlin

1-Page Summary1-Page Book Summary of Helping Your Child with Extreme Picky Eating

Understanding a Kid's Unique Eating and Developmental Challenges

This section explores the spectrum of typical feeding behaviors in children, including the many ways that children can vary within a normal range. Then you'll examine some of the common medical, physical, sensory, and behavioral challenges that contribute to extremely picky eating (EPE), as well as how those challenges may be exacerbated by misunderstandings or misinterpretations of a child's behaviors and growth.

Recognizing Typical Patterns in Kids' Eating

Before we look at issues that may contribute to extremely picky eating, it can be helpful to realize that even typical eating can seem unpredictable and inconsistent. Knowing what is normal helps you to tease out if and where your child may be struggling. The variability in intake, development patterns, and developing skills is as individual as each child.

Variations in Children's Eating, Growth, and Mouth Development Are Normal

Many parents are concerned about how much their child eats and how they're growing, fearing the child might not consume sufficient food to support healthy development. The authors explain that children's food intake and growth isn't as straightforward as current guidelines and charts might imply. For instance, it's typical for young kids to skip balanced meals every day. For instance, they might consume nothing but fruit for one meal and then only have noodles at another.

In addition, children's growth occurs in stops and starts, and their patterns don't always follow the smooth curve on the medical charts. While it’s crucial to monitor your kid's development over the long term, if their weight or height is consistently at a lower percentile, that doesn't necessarily indicate an urgent problem. Rather, some children will naturally be of a smaller or larger size than the average, just like adults. The authors caution parents to keep the big picture in mind when considering their child's physical development. For example, if your kid is petite but otherwise doing well and growing steadily, that's likely indicative of healthy development. They advise using weight-to-length ratios to monitor development until age three, rather than relying on BMI, which can be misleading.

The typical process of learning to eat takes time, and it's not unusual for an infant to gag while exploring new textures as he transitions away from breast milk or formula to purees and then to more solid fare. During this learning process, gagging defends their airway by preventing them from swallowing anything prematurely, prior to adequate mastication. As a child's mouth muscles develop, and with more opportunities to practice chewing, the gag reflex is activated further back on the tongue, and even if a child gags, he usually recovers quickly and continues eating.

Other Perspectives

• Some experts argue that consistent patterns in eating and growth can be established through routine and structure, which may counter the notion that these aspects are not straightforward.
• The use of standardized growth charts allows for a common language and reference point among healthcare providers, which can be important for early detection of growth disorders or nutritional deficiencies.
• Some children who are consistently at a lower percentile for weight or height might experience social or psychological challenges, such as bullying or low self-esteem, which should be addressed alongside physical health considerations.
• It's essential to recognize that environmental factors, such as socioeconomic status and access to nutritious food, can also influence a child's growth and may contribute to them being smaller or larger than average, which may require intervention.
• Focusing solely on the big picture might lead to a lack of timely interventions for developmental delays or nutritional deficiencies that could have been addressed with earlier recognition and treatment.
• Relying solely on weight-to-length ratios until age three might miss early signs of potential health issues that could be identified through other measurements or assessments.
• It's essential for caregivers to be educated on the difference between gagging and choking, as the latter is a serious and potentially life-threatening situation that requires immediate action.
• Gagging is not always an effective defense against aspiration, as silent aspiration can occur without a gag reflex being triggered, especially in children with certain neurological or developmental conditions.
• While it's generally true that the gag reflex moves further back on the tongue as mouth muscles develop, this is not a uniform process and can vary significantly from child to child.
• In certain cases, frequent gagging could be indicative of underlying issues such as oral motor skill delays, sensory processing disorders, or anatomical anomalies, which might require intervention from a specialist.

Identifying Challenges Contributing to Intense Picky Eating

For most kids, refusing diverse foods is not just willful or bad behavior. Rather, multiple challenges can make learning to take pleasure in diverse foods particularly difficult. These challenges include medical issues, problems with mouth and muscle skills, sensory processing differences, and temperament considerations. This section will help you recognize those challenges from your kid's perspective.

Handling Health Issues Causing Discomfort During Eating

Rowell and McGlothlin explain that extreme pickiness in eating, or EPE, is sometimes caused by underlying gastrointestinal or other medical problems in a child. If eating causes negative sensations like pain, nausea, or difficulty breathing, a child makes the connection that eating is uncomfortable, or even scary, and learns to avoid those foods or situations that trigger the pain or discomfort. Some medical conditions that may lead to kids' resistance to eating include allergies,...

Helping Your Child with Extreme Picky Eating Summary Recognizing Parents' Role in Improving Mealtime

When children struggle with eating, parents can easily blame themselves. Even if you haven't directly forced your child to eat, you've likely tried other recommendations you now recognize as pressure. In this section, you'll explore the many ways that adults who love and care for children may unintentionally make feeding more difficult, and you'll discover approaches that can support your efforts to guide your child toward more competent and happy eating.

Parental Anxiety and Worry Drive Unhelpful Ways of Feeding

Parents with children who have eating difficulties understandably feel anxious, especially when they are bombarded with messages from doctors, family, friends, and parenting books about what they are doing wrong with feeding, and aren't getting realistic and useful help. The authors explain that feeding fears and worries can begin with misconceptions about nutrition or a misunderstanding of the child's growth patterns. These anxieties can in turn contribute to approaches that make the feeding relationship more strained and hinder the child's eating success.

Nutrition Fears: Role in Pressure and Battles for Control

When nutrition goals dictate feeding, it...

Helping Your Child with Extreme Picky Eating Summary Implementing the STEPS+ Approach to Address Picky Eating

Authors Rowell and McGlothlin, based on years of experience and knowledge, have created the Supportive Treatment of Eating in PartnershipS (STEPS+) method to help parents and families overcome feeding problems in a realistic and sustainable way. This approach is based on knowing the typical way children learn to eat and how parents can support their progress, honoring the fact that individual children's requirements and rates of progress will differ.

Reducing Conflict and Relieving Stress and Pressure

The first step in STEPS+ involves addressing anxiety and stress, both in the child with extreme picky eating and in the parent. Lower anxiety will make for happier mealtimes and, more importantly, will enable your child to reconnect with his innate sense of appetite.

Managing Parental Anxiety About Your Kid's Diet

The authors recognize that reducing anxiety may feel impossible to the parent who has spent months, or even years, worrying about her child's growth and nutrition. The initial step is learning to accept your child's current eating habits. This doesn't imply you will never see a balanced meal or hear her ask for more; rather, it means that you trust her desire...

Helping Your Child with Extreme Picky Eating Summary Building Child Capabilities and Determining if Treatment Would Help

This section provides you with specific tips to aid your child's advancement with eating skills by focusing on mouth movement and sensory input. In the latter part of the chapter you’ll review approaches to feeding therapy, suggestions for finding the right provider, and red flags of counterproductive therapy.

Opportunities to Practice Eating Independently and Build Oral Skills

Here, you’ll explore the many ways that you can, by changing the way you present and prepare foods, encourage your child's development of oral-motor skills and sensory awareness, along with her capacity to safely and confidently handle and explore different foods.

Support Tools and Techniques for Chewing, Drinking From Cups, and Investigating Foods

Rowell and McGlothlin offer a wealth of ideas for supporting your child’s eating, from using non-traditional dipping devices like wooden craft sticks, to adding crunch to a favorite fruit, to letting your child mash his own food. The best way to help your child develop a broader taste for different foods is to make sure you serve foods that he is capable of managing and enjoying at his current developmental level. You can use the sample list of...