Diet Archives - North Shore Pediatric Therapy

Food Milestones: From Mashin’ to Munchin’

in Birth-3, Development, Diet, Feeding, Nutrition, Parenting

Mealtime and achieving food milestones can be a stressful time for many families, especially for those whose kids demonstrate difficulty consuming a variety of flavors and textures. Instead of stressing over consuming those calories and pumping on the weight, take time to relax and enjoy a meal. Take away the stressors from your day and use mealtimes as an opportunity to bond with your little one. There is great variety in the development of infants and toddlers due to differences in the rate of physical and mental development as well as how often these skills are promoted by caregivers. As children develop their preferences for different foods (tastes & textures), they learn to accept or reject specific foods, which is OKAY!

The old mother’s tale “you can’t get up until you finish your peas” has proven to be an ineffective way to have children smoothly go through the realm of trying different foods. Instead of “forcing” your child to eat different foods, give them options…”you can eat 5 or 6 peas…you pick!” Give great verbal praise despite how big of a gain the child has made that meal.

Please see the developmental chart below that guides you through a variety of food milestones while providing ideas on how to keep mealtime positive!

Age	Strategies and foods that should be introduced	Tips and Tricks
Birth-2 months	Nipple feeding by breast or bottle Semi-reclined position during feeding Foods: Breast milk or formula (approx. 18-28 ounces)	Sing songs or tell stories while you feed your infant, build a rapport
2-3 months	Start forming a consistent schedule Foods: Breast milk or formula (approx. 25-32 ounces)	Make silly faces with your infant, make meal time a reciprocal relationship
3-4 months	Infant starts to put hands on bottle during feedings Foods: Breast milk or formula (approx. 28-39 ounces) ˷4 mo, rice cereal trials	Always avoid television or electronics during meal time, practice songs or rhymes Have your infant sitting at the table during adult meal times
5-6 months	Start to introduce pureed spoon feeds Tongue will continue to “mash” the food to consume Foods: Breast milk or formula (approx. 27-45 ounces) Overly ripe fruits/vegetables Oatmeal Rice or wheat cereal	Puree a food that you are having for dinner to make it easier with food preparation
6-9 months	Moves to a more upright position during feeds Helps caregiver with moving spoon to mouth Foods: Breast milk or formula (approx. 24-32 ounces) Sweet potato mash Cottage cheeses Puff cereal bites	Encourage infant to hold bottle independently Think of a variety of different flavors to introduce, even mix flavors based off babies preference Take small trials of foods from your plate to give baby to try
9-12 months	Progresses from pureed to more textured food Increases finger feeding Introduction of straw based cup or open cup Moves to a more “munching” formation with jaw and tongue Foods: Breast milk or formula (approx. 24 ounces) Egg-free noodles Variety of fruit/vegetables Mild cheese slices	Offer new foods without the expectation of eating the food (he/she can poke, smell, lick, etc) Always offer small portions on a child sized bowl or plate (don’t overwhelm)
12-18 months	Grasps utensils and self-feeds Complete transfer from bottle to straw based cup or open cup Foods: White potato mash Chicken Beef Beets	Offer foods of different textures: pudding, soup, crackers, mashed sweet potatoes, etc Have child come with you to the store to pick out their “special cup” to encourage discontinued use of nipple based bottle
18-24 months	Primarily self-feeding Able to chew different textures and flavors Foods: Eggs Lentils Beans Cantaloupe	Never ask a child “Do you want ____” because you will have to respect if they say “no”
24-36 months	Holds open cup independently Eats a wide variety of solid foods Foods: Cleared to try any food	Have your toddler “get messy” with their food, spread the different textures on their hands, face, or even nose
Continuum into childhood	Continue to use choices to give your child the “control” during mealtimes	Have your child participate in mealtime prep as much as possible

Remember, mealtime goals shouldn’t be about consumption, but about a positive experience for the child. Always consult your pediatrician about diet concerns or questions.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

References:

Developmental Stages in infant and Toddler Feeding., Infant & Toddler Forum., 2014.

McCarthy, Jessica., Feeding Infants & Toddlers: Strategies for Safe, Stress-Free Mealtimes. Mosaic Childhood Project, Inc., 2006.

1998, The American Dietetic Association. “Pediatric Manual of Clinical Dietetics”. 1998.

Should Your Child with Autism Avoid Gluten?

in Aspergers, Autism, Autism Spectrum Disorder, Diet, Health Topics and Conditions Database, Nutrition, Parenting

The Atkins Diet. Weight Watchers. Paleo. Coconut oil. Gluten Free. Casein Free. You may be familiar with some of these diet trends. People are constantly on a quest for the perfect diet that will shed the pounds and keep them off. Others are looking for diets that regulate their digestive systems and keep their stomach calm. And if you are a parent of a child with autism, you may have heard people maintain that a gluten-free or casein-free diet can be used to help manage behaviors associated with autism.

With the idea of placing a child on a diet for management of symptoms, many questions arise. Does a gluten-free diet make a difference for children with autism? What does the research say? How do you know if it’s working?

Let’s back up a little bit and look at why specific diets for children with autism are being considered. Gastrointestinal problems are often described in children with autism, however the prevalence of these issues has not been consistently proven to be higher than in the general population.

Unfortunately for the sake of determining benefits of a gluten free diet, every child with autism presents differently and will likely have different responses to dieting. Also, unfortunately, the literature is extremely limited and providing conclusive evidence that a specific diet improves behaviors associated with autism has yet to be done. Some studies have yielded positive results (improvements in symptoms), while others have yielded negative results (no improvements noted). It is important to note that none of these studies have provided conclusive evidence; studies reporting positive results were merely suggestive (the lowest level of certainty).

Now you may be thinking, what will it hurt to place my child on a gluten-free or casein-free diet? According to Mulloy et. al, these diets may put children at risk for nutritional deficiencies. Further, this population of children often encounters challenges to ingesting a typical diet to begin with, such as sensory processing difficulties that lead to limited food intake and restricted diets. This can make feeding your child difficult if they are already only accepting chicken nuggets and string cheese. Additionally, implementing a diet of this type is costly and time-consuming.

Should you decide to try a gluten-free diet for your child with autism, here are some important things to remember:

Keep objective measures: It will likely be hard for your child to accurately report how they feel given commonly associated language deficits in children with autism. Ask yourself, “How do I know that my child’s sleep is improved?”, or “How do I know that attention is improved?” Find a way to measure data for these questions, such as counting naps taken each day or minutes spent engaged in a task.
Involve others: Ask for help from people that spend a lot of time with your child. Ask them to objectively measure behaviors as best they can, and seek their results.
Keep a food diary: Track what your child eats for every meal, and any notable behaviors or improvements for each day. This ensures accurate implementation of the diet and gives you the ability to reflect on the weeks and months.
Be committed: In a systematic review, more positive results were yielded with longer implementation of the diet. For example, studies yielding negative results were implemented for an average of 5 weeks while studies yielding positive results were implemented for an average of 18 months.
Keep other factors in mind: It is challenging to prove that improvement is due to one factor vs another. For example: If your child experiences improved sleeping patterns, perhaps eliminating sugary foods in general is the cause as opposed to the removal of gluten. Always think twice before determining cause, and consider all potential variables at play.

If you are exploring diet options for your child, seek the guidance of a dietitian or nutritionist to ensure healthy implementation.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

References:

Mulloy, A, et al. Gluten-free and casein-free diets in the treatment of autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders (2009), doi: 10.1016/j.rasd.2009.10.008
Buie, T. (2013). The relationship of autism and gluten. Clinical Therapeutics, 35, 578-583.

Top Warning Signs of Anorexia Nervosa

in Diet, Mental Health, Parenting, Social Work

Anorexia is term that is often loosely thrown around to describe someone who is skinny or overly weight-conscious, however there are clear criteria that characterize this serious disorder. According to the Diagnostic and Statistical Manual for Mental Disorders V, Anorexia Nervosa diagnostic requirements include:

–Restriction of energy intake leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health

–Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain even though at a significantly low weight

-Disturbance in the way in which one’s body weight or shape is experienced, undue influence on body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

If you are concerned that a loved one exhibits harmful/restrictive eating habits, low body image, and obsesses about thinness check the facts outlined by the National Association of Anorexia Nervosa and Associated Disorders regarding the presence of Anorexia:

-deliberate self-starvation with weight loss

-intense, persistent fear of gaining weight

-refusal to eat or engages in restrictive eating patterns

-perpetual dieting

-excessive facial/body hair due to the inadequate consumption of protein

-abnormal weight loss

-abnormal hair loss

-absent or irregular menstruation

Consult your family physician or schedule an appointment with a mental health provider if these symptoms develop or persist for effective treatment options.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

Picking Apart the Picky Eater: 5 Tips to Address Your Child’s Problem Feeding

in Diet, Feeding, Nutrition, Parenting, Sensory Integration

In an era with Whole Foods, Paleo diets, and organic produce at our fingertips, how do we improve a child that is a picky eater? Modern day life can be hectic and as the result feeding may reflect fast, convenient options that taste good but are not always the most nutrient-dense. So, how does one correct picky eating to support a more balanced diet?

5 Tips to Address a Picky Eater

Re-create expectations around feeding. Eating does not just have to be about pleasure, it can be about sustenance, nutrition, and a time for social interaction/community. To frame feeding in terms of just for pleasure, we overemphasize the role of taste in our feeding practices; if it doesn’t taste good or initiate our pleasure receptors, we shouldn’t eat it. Really, we eat for a variety of reasons and taste can be one of them. If we re-create our expectations to encompass eating for nutrition, sustenance, as well as taste it can become easier for your child to engage with non-preferred, more healthful foods.
Motivate compliant behaviors through incentives. Feeding is a behavior just like any other so if you want to target increased compliance with eating certain foods, provide incentives to encourage the desired behavior. For example, if your child refuses to eat vegetables with dinner, create a log that tracks compliance with trying at least 3 bites of the non-preferred food. Upon completion of the bites, the child can get a sticker, equating with a long-term prize at the end of the week for compliant behaviors or result in shorter-term gratification which can look like being served dessert. Identify what may motivate your child the most to get through challenging tasks and work with this to create investment towards a new mode of eating. The 3-bite rule can help the child also determine if this is truly a food they like or not as they engage with it more.
Debunk negative thinking. Chances are your child’s refusal of food is due to negative thoughts around how they perceive the food to taste or impact them. For example, if a child fears that a food will make them gag, taste disgusting, or make them sick, it would make sense that they would want nothing to do with these foods. The fact of the matter is, there may be limited to no evidence supporting these interpretations so it is important to challenge or debunk this negative thinking. If the child asserts that they don’t like broccoli, inquire about what they believe will happen to them if they eat it. Will they gag? Will they dislike the taste? Will it make them sick? Likely, they will report they just won’t like the taste. If that is the reality, this is a small problem that they can overcome with practice, perseverance, and supplemental positive thinking. Thinking that broccoli is just “ok” but nothing bad will come as the result can facilitate easier engagement and consumption with the non-preferred food item.
Pair foods together. No one says that a meal will only consist of just preferred or just non-preferred foods so it is important to teach balance This can look like pairing favored foods with non-favored foods to emphasize this point; incorporating chicken nuggets with vegetables or fruit instead of French fries or dipping peanut butter and apples together can make unpleasant foods more pleasurable.
Model. Model. If you want your children to get healthy foods and interact with a balanced plate so do you! Align with your child and demonstrate for them that these foods are good and good for you.

NSPT offers Sensory Processing Disorder (SPD) and Nutrition services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

6 Ways to Get Your Baby to Take a Bottle

in Birth-3, Diet, Feeding, Speech and Language

The American Academy of Pediatrics, as well as many other national and international health organizations, recommend that babies be breastfed exclusively until 6 months of age to ensure adequate nutrition for your baby’s growth and development. However, it is not always possible for a mother to breastfeed, making bottle feeding necessary. If this is the case, and you’re having trouble getting your baby to bottle feed, read on for some helpful tips to get your baby to take a bottle.

6 tips to get your baby to accept a bottle:

Bottle feed your baby when she shows signs of hunger, rather than on a schedule. Your baby may be hungry if she does any of the following:
- Attempts to lie back/get into position for nursing
- Licks her lips
- Opens and closes her mouth
- Moves her head quickly from side to side
- Cries
Stroke baby’s lips from top to bottom with nipple to stimulate rooting response of open mouth. Allow your baby to seek nipple rather than trying to push the nipple in her mouth.
Try using different nipple shapes to see if your baby prefers one over the others.
Make sure the nipple hole is the right size for your baby. Fast flows can cause babies to gag. Slower flows may cause her to suck with too much effort or gulp air.
Burp your baby every 3 to 5 minutes during bottle feedings and hold your baby upright after feedings.
Do not force your baby to finish the bottle. If your baby is falling asleep, remove the nipple before the bottle is empty, as this means she is done.

If you have any questions or concerns regarding your baby’s feeding or nutritional needs, contact your pediatrician or schedule a consultation with a speech language pathologist who specializes in feeding issues.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

Help! My Child Has a Texture Aversion

in Birth-3, Diet, Feeding, Kindergarten-5th Grade, Parenting, Preschool, Speech and Language

“Just take a bite!” “Just try it!” “One bite and you can eat the rest of your food.”

Does this sound all too familiar to you? Do you recognize this battle during mealtime? Your child may have a food texture aversion.

Signs your child may have a texture aversion:

Only accepting a narrow range of food choices
Extreme preference for certain brands of food
Anxiety when faced with a new food item
Inability to eat any foods, including foods regularly chosen within the home, when not at home
Preference toward avoiding food, often for an entire day, instead of trying something new
Difficulty chewing or swallowing
Frequent gagging when served certain foods
Facial grimacing or spitting out foods
Vomiting when new food is introduced
Refusal of food is not related to a food allergy
Prolonged mealtimes

What you can do to help with a texture aversion:

Reactions
- Keep a journal of the types of foods your child eats and his reactions to these specific foods. This list will be extremely helpful for the speech-language pathologist or occupational therapist when taking your child in for a feeding evaluation.
Don’t push
- Don’t reinforce the food aversion. Many parents believe that withholding favorite foods as punishment will force the child to give in, but this will only worsen the problem. Also, promising rewards for trying disliked foods will also reinforce food aversions.
Modeling and fun
- Model the behavior you want to instill in your child by eating a wide variety of foods. Children will often adopt the behaviors they are exposed to. With positive reinforcement your child will reduce stress around new foods. Also, get your child involved in meal preparation. Make playing with new types of food fun. Learn about foods and where they come from. Teach your child how foods help our bodies. Expose your child to new foods or averted foods in a fun, stress-free environment.
Evaluation
- Take your child for a feeding evaluation with a speech and language pathologist or occupational therapist. These professionals will help you determine if further therapy is necessary and can introduce the concept of food chaining to your child.
  - Food chaining is the systematic process of slowly introducing averted or new foods to your child. This should be done with professional guidance.

If you believe your child may have a texture or food aversion consult with a professional feeding therapist. Remember, take the stress out of eating for your child and make eating foods a fun and exciting activity. The goal is to reduce stress for you and your child.

The 8 Best Ice Cream Spots in Chicago

in Around Town, Diet, Parenting, Summer

As we enter August, what better way to remind us that we still have a little touch of Summer left then to list some favorite ice cream shops around Chicago!

While I have not “tested” all of the places listed below, most I have visited and are guaranteed to be delicious!

1) Scooter’s Frozen Custard–Roscoe Village, Chicago

Started by a husband and wife who quit their jobs working in sales, they opened in 2003 and most days you will find a line out the door! There is a “Flavor Schedule” so each day is different (which means more than one visit is needed!). Their “Concretes” are heavenly and big enough to share. Open seasonally, make sure to stop by between March and the Friday after Thanksgiving.

2) Tom and Wendee’s Italian Ice–Lincoln Park, Chicago

I knew when my best friend, who doesn’t eat chocolate, took me here to have the Chocolate Italian Ice that this was a special place! It is open seasonally, March to October. Some favorite flavors are Black Cherry, Chocolate Coffee Toffee, and Watermelon. If you can’t decide, they can do ½ and ½!

3) Capannari Ice Cream–Mt. Prospect

A hidden gem in the suburbs, this place is a true “ice cream parlor”. It is family owned and the ice cream is made on-site. They host a lot of events, especially in the community, which is always nice when local places give back. Their list of “standard” flavors is quite large and there are also rotating flavors!

4) Jeni’s Splendid Ice Creams–Lakeview, Chicago

Having gone to The Ohio State University and having lived in Ohio for many years, I knew about this terrific place before they branched out to other states. Yes, it is a bit pricey, and the flavors are quite unique. Stop in and you will see what is meant by this quote from their website: “Jeni and our kitchen team make every ice cream, sorbet, and frozen yogurt from the ground up with grass-grazed milk, local produce, American bean-to-bar chocolate and select ingredients from around the world”.

5) Original Rainbow Cone–Beverly, Chicago

A favorite at the Taste of Chicago, the rainbow cone, consists of the following flavors all mixed together (in a cone!): Chocolate, Strawberry, Palmer House, Pistachio and Orange Sherbet. Open seasonally from March to November, there are other items on their menu…but why not treat yourself to 5 flavors all together!?

6) George’s Ice Cream And Sweets—Andersonville, Chicago

Ahhhh, with a place so close to home, George’s is certainly a favorite! Their fun, unique flavors are sure to please, especially the Fat Elvis (banana ice cream, peanut butter ripple, and liquid chocolate chips) or Horchata. With plenty of seating inside the shop, you can relax and enjoy your ice cream. BTW, the staff also allows you to “taste” as many flavors as you want…handing you numerous tiny spoons with smiles on their faces!!

7) Homer’s Homemade Gourmet Ice Cream –Wilmette

With so many flavors to choose from, you can’t go wrong!

Another great thing is you can share the fabulous flavors with out-of-towners—they ship via Fed Ex. You can also find it locally in some grocery stores!

8) Paciugo—Lincoln Square, Chicago

I discovered this place as I was walking with friends after dinner and wanted something sweet. To my amazement, their gelato hit the spot! The flavors rotate daily and are divided by category (Milk, No Sugar Added, Soy, Water-Sorbet) so there is something for everyone! The best part is you can do a small cup and choose 3 flavors…and it is 70% less fat than ice cream. Hey, why not order a medium?!?

Click here to get the official scoop on ice cream and nutrition!

Finger Foods for Babies

in Allergies, Birth-3, Cooking, Development, Diet, Feeding, Milestones, Parenting, Speech and Language

How many times have you tried to give your baby a bite of his food and he reaches for the spoon, ready to do it himself? Probably just about every time you feed him. When your baby is about 9 months old, he has begun to develop the fine motor skills needed to start feeding himself. This is often a favorite (and very messy) activity for little ones. It’s important to remember that finger foods for babies don’t have to be bought in the baby food aisle. Many of the things we eat can be adapted for baby! This will reduce your worry about always having something for him to eat as well as expose your baby to a new foods and textures.

Allowing your baby to feed himself as much as possible will help to encourage independent, healthy eating habits. This gives your child some control over what, and how much, they eat. There will be days that he will clean his plate, and there will be days where everything ends up on the floor…but that’s okay! He is learning the process of self-regulation and learning to recognize when his tummy is full.

Rule number 1: Always try the food first.

Here is your finger foods checklist:

Is it soft?
Is it cooked enough so that it’s mushy? Overcook those veggies!
Does it melt in your mouth? (Think puffs or Ritz crackers)
Can you gum it? (i.e. eat it without teeth)
Is it cut into small pieces?

Rule number 2: Give your baby a variety of foods.

It can take up to 10 times for a baby to accept a new food into their repertoire. Don’t give up if the avocado ends up on the floor the first 4 (or 7) times.

Rule number 3: let him get messy!

Food play is an important learning experience. You have similar nerve receptors on your tongue and fingers so playing with food will help your baby experience different textures and temperatures.

With those three rules in mind here is a list of great finger foods to try with your little one!

Bananas-To make bananas easier to pick up, try dusting them in crushed Cheerios first.
Mandarin orange/peach/pear cups.
Grapes without the skin
Blueberries-If they aren’t small enough, cut them in two.
Watermelon (seedless, of course)
Cooked veggies: zucchini, carrots, sweet potato, butternut squash, etc.
Avocados or guacamole
Extra soft pasta
Small pieces of slow cooked or ground meats like meatballs, etc.
Fish
O-shaped cereals
Egg yolks-Once your baby is one year, they can have egg whites too. Try chopping up hard boiled eggs!
Rice cakes
Cheese-Start with something bland like mozzarella or cheddar.
Quesadillas
Waffles and pancakes

Remember, now that your baby is eating these foods, the biggest issue to avoid is choking. Make sure your baby is strapped into his high chair and your eyes are on him at all times when starting these finger foods. Don’t give him any foods that could get stuck in his throat: popcorn, raisins, raw veggies, fruit with hard skin, hot dogs, etc.

Have fun with it! Get creative! And, don’t think you can only give him “baby” food! If you have questions about your baby’s feeding, contact our Speech-Language Pathologists for answers.

IBS Versus IBD: What Is The Difference And How Can Diet Help?

in Cooking, Diet, Nutrition, Parenting

Does your child suffer from gastrointestinal pain, bloating, diarrhea, or even vomiting episodes? Have you researched the symptoms or spoken with your pediatrician? You may have come across the terms IBS (Irritable Bowel Syndrome) and IBD (Irritable Bowel Disorder). These two gastrointestinal disorders can present with similar symptoms, so it may be confusing to decipher what’s really going on at first. However, there are distinct causes and ways of diagnosing them that determine whether a patient has IBS or IBD.

Irritable Bowel Disorder (IBD)

IBD is a term used for two specific gastrointestinal diseases. One form of IBD is Crohn’s disease.

Symptoms– Painful “flare-up” episodes. The pain can occur anywhere in the gastrointestinal tract. The flare-ups cause diarrhea and sometimes vomiting, either of which may contain blood. These episodes may be accompanied by fever and/or fatigue. Weight loss can also occur.

Causes– A variety of factors that trigger an autoimmune, inflammatory response.

How it is diagnosed– A gastrointestinal doctor will perform a “scope” (endoscopy and colonoscopy) of the suspected areas affected in the gastrointestinal tract. This involves being sedated, having a tiny camera inserted into the gastrointestinal tract, and biopsies taken. The doctor can diagnose Crohn’s based on what he or she observes from these tests. If the inflammatory sites are located in patches or varying locations along the gastrointestinal tract anywhere from esophagus to anus, it is indicative of Crohn’s.

Treatment– During flare-ups, doctors will evaluate and may prescribe steroids, antibiotics, pain killers, and a modified diet that is low in fiber and other foods that may trigger inflammation such as lactose. In severe flare-ups, patients may be hospitalized and required to be on bowel rest, which means consuming nothing by mouth. When not having a flare-up, patients with Crohn’s are encouraged to eat a healthy diet with good sources of fiber. “Trigger foods” should also be avoided in general, which may include high fat or fried foods, excessive amounts of dairy, caffeine, and others.

The other form of IBD is Ulcerative Colitis.

Symptoms– Pain and cramping focused in the lower intestines. Diarrhea, sometimes with blood. Weight loss and fever can occur as a result of severe inflammation and diarrhea.

Causes– Inflammation that can be caused by a variety of factors and becomes chronic. Inflammation is in the colon and may progress continuously up the lower intestine.

How it is diagnosed– A gastrointestinal doctor will perform a colonoscopy with biopsies.

Treatment– Similar to treatment of Crohn’s.

Irritable Bowel Syndrome

IBS is a bit more of an ambiguous condition than IBD, and can be difficult to identify and treat.

Symptoms– Abdominal pain, bloating, gas, diarrhea and/or constipation, general maldigestion and discomfort which may or may not be associated with eating any particular foods.

Causes– Definite causes of IBS are still unknown, but are currently being researched.

How it is diagnosed– IBS is diagnosed by closely tracking symptoms and ruling out all other diagnoses.

Treatment– Individualized modifications in diet and lifestyle which differ from person to person and may change over time. Some IBS sufferers trial “elimination diets” where common problematic foods are eliminated (such as wheat, dairy, corn, eggs, soy, etc.) to see if symptoms improve. Another recent diet therapy for IBS is the FODMAP diet, which eliminates high fructose corn syrup, some legumes, wheat, and various fruits and vegetables, among other things.

If your child suffers from IBS or IBD and you would like more guidance on diet therapies, schedule an appointment with a registered dietitian at NSPT. 877-486-4140.

Picky Eater vs. Problem Feeder

in Behavior, Birth-3, Cooking, Development, Diagnostics, Diet, Feeding, Kindergarten-5th Grade, Parenting, Preschool, Speech and Language, Therapy

Eating. What’s not to love? Whether it’s a gooey, cheesy slice of pizza or a warm cookie fresh out of the oven (yum!), let’s face it -humans love to eat. Little humans, ehh not so much. Little ones can be incredibly stubborn when it comes to eating, especially when they’re toddlers. What three year old didn’t go through a phase of just eating her go-to; whether it was mac-and-cheese, hot dogs, or PB&J. Many parents have said the words “picky eater” in reference to their child’s eating habits, but it’s important to know the differences between your run-of-the-mill picky eater versus your problem feeder.

Problem feeding is not a normal part of child development. Feeding problems are estimated to occur in up to 25% of normally developing children and in up to 35% of children with neurodevelopmental disabilities. A common definition for feeding problems is “the refusal or inability to eat certain foods.” Feeding problems can lead to serious medical issues such as malnutrition, dehydration, and impaired intellectual, emotional and academic development. Because of these potential impacts on the child’s development, early recognition and management are critical.

The table below can help you determine if your child’s eating skills are following a normal trajectory or further evaluation is needed:

Picky Eater	Problem Feeder
Eats a decreased variety of foods, usually around 30 foods	Eats a restricted variety of food, usually 20 or fewer foods
Foods lost due to “burn out” (i.e. one too many hot dogs = refusal) are typically incorporated back into the child’s diet after about 2 weeks	Will eat food over and over again like a picky eater but once they burn out, they will not incorporate that food back into their diet
Can tolerate new foods on their plate, will touch or taste a new food even if they aren’t really excited about it	Crying/screaming/melt-down mode if a new food is on their plate and will not tolerate touching or tasting
Eats at least one food from most food group textures (e.g. crunchy, soft, puree, etc.)	Refuses entire categories of food textures
Will eat a food after being exposed to it at least 10 times	Will not try a new food after 10 or more exposures
Sometimes reported as a “picky eater” at pediatric wellness visits	Persistently reported as a “picky eater” at pediatric wellness visits

What to do if you suspect your child is a picky eater:

Always eat with your child. Eating is a social experience! If your child is expected to eat alone he may feel left out or neglected. (“Why do I have to eat if no one else is?”)
Stick to a routine. Give your child three meals and two snacks at the same time each day (or about the same time each day, let’s be realistic here). Offer juice or milk with his meals, not in between, to avoid filling up his tummy and decreasing his appetite. Offer water in between meals to quench his thirst.
At meal times, always offer him one to two preferred foods (i.e. hot dog, chicken nugget) and one new food. When he sees his preferred food, he will feel more comfortable with his plate. Try to make the new food something you’re eating as well.
Always talk positively about food! Even if you don’t like something, do your very best not to talk negatively about it. For example, “Mmm, these sweet potatoes are so yummy!” NOT “Ugh, these potatoes are mushy and gross!”
Make it fun! Get some different dips out for his chicken nuggets – ranch, BBQ sauce, ketchup, mustard! Cut sandwiches out with a cookie cutter. Use food coloring. Serve breakfast, for dinner!
Have your child help! Let him pick things out at the grocery store. Have him wash the vegetables or fruit. Let him mix up the batter.

What to do if you suspect your child is a problem feeder:

Contact your pediatrician and explain what you’ve been noticing about your child’s eating habits.
Your pediatrician may refer you for a feeding evaluation run by a multi-disciplinary feeding team (speech therapist, occupational therapist, nutritionist, physician, psychologist/behaviorist) to determine if in fact your child has a feeding disorder and next steps.

Works Cited:

Sisson LA, Van Hasselt VB. Feeding disorders. In: Luiselli JK, editor. Behavioral Medicine and Developmental Disabilities. New York: Springer-Verlag; 1989. pp. 45–73.
Palmer S, Horn S. Feeding problems in children. In: Palmer S, Ekvall S, editors. Pediatric Nutrition in Developmental Disorders. Vol. 13. Springfield: Charles C Thomas; 1978. p. 107–129.
Feeding problems in infancy and early childhood: Identification and management
Debby Arts-Rodas, Diane Benoit
Paediatr Child Health. 1998 Jan-Feb; 3(1): 21–27.