Food issues are very common with adopted and foster children and are one of the most frequent concerns adoptive and foster parents have. We will address common food issues and provide practical suggestions for parents to implement to help their child. Host Dawn Davenport, Executive Director of Creating a Family, the national adoption & foster care education and support nonprofit, interviews Dr. Katja Rowell, The Feeding Doctor, and author of Helping Your Child with Extreme Picky Eating and Love Me, Feed Me as well as Kate Miller, Feeding and Disability Specialist at SPOON, an NGO focused on eradicating malnutrition for children who are isolated from their communities due to a disability and those living in orphanages and foster care.
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Food issues are very common with adopted and foster children and are one of the most frequent concerns adoptive and foster parents have. We will address common food issues and provide practical suggestions for parents to implement to help their child. Host Dawn Davenport, Executive Director of Creating a Family, the national adoption & foster care education and support nonprofit, interviews Dr. Katja Rowell, The Feeding Doctor, and author of Helping Your Child with Extreme Picky Eating and Love Me, Feed Me as well as Kate Miller, Feeding and Disability Specialist at SPOON, an NGO focused on eradicating malnutrition for children who are isolated from their communities due to a disability and those living in orphanages and foster care.
Please leave us a rating or review RateThisPodcast.com/creatingafamily
[inaudible].
Speaker 2:Welcome to creating a family talk about adoption and foster care. Today we're going to be talking about practical solutions to typical food issues with adopted and foster kids with doctor[inaudible] Rao. She is a family medicine doctor who goes by the name of feeding doctor and she's also the author of helping your child with extreme picky eating and love me. Feed me. We will also be talking with Kate Miller. She is the feeding and disability specialist at spend and Ngo focused on eradicating malnutrition for children who are isolated from their communities due to a disability and those living in orphanages and foster care. Welcome Dr. Route and Ms. Miller to creating a family. We are so glad to have you talking with us today about, um, about this really, uh, I, it's almost especially with with children adopted past infancy, um, food issues come up all the time. So, um, I'm so glad to have you. The expertise of both of you to, to, to help us understand more. Let's start by a doctor. Raul, can you talk, tell us what you mean by food issues. Just kind of generally. So we get everybody grounded in what the, what the breadth of his old we're going to be talking about today.
Speaker 3:Sure. Well, thanks for having me today. I'm absolutely, when I talk to social workers and families, um, adopting or in the foster care, they say that after sleep feeding and food issues are the number two problem and there seems to be such a lack of training, um, especially before children are with families. And that's really frustrating. But, um, food issues, um, generally kids who have come from a hard place have difficulty with self regulation because they've had, um, maybe not the most ideal reading situations where they weren't fed enough food or variety or um, at regular intervals where they could count on being fed. So there's a whole lot of food insecurity, um, you know, in the history and different challenges that come up that, that families may not be really prepared to deal with. And so this manifests itself in things like sneaking and stealing food. I'm seeming to not be able to stop eating. Or the flip side of that is children who don't seem to want to eat at all or have an appetite or have anxieties or have had negative experiences around food. And it can be really bewildering when you're at that family table with two or three kids and there are all these different issues going on. So I'm glad we're here to talk about how to support families,
Speaker 2:Ms. Miller, what type of adopted kids are more prone to food issues. I thank you so much for having, for having
Speaker 3:me here with you as well. You know, I think, um, that often
Speaker 1:children who are adopted have been in foster care, have been exposed to um, perhaps some trauma early in life. Um, and so children who have been exposed to trauma, um, it can impact their sense of safety, ability to trust and navigate life issues. And I think we see that commonly play out, uh, related to feeding and mealtime.
Speaker 2:All right. Um, as, as, as, as evidenced by the title here, practical solutions, this is going to be really focused on, on, on tips of what parents can actually do. So we're going to break it down. The rest of our uh, discussions can be broken down by the type of food issue and with with both of you suggesting an approach for parents to use. And the first one I want to take is a tackle is hoarding or food sneaking and we have a question from Bethany. She says my daughter has been home one and a half years and she is now eight. She is wonderful and we have all adjusted in bonded well but we are still struggling with food, stealing. She loves anything with sugar. Our family has desserts on the weekends but during the week we offer fruit for anyone who wants it. After dinner she does have a sweet treat in her lunch every day and she gets to choose which one. The problem is that she will go into the pantry and sneak all the lunch suites and hide them in her room. We started off just redirecting her and talking to her. That has not been effective. The logical consequences that she will not have dessert for the school lunches for the rest of the week because she ate them all. But neither will any of the other kids because she has eaten their treats as well. We have tried giving her all of her lunch treats at the beginning of the week and letting her choose when and where to eat them. But she them up all at once and then takes from the other kids. We have even locked the treats up. And while that works, it feels like we are the food police help. So let's start, uh, Doctor Raul with you. Um, so this is Bethany or daughter is, is sneaking. And she had said in a separate email that I cut out that our daughter had not experienced, uh, as far as she knows a great deal of trauma or food insecurity for what that's worth. All right, so doctor Rau, uh, if you can start and then Ms. Miller will turn to you second.
Speaker 3:Yeah. So, um, these are so complicated. And so one thing I want to say is that, um, there's a limit to, you know, we, we have to give general information, but we also have to sort of have a caveat that you should certainly always be working with your child's healthcare team in any therapists you're working with because we just don't know the whole picture. But with that said, I definitely want to give some tips to get folks started. Um,
Speaker 1:so
Speaker 3:there's just so much going on here. One thing I wanted to mention though is that I hear about this problem all the time in children who are not adopted or in foster care. And so that's kind of reassuring sometimes is to go, okay, this is a problem that, you know, kids born into their families deal with also is this preoccupation with sweets and treats. Um, I'm not going to plug my book the whole time, but I did want to just mention that, um, I have lots of information in the love me, feed me for adoptive and foster families on how to deal with sweets and treats. But a couple things that stood out is, is one thing, I think it's okay to lock away the treats for the other kids while you're working on this. So we want to make sure that while, while this is being addressed that the other kids certainly still get their lunch treats. Um, right now parents are so worried about sugar and sweets and, um, you know, certainly there are children who eat lots are people who don't have that balance. But, um, with sweets and treats, often what I find is number one is the language that we use around foods is really important. So we don't want to create shame or feel it in, you know, making the kids feel bad for liking these foods. And so we don't want to call them things like junk or, you know, sugar is addictive. Um, sugar is poison. So we want to first of all, neutralize any shame or bad feelings around this week. Um, and ironically, sometimes when kids are fixated on sweets and treats, we have to allow more access to them to kind of, um, get rid of the allure of it. So one of the things I would say is when you're serving the sweets and treats on weekends at home, serve them with the meals. So I'm curious if in this family they have the setup where the children have to eat all of their food before they get the dessert. So one of the things in the feeding model we work in, the division of responsibility is sweets are served with the meal and then it gets rid of the pedestal of, you know, I have to slog through my chicken to get to my dessert. So serving the suites with the meal and they get one portion of it and they can eat it during the meal time whenever they want. Um, and one thing I want to say too is anything that I talk about can be used for all the children in the family because the division of responsibility or responsive feeding works for all children because it is helping them to eat based on those cues and signals coming from inside their body. So you can do this with the child who's bigger or smaller or selective or eats everything. Um, for everything. I think Kate and I say, and if not, we'll try to point that out. But, so one thing I might consider doing is, is actually having a dessert every night, um, and offering something every night. So there isn't the anxiety around it. So she knows that she can have it. Um, another thing that works for a lot of families is having once or twice a week where they can have as much sweets they want so that there isn't always this feeling of scarcity. Like, I'm not going to get enough so I have to eat as much of it or sneak it when I 10. So that might be, um, you know, if, if it's a church going family, it might be that at the, you know, the cookie buffet after services, they can have as much as they want or maybe after school. Um, it's the day that you're all going to make rice crispy treats together and you serve it with their favorite fruit, you know, bananas and some milk and they make them and they get to eat them until they're full. So those are a couple things in terms of trying to dethrone the sugar, it sounds counterintuitive but actually allowing more of it. Um, because so often families are told just don't keep it in the house and get rid of it, but then it's exactly what's happening is they're off to the neighbor and they're binge eating or they're eating out of control. So those are just a couple of tips but certainly dealing with sweets and treats this kind of black belt level stuff. So I'm getting as much information as you can before diving in with some of these changes is also important.
Speaker 2:Okay. Um, Ms. Miller, do you have any thoughts on um, uh, specifically either suites or let's also expanded into hoarding, um, because sometimes children are hoarding, are sneaking food into their rooms, are out of the pantry or whatever, um, that are not sweet oriented in this, uh, in Bethany's example it was, but uh, what about children who are, um, are hoarding food because that is not necessarily sweet oriented?
Speaker 1:Yeah, I think Katya is very right, that, um, part of it is ensuring access to the food that when, when there is fear of lack of access that that perpetuates that desire to, to hold on to it, to hoard it and get enough of it or what feels like enough of it for the child. Um, and I think it's really important to work with parents to help them neutralize their response to the food, um, that, that we have this tendency to, to deem food as good or bad or positive or negative. And that in doing that, um, we might kind of increase the desire for it or, or the desire to kind of hold on to it. Um, so that, those are definitely two of the most important approaches to kind of shift, um, that that imbalance of, of hoarding the food are those the sweets and treats that feel like they're unattainable or they're only attainable in very limited quantities.
Speaker 2:Okay. And for children who, and this is not a, and that's not uncommon for us to hear, um, of children who are keep a stash of food under their bed. Parents are, again, this is not necessarily suites, um, parents are concerned because of vermin, you know, bugs and other things aren't the, are the food spoiling because children might have a cheese up there or am I have bread or something that would be possibly spoiling. So thoughts on how to handle, uh, uh, when your child, is it creating a stash of food in their room? Um, let's see. Let's, let's, let's go to you Ms. Miller.
Speaker 1:You know, I would suggest that, um, working with the child to create a space where they could have a stash maybe in the kitchen or in the cabinet where they always have access to the food, but where parents feel, um, like it's not going to be susceptible to, um, causing a mess or, or pests so that the children still feel like their access is unlimited to that food. Um, but that parents can feel like they're not digging food out from under the bed or, um, leading to kind of a lot more clean up later.
Speaker 2:Okay. So moving the, moving their stash to a place where, uh, it's less susceptible to bugs and also that parents can make sure that the ziplocs or zipped or whatever. So that, that, uh, that there's not an attraction, um, Dr Rally anything that you would add for, uh, children who are creating a stash of food or hoarding food in other ways?
Speaker 3:Absolutely. So, um, I agree with everything Kate said and I would also add that sometimes kids hoard food if they don't feel like they're getting enough. And this can be really tricky if you have, you know, a foster child who comes to you and they're in a larger body and there's a lot of pressure to kind of try to get them to eat less or to lose weight. There's an impulse to try to portion control or restrict or, or diet them. And if somebody come from a history of food insecurity and we do that to them, uh, the anxiety goes through the roof and the natural survival responses to get it while you can. Um, and these are deeply ingrained anxieties and, and learned and felt in the body. Um, and it takes a long time to feel calm and safe and having enough food. So the first thing if a child is hoarding or stealing food, I want to know that they're getting enough, that they feel like they're getting enough. And this is really tricky, especially when kids are in bigger bodies, but children need to be fed every two to three hours, uh, whether they're big or small and generally two hours. If they're younger, you can stretch it to three to four hours if they're older. But we need to be absolutely reliable and reassuring young people that they will be fed, especially if that hasn't been their experience. So that means providing the adult provides, um, choices of foods and it's breakfast often a mid morning, maybe lunch, maybe something after school. Usually that's when they're hungry, is so have a really substantial, you know, sandwiches and yogurt and fruit and chips and you know, having, when they're hungry, you know, having that, that substantial meal and then maybe a couple hours later there's another meal so they know they will always get enough food walking past the pantry. I'm looking at, you know, maybe you have to get a couple extra cereal boxes and just say, you know, there'll always be enough food. Um, and children will often do what looks like over eating, especially in the beginning until they've really felt secure. And I believe we need to allow them to do that. Um, and so we're feeding them. We're not saying, Ooh, you know, he could lose some weight, so we're going to skip snack while he's at the park. And then suddenly he's starving and he's anxious because nobody has provided the food. So even if you're playing with a nine year old at the park and part of your impulse or your doctor's saying, Oh, you know, he's quote unquote obese. So try to skip the snack that increases the anxiety, slows the healing process, and actually fuels bingeing. I mean, think about everyone listening. If you were ever on a diet, how preoccupied you are with food and when you went off the Diet or you quote unquote broke the Diet or it was a cheat day, you felt out of control with your eating. And so it's the same anxiety. And this experience we need to address. So if a child is hoarding, you know, a lot of families would say, Gosh, all we were told to do is let him carry around a Baggie of carrots and then they would just shove it in their faces fast as they could. So we want to sit down and make sure that they had plenty of food and they might eat a lot for those first weeks to months, even if they're older teens. Um, but we, we need to make sure they understand they're going to be fed and then they can feel safe and start to self regulate and realize, oh, this is what full feels like and this is what hungry feels like. So, um, the other thing is that different families do things differently. So if you're doing all of this and you've got the stash drawer, um, and they still are sneaking food under the bed. I know some families have said, we just let them have a Tupperware container with granola bars, you know, on their bedside table. And, um, we just say, you know, let's put it in the Tupperware so we can just address each problem as it comes up kind of flexibly with each child in mind. And I mean, I could talk for, I know Kate and I could both talk for an hour and a half on this topic alone, but I want to make sure we, we get to some other things too, but there's a lot to it.
Speaker 2:Yeah. And I'm going to summarize it. The one other thing that you had said, uh, well, certainly to make certain that they allow them to have the stash, move it to a, a, a place where the parent can have, make certain that there's in that things are tidy it up and so that, that we're not attracting bugs. That's one. The other one make certain that the child is getting enough and is not feeling a sense of scarcity, a of scarcity. And then the last thing is depending on the situation, allowing the child to have their food that they are storing in their room, but address the[inaudible] concern is as a parent, let's say your concern is we're going to be attracting mice. Um, then addressing that, okay, how can we make certain that we don't attract mice? Well, let's put it in a Tupperware and work with the child to come up with a way to, uh, to address your concern and allow that child have and so those and allow the child to have a stash. So those are, um, a summary of, um, uh, some of the things you can do with hoarding and not specifically hoarding to treat with tree with sweets. All right. Um, your, uh, Doctor Raul, your discussion is a beautiful segue into the topic that we got. Uh, and, and we do receive the most questions just at creating a family. Uh, we have a large online support group and this is probably the question we get the most of. And that is a child, uh, adopted her foster child who is eating too much at one time. We've got a number of questions, I'm just going to read them and then turn over to you guys to talk about. This one comes from, I think it's Twanda. She says, my foster son is a bottomless pit. He literally will keep eating at first I let him eat what he wanted, but it's like he wouldn't stop now. I limit the amount I give them to what a normal adult man would eat. And then I offer fruits and veggies until he is full. It has been over a year and we haven't seen him start to self moderate. Not sure how long is normal or what I should do to help him. I worry that on top of all the other things in his life, learning disabilities and Adhd, that he will also have a big white problem. Um, so, uh, Ms. Miller, let's turn to you on that. When we a doctor Raul has talked some about that, but to Quanta is worried that, you know, is she creating a pro? Just another problem for her son to have to deal with.
Speaker 1:I understand how, how complicated and nuanced, um, meal time is and that, you know, she understands her son and how much he's been through, um, and has given it time. And she just worries about setting him up for more challenges moving forward. Um, and I think, I think she's done a nice job of creating access to food. Um, and I think it's important to continue to, to meet that need, that basic need of having enough food, enough acceptable food, um, and that the access is reliable. Um, but I, I think, you know, that, that she has concerns that, that she's making sure, um, that he's healthy and healthy is, is different. Um, bodies come in all shapes and sizes and so he may a bigger appetite. And so I think it's important for her to work with her medical providers and make sure that, um, you know, that as she gives him the food he needs that, that he continues to grow as his body should grow. Um, but I, I understand her concerns.
Speaker 2:Let me read another question. Uh, and this one because it's very similar and I want to make sure we get it in. And this is from Megan. She says we have an eight year old foster to adopt son. He has been a loving foster care for two years but was neglected by his bio family. He eats way more than he should for his size. He asked for as much as we will give him at meals. We have an anytime basket or fruits and protein bars and he will eat from it constantly. Even right after a meal. He is overweight, he has no sense of full. I'm concerned about his health, but we also want him to feel safe and confident that he will be fed.
Speaker 4:Dr Rao. Well these are such, such tough issues that we're dealing with. And one of the things that she mentioned is that she has an any time basket that's not working in this situation. So this is where, you know, having their own drawer or their own stash is not helping. And I would really urge this, this family to read, either my book loved me, feed me, um, and, and it's about weight, preoccupation and all of these weight worries. Um, I came to this as a parent also with my own concerns about weight and I had to learn a lot before I buy dove in. But, but with that said, because this is so complex, there's no way, and even if we spent the rest of the time talking about this, but the anytime basket, the stash is not working for them, even if it's fruit and granola bars. Um, now with the eight year olds in particular, I did hear her say we give him as much as he asks for. So another big thing that's important is having what are called family style or buffet style meals. Um, my sense is even though this child has been with them for a year, I recently worked with a family who has had a child for eight years, um, where they had some food preoccupation still from even as a two and three year old. So, you know, just because they've been with you for a year and a half or two years doesn't mean that it magically goes away and there are things that sound like can be tweaked. So I would get rid of the anytime basket. I'm also with the last question I heard somebody say, I think the hands and of course, I don't know the whole story of he's allowed to eat whatever he wants. Um, and so really being the provider of food. So setting the meals down, eating together if at all possible. And a family meal doesn't have to be everyone in the family. It's one loving, trusting adult eating with the child. So, um, having that absolute, you know, for the eight year old, every two to three hours we're gonna sit down and have food. When there's a history of trauma, it can impact self regulation. So particularly for the team or for this eight year old, even though they've been in a loving situation for a few years, this embodied trauma can impact things. So doing things to help with self regulation. So they might do, if they've had an occupational therapist in the past, they might like swinging or walking or bouncing or dancing or singing before a meal to help them to self regulate and tune in. We want meals to be super predictable and snacks to be predictable and they're balanced, um, offerings. Um, and so, so I think with this eight year old, it's easier to address this with an eight year old than with a teenager. Um, but making sure again that there's enough food and that they don't have to ask for it because then you're, the adult is in the middle of it. So the food's on the table and if they want to roles, they can have two roles if they want to eat, you know, more grapes are more chicken than they can serve themselves. And as the adults then not making comments like not saying, Gosh, I think you've had enough or that should be enough for your, you're eating too much. So this is the really hard part and I talk about white knuckling it in the book. Sometimes as we watch kids eat more and more. And I have worked with kids where parents have said he has no stopping point. He will eat til he vomits if we don't stop him and absolutely be able to turn this around. And so I would really caution, um, and we'll talk about this later, I'm sure also with kids who don't seem to have an appetite, I would be really careful to say things like, well, he has no stopping place. I believe that these kids have these abilities and they can tune into these signals, but it takes a lot of facilitation and it takes a lot of time and patients, and this is not a quick fix where I'm going to give like two tips but um, but those skills are there. Let me ask a question about the family style eating. So family style means that the bowls of food or plates or bowls, you know, the, the, the serving bowls are set on the table and everybody serves themselves. Um, do you have, what about families who have the rule that says you need to take a bite of everything or you know, you need to have one spoon of, of everything. Then come then come back for seconds. Do you have any, do you suggest anything like that? Or it's just on the table. Everybody puts what they want on their plate. No comments that I prefer. The second version. And the reason is now, first I want to say if you're doing a no thank you bite or a one bite rule and your kids are happy and they're eating great and they're self regulating, then go for it. But if you've got a no thank you bite rule and it's a 45 minute standoff or they're crying or they're negotiating, now their anxiety level is up and they can't tune into hunger or fullness. So kids who are overeaters, quote unquote, um, we'll tend to eat more than their bodies need when they're kind of wrapped up and anxious and kids with low appetites will eat less than their bodies need. So the table has to be a safe haven that, you know, as Kate was saying, they need to feel comfortable and safe, especially if there's a history of trauma because these kids can pop into, you know, hyper arousal. Um, if that's the state that, that they've lived in for years. So we want to have meal times be very pleasant and calm and anything that you're fighting about, um, try to address, you know, try to get rid of the power struggles and the one bite rule, the no thank you bite rules. I don't believe they help anyone do better. And I think that they help a lot of kids eat a lot worse. And I think kids who do well with the no thank you bite would do just as well without it. So I'm not a fan of rules like, no thank you. But I think if you want to try to make them eat vegetables first before they can have foods they, they want, that's increasing conflict, that increases anxiety and now they're more likely to over or under eat.
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Speaker 2:this is a simple form they have to fill out. All right. Another issue with the eating does kind of, it's tying into the sense of it and it's something that, that you said Kate, that different, that there's lots of different body types and, and it's also somewhat cultural. And I wanted to read this from Steph. She has a 12 year old home from Africa for lesson six months. Um, she, she does eat a lot. Uh, and the mom is not really, she's not asking for her to be skinny, but she does worry. Uh, and it's in the mother says her behavior and the things she said are like, she wants to be big. Like it is, it is her goal to gain weight. She gets mad if she thinks she has a smaller stomach than other people. She says she loves big stomachs, big legs, et Cetera. She is adjusting well and is very attached. I would just love to know some ways to address this or do I, I don't want to create issues that aren't there, but I also don't want to ignore something that I should have slowly, gently started addressing. Now thoughts on that? I thought it was an interesting twist because from where this child comes from, it may be cultural that uh, that being big is a good thing. Um, so thoughts on that? Uh, Ms. Miller?
Speaker 1:Yeah, I think the first thing that I thought of when you read that was definitely the cultural piece. Um, I think that that where she comes from, it's very possible that, that, that a bigger body is a sign of health and, and wellbeing. And so it's, it's possible she carries that with her. And when I think of culture for kids who are in foster care, who've been adopted, um, they certainly come from their own culture, especially around mealtime and they're entering a new culture. And so I think we have to be mindful of, of how we respect their culture, but also invite them into the culture of the family that they have joined. Um, and I think that's important to keep in mind in, in having those conversations with children and respecting what they bring to the table, but also the table that they're coming to. Um, it, it does sound to me like that is potentially a coming from a very different culture. And so I think it's again, complex to address but important to, to begin those conversations about.
Speaker 2:Okay. Yeah, I agree. I think it probably could very well be cultural. I guess I would also want to know if, if she's just large but not obese and there, there may not be health consequences and, and she may feel that this is, that she is beautiful. Um, any thoughts, additional thoughts on that? Doctor Ralph?
Speaker 4:Yeah, thank you. Um, you know, and very certainly maybe someone she was attached to, uh, in Africa was someone in a bigger body. And, um, you know, this is also true of foster families. They're the people they loved and have their relationships with also come in all kinds of shapes of bodies and sizes. And so I think it's really important to make sure we're not shaming or speaking ill of any body type. Um, and you know it, if she's only been home for six months, I remember doctor, Gosh, I'm blanking on his name. This is terrible. Kate doctor, I'm from Minnesota. Thank you Dr. Johnson. Not the data jobs. I mean, I think I was on a podcast with him here, but he's not the room here. And He, and he says, don't worry about overeating in the first year. But I would say, you know, um, if she says I want a bigger body or bigger thighs too, to reinforce the wisdom in her own body to say your body has its own ideas and you know, you listen to your body and then it will grow the way it grows and you might have a bigger tummy, you might have a smaller tummy. Um, so that we're not shaming around the body shape. Um, and one other thing I wanted to mention in this case, and especially with the foster teen who also had ADHD and learning disabilities, we focus so much on vegetables as like the holy grail or weight. But um, I'm much more worried trauma and childhood bad things in childhood I feel are much more correlated with poor health outcomes. Then, you know, eating vegetables are, and so we know that the higher the aces, you know, the trauma score that that has impacts in terms of inflammation and heart disease later on. And so to me, as one mom said, I addressed the heart needs first. So addressing trauma, finding a therapist who does embodied or somatic work so that we can help with self regulation, but also not ignoring the other determinants of health and feeling a little bit reassured that the best thing for their health is to love them. Exactly as they are. Whatever body they come in. You know, the American Academy of Pediatrics in 2016 really came out strongly saying young children or teens should not diet. There should be no diet and weight talk. So you know, not saying, well if you'd be healthier, if you lost some weight. And we all know that the word healthy now means thin. So we want to be really careful if we say don't eat so much, we want you to be healthy. They know it's about about fatness. So we want to not ignore that love and community and if faith is important to you that having a faith tradition and pets and having a purpose and volunteering and you know, singing or being involved in something, you know, with a group or a team sport just came out. Also to say that that can help with trauma involving young people in team sports. So I, I think that so much I see parents handwringing and fixated on vegetables, not realizing that they're making a huge impact on the child's health and health outcomes. By loving them, by ensuring they get enough sleep by finding activities that they can do together. Maybe go Geo caching or walk around your neighborhood and do you know, a scavenger hunt. So I just want to, I know that this episode is about food, but I think there's so much anxiety around food and nutrition and vegetables that we, we can almost sabotage and make things worse than if we put some of that focus into other things that we have more control over. We could also feel good that, you know, Gosh, we're really supporting our child's health and the battle over the vegetables isn't working. So while we figure that out, we're going to do all these other things. That's a great segue into, um, the next food topic, which
Speaker 6:is extremely picky eating. Let me pause a moment though. And, uh, you mentioned, uh, aces and just so that everyone who is listening may not know that adverse childhood experiences and there is a lot of research that indicates that for each adverse childhood experience you have, your longterm health can be impacted, not just emotional health but physical health as well. Um, that is uh, your, your comment was a great, uh, your response, whether it was a great segue into the next topic, which is extremely picky eating. Um, and this is a question from Teresa. She says, my daughter, who was adopted at six and is now almost eight likes to things, peanut butter on white bread with one brand of grape jelly and Mac and cheese. Again, one brand, she refuses to eat. Anything else? I am at my wit's end. I've tried to require her to take one bite of the other foods. She pitches a fit and ruins dinner for everyone. I've tried serving Mac and cheese at every meal thinking she would eat that, but try other things that didn't happen. She grabbed the Mac first and heaped a huge serving on her plate and ate nothing else. I've tried not serving either Mac and cheese or PB and J for dinner and then she doesn't eat. We do let her have them for breakfast and lunch, but I want to have her eat normal food with the rest of us for dinner. I also worry that she is getting zero vegetables or fruit. I'm not kidding when I say that. All she will eat is those two foods. Uh, we'll start with you doctor Raul. This is um, um, right up your alley and, and right up the alley of your book. Uh, but uh, and you also addressed some of it. All right. We've got a kid who, who it sounds like for breakfast, lunch and dinner eats two things. Umm, so thoughts to help. Teresa, can I actually send this over to Kate first with maybe some sensory in oral motor stuff? Okay, sure. We'll start with, uh, you, Kate. I was going to move into a texture and sensory issues. So let's go ahead and, uh, we could start with that, uh, texture and century issues and then we will come back to Dr[inaudible].
Speaker 1:Yeah, absolutely. I think, um, like doctor Al said earlier, it's hard to, um, give very specific advice with just a question, but let me try a few ideas. Um, first I think it would be important for this family to, to seek the help of a, um, of a feeding specialist who could help them work, um, towards it can have a greater repertoire of food, um, to, to meet those nutritional needs because we know that children need a variety of food, um, to meet all of their nutritional needs. And so, um, I think it would be advisable for them to work with a medical team or a therapist and occupational therapist or speech language pathologist who could, um, help the work through any sensory related or oral motor related issues that contribute to such a limited diet. You know, I think we have to keep in mind that, um, that children with a history of trauma, but also, um, other children often have seating difficulties that are bigger than, um, than can be addressed at home and that they might need to rule out any sensory related issues or, um, difficulties with the functions of their mouth. Like biting and chewing and swallowing to make sure that the child can safely consume a variety of textures and a variety of foods. Um, so I think that would be the first step would be to, to seek help if someone who is well trained and understands this child's history, but that can also help the child learn to, um, to manage a variety of suits.
Speaker 6:Yeah, I mean it's a good point that when you see really extremely picky eating that there could be a texture or a sensory processing issue that going on. Um, so we say work with the feeding specialist. Do you are a, is that a sub specialty of occupational therapy or how would a parent find, uh, Kate a feeding special?
Speaker 1:Absolutely. So, um, you'll find either occupational therapists or speech pathologist, um, who, who treat feeding difficulties. Um, so I would recommend going to your pediatrician and requesting a referral for an evaluation of feeding skills. Um, and then they would refer you either too, depending on who does that in your community. I'm an occupational therapist or a speech pathologist. Um, I think there are some other, um, specialties that, that may have some experience in that, but I think you'd want to make sure that you seek a professional who makes attempts and approaches that are responsive, that, that, um, that are in line with the way that you see meal time and making sure that, um, that, that they understand your child's specific needs.
Speaker 6:Okay. Excellent. Doctor Realm. Um, would this be if using your family serve things as a family? Let everybody take what they want. Would you make certain that you always have a peanut butter and Jelly on white bread and that brand of, of Jelly or, and or Mac cheese at every meal and then just simply daughter job?
Speaker 4:Right. So, um, I I wanted to say also when you're looking for a therapist, um, I would, I would say Kate, someone like you, a speech pathologist or if you're seeing an OT, make sure they have, um, training in assessing, swallowing and motor things, maybe even at dentist to rule out a tongue tie. And the reason here is that she's only eating things that you don't have to really chew. Um, so that's a big red flag to just get it ruled out that there isn't some, something that we're missing. Um, and I would be careful. Uh, she makes a great point. Find a responsive therapists. There are therapists who will say, you know, don't make eye contact if they're not eating and things that are not trauma informed. So trust your gut as a parent. I've had so many adoptive parents say, gosh, we went to this therapist and it felt like we were, you know, being told to ignore them and it's went against what our attachment therapist said. So, so trust your gut on extreme picky. eating.com we have an article on how to find a therapy partner, how to find the right therapist for your child. And there's a whole chapter in the book. So, but yes, once you've ruled out, you know that she has a severe tongue tie. And at eight, I've seen these things get missed, you know, to the point where kids are eight and nine. And so it's not, um, unimaginable. And you know, if a child spent their first three years drinking thickened liquids from uh, you know, bottle open, cut nipple, there very well could be sensory things. So an OT could help with that. So it's, so yes, part of this is that at every meal and snack she sees something off her preferred list, which is extremely, um, extremely narrow. However, in our book, um, extreme helping your child with extreme piggy eating, we have five steps that we break it out into. And so what you put on the table is kind of the last piece of the puzzle. So I would be curious if she also has anxiety. Anxiety is very common, um, uh, to occur with kids with extreme picky eating. Um, OCD sometimes is associated with it. So, uh, I would want to make sure that if she does have anxiety, that there may be also working on skills with self regulating and calming herself down, that mealtimes are pleasant and that there aren't comments or battles and part of having a pleasant meal times so that the, you know, butterflies in your tummy don't, don't, you know, leave no room, leave any room for food would be to make sure that at every meal and snack that there's something available. Um, and we have all kinds of different hints and tips on how to expand. So for families listening where their child might eat 15 different foods and they have a wider repertoire, there are lots of ways to bridge to new foods. So she might begin by using a different brand of white bread or maybe going to a whole wheat white bread. So nutritionally, if we're talking about nutrition, if there's a whole whole grain or, or a protein enhanced white bread, um, then that would be something to consider. Um, you know, if she may be like smoothies, certainly a nutritionist, um, being involved with this limited of a repertoire. Um, once you know, the, the oral motor stuff has been ruled out, can be helpful as well. So, um, you know, if a child like through these are popsicles, there are different ways to support nutrition while they're building skills.
Speaker 6:Let me ask a question. No. You're suggesting, uh, making a shift into the type of bread or the brand of jelly or are the brand of Mac and cheese. Would this be something you would do, uh, upfront with your child, let them know you are doing it or would you simply do it and not let them know?
Speaker 4:I definitely would let an eight year old know that it was happening because, um, if she finds the bread or cheese will likely notice. It's different because she is so, uh, so selective. If you try to trick them or sneak food, you risk kind of blowing trust out of the water. And I've had this happen with families where they've tried to put, you know, spinach and brownies and then they find it and then they will never eat anything again or they follow you around like, uh, you know, watching everything you do. Or they only will be packaged foods. So that trust is important. And with old enough children definitely talking about it. But, but this girl might have her exposures to new foods be around baking for other people. And so this is again in the book where we talk about and that a therapist can help with is they might do a playing with food at first or she might help with cooking or mixing different foods and get exposures that way, even if there's no expectation that she eat it. Um, you know, I would start there also while we're going to bake muffins for the senior center, let you know, do you, should we make blueberry or whatever, would you help me bake them? And you don't have to eat them. And so a lot of times we don't know if she was forced fed in the past, if she had truly traumatic experiences around food. You know, a lot of kids with this extreme picky eating where you don't know their history, they may have been forced fed, they may have aspirated, um, Kate's and expert in positioning. So some kids and baby homes were fed flat on their backs and not able to safely manage different foods. So she may have a history of trauma around food where no addressing that again with an embodied or somatic therapist, um, or just, you know, with this very skilled, responsive nonpressuring coercive therapist may help. They could take her to a feeding program where they will hold her down and force feed her. Um, but my sense is that that, um, that may not, that that's not what I would recommend. So be very careful with the help you seek out.
Speaker 1:Yeah. And I think it's important to really be trauma informed in that approach that we remember that the quality of the relationship that's being built is, comes before the nutrition, um, that we're creating like emotionally safe environments and, and that we're transparent with the child about the mealtime decisions we make so that we can explain the why whenever we're able to. Um, and that we restore power to the child to make those food choices that, you know, it's important that all the professionals that were kind of calling in to address this challenge, that they're, that they understand and they're onboard with a really trauma informed approach.
Speaker 4:Yeah. Excellent. And as a doctor, I can call out my colleagues that most of them are not informed about this stuff at all. And so unfortunately some of the worst advice has come from pediatricians and family doctors, you know, just starve him out. Well this little girl, you know, if you said, well, don't ever let their, her have peanut butter and jelly, she'll eat when she's hungry. There are kids who will not eat and end up dehydrated at the hospital in the emergency room. So, um, so unfortunately, um, are, are our first line of questioning is often not a great resource, which is why I'm thrilled you're doing this. And why, you know, adoption nutrition.org is up there, which is the spoon site and our site because unfortunately as, as these as parents listening are all too familiar, you will have to advocate for your child when the experts may not be fully informed. So it's, it's a tricky,
Speaker 5:you are listening to creating a family. And today we're talking about how to help your child with typical food issues that we see and adopted and foster children. This show would not happen without our partners and our partners or agencies that believe in our mission of providing unbiased information for pre and post adoptive families and foster families. One of those partners is adoptions from shepard care. They are a nonprofit adoption agency founded in 1980 providing domestic infant adoption, international adoption from Colombia and domestic and Hague approved international home studies. Another partner is Spence and they are an adoption agency in New York City and they are currently in need of some the recruiting, uh, adopted adults age 21 and older to serve as volunteer mentors for their adoption mentorship program. The mentors serve as role models
Speaker 6:to encourage mentees to ask questions, feel comfortable with their identities and of course develop healthy stuff is self esteem. Not only do mentors find it rewarding to engage with adopted youth, they can also grow in their own adoption journey. The program only meets once a month during the school year. So an adoptee who lives in New York, New Jersey or Connecticut would be ideal. You can get more information about this mentor program and it really is a great program are you can get more information about it at the spent hyphen chape and c h a p I n. Dot org website. Look for mentorship.
Speaker 5:All right. So another, uh, we've touched this but, uh, with
Speaker 6:the extreme picky eating, but I, I wanted to bring it up because we, it's a question we get a lot and that is, and we particularly see it, uh, with children coming from foster care, although it's certainly not exclusive there. And that is children only wanting processed food or what many parents call junk food. Uh, and I, I think that, uh, I think, uh, Miss Villa, you, you address that somewhat when you talked about how the culture of where our children are coming from when we think of culture and we think of course of international adoption in this context. And that certainly is a different culture, but there can be different food cultures within the US. So let's talk a little about, uh, children coming into our home and with a different food culture and in our minds, often a, um, a worse food culture because it is not as nutritious. It's junk food is processed to lots of, you know, hidden fats and all that good stuff that we read about and tell us it's bad. Uh, so if you can start talking with us about that, uh, Ms. Miller, that would be helpful.
Speaker 1:Yeah. You know, we recently met with, um, the foster youth here in Portland, Oregon and we asked them what their, um, what their like biggest, um, challenges with meal time and entering mealtimes in new homes was. And the number one thing they talked about was food culture and how they brought their own food culture with them into a new home and had to learn a food culture. And, um, you know, I think it's very easy for us to label food, um, that is outside of our culture that we have deemed as junk or bad, uh, without acknowledging that perhaps that was, um, the food that was, uh, most loved are prized in another person's culture. And so I think it's really important for us to be sensitive to that when we are talking about sued, um, and learning about somebody else's food culture. Okay.
Speaker 6:Okay. Doctor[inaudible] thoughts on, on that whole thing about junk food and, and it is a concern if you, especially if you don't want to serve process foods to the rest of your family, so how to handle that.
Speaker 4:Yeah. Um, you know, it's very tricky and I often there's a transition period. So first of all, I would say, um, practice really hard using other words than junk or crap. Um, you know, just so, so you're not saying, well, we don't eat that crap here. We don't eat junk food or, you know, that's, it's poison. It's toxic. Trite tried to, you know, honor again, their experience. This is what kept them alive and where they associate with, um, you know, with their biological families and where they came from. And so, um, I would say certainly if, especially if they're having visits with families, um, one of the complaints is often while they feed them all that crap when they're, you know, and that makes sense way of bonding and having that experience together. So I would, I would just try not to focus on the food and say, oh, did you have a good time? And, Oh, I'm glad. And Oh yeah, you love Pizza Hut. I'm, you know, that, that's great. But also when a youth is first with you, you know, trying maybe to sit down and say, what are some of your, your favorite foods? What else do you like to eat? Um, tell me about some more foods. And um, you know, maybe they like to have, uh, you know, they have, have liked a certain processed, you know, or in a package or rice mix or something like that. And so I think it really honors them to try to include those foods with meal times. So maybe they like mashed potatoes from a box, right? And so, um, you might serve those for a time alongside the foods that you expect them to like to eat, where they're all kind of on the same playing field. And one is not worse than one is not better because if you're pulling on the rope with teenagers, especially teenagers from hard places where they may seek out conflict or the, or testing or it feels familiar, food is an absolute area where you can get into the battle. So it's kind of like dropping the rope. Um, there's a book I love called three little words and the author Ashley Roads Corridor was adopted at age 12 after being in foster care. And she absolutely describes these battles with her adoptive mom. Like she would say eat something healthy and I would shake the bag of Doritos at her with the glint in my eye. Right. So she's actually, because of the conflict eating those foods that make her adoptive mom upset more to make her upset, she would say actually, you know, the chicken tenders she made in the oven tasted pretty good, but I didn't want to let her win. So you don't want them to eat or not eat based on, you know, conflict. And so I would say it in the transition. I believe that you know, that your family will be, the rest of your family will be okay. Adding some processed foods into the mix, the novelty, the other kids might be like, oh, we're having, you know, rice mix or we're having, you know, a chicken fried chicken from the grocery store. Um, they may eat a lot of it. And think it's cool for awhile, but they will go back to the foods that they grew up with and usually over time then you can slowly phase those out. But snack times are times when they're with their, um, you know, with their family or their friends that that may also be a time where they can enjoy those foods. And so I would say include them and serve them alongside and honor all of it. And, and I think young people really do want to, you know, learn to like new foods, but if the more we make, make the feel shameful or conflict around it, oftentimes it, again, it slows the process down. Well, and you've talked about, uh, Doctor Raul a transition period, and then you also mentioned with Doctor Dana Johnson said,
Speaker 6:I'm paraphrasing you. I think you said that, uh, don't worry about food for the first year. Focus on the heart issues. Um, so how, when should parents start saying, okay, we, we need to, we need to address this. Should you give it a year? Should you give it six months? Should you give it longer?
Speaker 4:Well, I don't want to misquote Dr. Johnson. I think he said don't worry about over eating for children from overseas in particular. So, um, so I'm not, it's not, don't worry about food. Um, it's actually a lot of work. What I'm saying, sometimes families misinterpreted and go, well it sounds like they can eat whatever they want, but there is structure around routine, predictable, pleasant meal times. Um, and a lot of families really struggle with how to facilitate in the face of these challenges. And so I would say, don't wait. Find Out, read as much as you can. If you're a weekend and you're, you're like, Whoa, we're in big trouble, you know, find the book, find some articles. Um, love me. Feed me. Um, is it has a huge index and so find, I'm really struggling with sweets and treats. I'm going to go to this issue or I'm struggling with this, here's this blog about it. Um, so get information and get support right from the start. And that's what I love about Kate and in spoon in Oregon. I'll let her talk about it, but I know they're, they're doing trainings for foster parents on how to address this. So even before a child is with you, if you can read and learn about it. So if you're struggling, don't just wait and muddle through for a year and say, well, oh, in a year it'll get better. Get help if you're, if you're spending significant anxiety and worry around weight, learn about it, learn what you can make better and how to facilitate things. But, you know, certainly a teenager who is losing weight, binge eating or vomiting or purging, we want to make sure that if there's an eating disorder, um, if they're very thin and they're trying not to eat and they seem to have body image issues, definitely get help for that right away. So I want to just to throw that out that there is, you know, actual eating disorders. So getting support right away. Don't just wait a year, but again, finding the right support, um, and, and trauma informed and learning as much as you can is really important.
Speaker 6:And for our last question, I want to turn to you. Uh, it's boon, uh, Ms. Miller and that is, are there nutritional issues that parents should tune into, um, that, that perhaps supplements this can go along with extreme picky eating, but it could be in general on that children who have come from a abuse and trauma, um, Ma that we may need to be focusing on are kids who have been adopted internationally, which of course also can bring its own trauma. Thoughts on that?
Speaker 4:Absolutely. You know, um, spoon has found that especially, um,
Speaker 1:kids adopted from overseas that there are high rates of malnutrition. Anemia is one of those indicators of malnutrition that we see pretty commonly in those populations. And so, um, we know that, um, it's preventable malnutrition and so, uh, we really advocate for um, pre fostering and pre adoption support, um, that, that parents, um, that they ask for and demand for more education and resources. Um, like Katya said to, to start early and start now, I'm educating yourself and connecting with, with people who can help you identify those, those early signs of malnutrition and, and where to start getting help. Um, because you know, nutrition in the first five years of life is so important for not only body growth but for brain growth and development. And so we know that identifying it early can make a lifelong impact for kids.
Speaker 6:All right, so, so perhaps, uh, something to suggest, and as you have both pointed out, you may have to be the advocate, you can't necessarily rely on your pediatrician knowing this, but suggesting that they do, that they, they look into anemia as, as a, uh, as a possibility when they're, when you bring your child for its, uh, his or her first appointment, would that be where you would recommend or would you, are the medically, yeah, I would assume you would recommend at that point that, that we have in analyze to see if the child is anemic.
Speaker 1:Yeah. And I would look into, you know, we train on, um, growth monitoring and so, and we look at an emia as one of those indicators of malnutrition because we want to make sure that kids can thrive. And so they need adequate nutrition to grow and to, to help their brains grow and develop. And um, so making sure that your pediatrician or your physician, um, looks at those indicators and tracks that over time to make sure that the kids are thriving and reaching their full potential.
Speaker 6:Well, thank you so much. Kate Miller, who is the feeding and disability specialist at spoon and doctor capture. Raul, who is the feeding Dr and author of helping your child with extreme picky eating and the book love me, feed me. The views expressed in this show are those of the guests and do not necessarily reflect the position of creating a family, our partners, our underwriters. And keep in mind that the information given in this interview is general to understand how it applies to your specific situation. You need to work with your adoption professional and your medical and mental health professional
Speaker 5:to get more information. Uh, about either of the organizations that have been mentioned here, you can go to spoons website, which is spoon foundation.org. You can also go find more information and blogging by Doctor raul@extremepickyeating.com
Speaker 6:and thank you for being with us today and I will see you next week.