Creating a Family: Talk about Adoption & Foster Care

Picky Eating and Other Food Issues

January 25, 2023 Creating a Family Season 17 Episode 4
Creating a Family: Talk about Adoption & Foster Care
Picky Eating and Other Food Issues
Show Notes Transcript

Have mealtimes become a battleground in your house, is your child a picky eater, or do you have a child who eats too much? We provide lots of tips in our conversations with Dr. Katja Rowell, a family doctor and author of Love Me, Feed Me, 2nd edition, and Helping Your Child with Extreme Picky Eating. She has a special interest in supporting foster and adoptive parents.

In this episode, we cover:

  • What are some of the typical food issues for adopted or foster kids, especially those who have experienced trauma?
  • How does trauma impact feeding?
  • Responsive eating leaves space to recognize what the body needs.
  • What do you mean by felt safety and focusing on connection?
  • What is a responsive and flexible framework for feeding kids with brain-based differences?
  • How to best deal with kids who are significantly underweight.
  • How to best handle extreme pickiness.
  • How to handle children who are eating too much, emotional eaters, or who are overweight.
  • Why do kids from foster care or institutional settings often become larger than optimal for their health?
  • Practical tips for establishing healthy eating patterns in adopted or foster kids
    • modified family style serving
    • supporting nutrition
    • sensory support at mealtimes
    • food “exposure” therapy

Additional Resources:

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Please pardon any errors, this is an automated transcript.
Dawn Davenport  0:00  
Welcome, everyone to Creating a Family talk about adoption and foster care. I'm Dawn Davenport. I am both the host of this show as well as the director of the nonprofit creating a Today we're going to be talking about picky eating and other food issues with Dr. Katja Rowell. She is a family doctor that specializes in feeding issues. She is the author of Love Me Feed Me, which is coming out in its second edition. She is also the author of Helping Your child with Extreme Picky Eating. And she has a special interest in supporting foster and adoptive parents. Welcome back. Dr. Rowell, I am so happy to have you back. This is a topic that is you know better than most we get a lot of questions. So let's begin by talking about what are some of the typical food issues for foster kids or adopted kids, especially those who have experienced some type of trauma, which is, you know, especially for kids who've been in foster care or international adoption is really the vast majority of those children.

Unknown Speaker  1:11  
Yeah, absolutely. Yeah. Little T trauma, big T trauma, all of that impacts how kids approach meal times food that that connected space. So some children have no challenges. So I want to put that right out there. So for some things go pretty well. But you're right, when I talked to parents support and social workers, this is one of the number one problems that parents are dealing with. And certainly if there's been a history of food insecurity, which is very common, where the child could not count on being fed reliably, that in and of itself is a form of trauma, and that absolutely impacts how children will relate to food, both in the short term and and even long term there. But there are ways that we can, you know, help children feel secure and deal with that difficult beginning. So certainly, the food insecurity can make children more likely to have problems with food, preoccupation. So these survival hoarding behaviors, sneaking, eating very large amounts, eating very quickly. You know, finding wrappers under the bed is a common story or they're swiping snacks from friends at school. So we see sort of food preoccupation, as well as the sensory issues we see. Generally more common with selective picky or anxious or even avoidant eating. So when there's been a difficult start with food, I, you know, I say anything that made eating, chewing, getting food into the mouth, digested, swallowed all of those things, if there were things that made that painful, uncomfortable, scary, if mealtimes were scary or unpredictable places that can make kids want to avoid eating and mealtime. So we see, both of those issues are kind of the main ones in terms of, you know, not wanting to eat or seeming to want to eat too much. And also there can be challenging behaviors at the table that can be related to nervous system safety and other things. So so we see a mix of of different things going on often for kids around food.

Dawn Davenport  3:23  
And how does neuro divergence impact feeding and we know that our kids can be neurodiverse for a variety of reasons. And quite frankly, many of them have been prenatally exposed, which to alcohol or drugs. And that can also cause neuro divergence. And trauma itself can impact the brain. So how does that impact we've talked about how trauma impacts feeding, but how does neuro divergence of differences in brain structure how can that affect eating and feeding?

Unknown Speaker  3:57  
Oh, absolutely. Lots of different things. And obviously, it depends on each child. But with with the neuro divergence and brain based differences, we see those sensory differences. So a child may experience things like crunchy foods as painful or if they are sort of the you know, you think of the sensory seeker where they're seeking that input, they may want to put hot sauce on everything and they may have trouble if there's a sensory motor issue where they gagged or you know, experience difficulties even just managing foods in their mouth. So maybe they had some scary experiences with different textures and so that child might prefer very similar foods. That's another trait we see often with autism or trauma or brain based differences is we might see a child very fixated on the packaging that a food comes in. So they want everything to be the same and predictable and not have sensory surprises. So we you know, these are often the kids where they're eating mostly processed foods or canned foods, and that's what they're comfortable with. Because it's predictable. There aren't any surprises, it's easier to chew and manage. And so we see that issue interoception is also sometimes affected and interoception is is just the ability to kind of figure out what's going on inside your body. And so we know that toileting is an issue or some some children with brain based differences may not feel the cold or feel the urge to use the bathroom the same way. And so hunger and fullness cues, especially early on may be really difficult for them to figure out, am I anxious, am I hungry? Am I full. And so sometimes these signals coming from inside the body can be hard to tune into. But all of those things can be supported with a supportive feeding environment. So I don't want to paint it like, oh, they they can't sense hunger and fullness. But there may be some challenges where we need to really be extra careful about having a supportive environment. Another thing we see is behavior. So so a child who needs to fidget and move or they're having that body experience may not be able to sit at a table for 30 minutes. And so that may be the child who's getting up and down frequently at mealtime, or who's fidgeting or kicking the table. And so some of these things that we think of is not being polite, or, you know, is is outbursts at the table are sensory based. And so, you know, we might have things like a weighted blanket at the table or allowing a child to stand on their toes or have a fidget toy. So there are lots of ways we can address these differences. And I wanted to mention that one thing that's in the new edition of the book that really I felt very strongly about, including more of that was was this flexibility and addressing some of the ways to help kids with these, you know, brain based differences in neuro divergence. And one last thing, if I may, about how does neuro divergence and neurodiversity impact feeding parents themselves may be neuro divergent, so a parent with ADHD or a parent who maybe is working through their own trauma or has is autistic may find things like menu planning to be more of a challenge themselves. So that also plays a role in you know, those those connected mealtimes

Dawn Davenport  7:33  
one of the things you say and love me feed me is how you feed matters as much or more or not, if not more than what you feed. So can you explain that about the concept of, of the the environment that we're establishing being most important?

Unknown Speaker  7:51  
Yes. So, you know, I think I have one chapter called Health Safety matters more than vegetables, and it's kind of what we're getting at is. And by the way, I came to this work as a parent, you know, I was a family doctor, having my own struggles feeding my daughter and, and a lot of the advice that's out there, even from primary care, you know, your child's pediatrician, they we don't get training in this stuff. So this is very tricky in that a lot of the advice that parents you know, are reading online or in support groups often focus on the food. So, especially around brain based differences. There's this sense of like, well, we can cure or we can address behaviors by avoiding sugar, or by putting more fruits and vegetables or avoiding processed foods. And there's a lot of focus and anxiety around the nutrition

Dawn Davenport  8:43  
and food coloring and additives. And yes, all of that

Unknown Speaker  8:47  
avoidance and fear often makes it actually harder to feed children well. So what I've found is that if we focus first on helping the child settle their nervous system, we co regulate, if we have those sensory activities before mealtime. So one child may need to swing for 10 minutes before a meal and other might need 10 minutes on a screen, to to get in that space of their bodies being as calm as possible. Having that felt safety, having that feeding environment that how where they feel safe and comfortable. That is the key then to down the road of that longer term goal of improving nutrition. And it leaves space for the motivation from inside their bodies of hunger, curiosity, it leaves space for those things to emerge and pleasure around food. And that's the path to having a child do their best with eating. Whereas if we're too focused on You know, getting chia seeds in the green smoothie, that that goal of really optimizing nutrition. It's kind of the enemy of better nutrition. So if we can have a smoothie that's got strawberries and bananas and milk and a little cream, almost almost like a little breakfast milkshake, which is what I had with breakfast this morning with my daughter, when we can feed from that place of connection, joy, things that tastes good and let go of some of that worry. For now, kids will find their way to that better nutrition, I believe more quickly and actually more sustainably than if we're battling over that bite of broccoli. And the child's crying and fighting and their heart rate is up and their stress hormones are up. We've kind of lost any benefit of that broccoli if the child is not in a in a safe space in their bodies.

Dawn Davenport  10:53  
What do you talk about felt the word felt safety and focusing on connection? What do you mean by by that? What do you mean by felt safety?

Unknown Speaker  11:05  
Yeah, so So that's a word I've seen really in the last five years coming up a lot more. And when I interviewed an adult adoptee and she said, Oh, that term felt safety. It just resonates with me. It's exactly what it sounds like you feel safe, you feel safe. And so we're learning more and more about the nervous system and how the body interact. So felt safety is when a child you might observe that their bodies are calm, their breathing rate is, you know, typical. It's not they're not panting or really slowed down. When we think about it in trauma, it's when we're not in fight or flight reaction. And that's so important that felt safety zone, our heart works better, our brain works better, we're open and able to learn and access curiosity and connection. Our energy storing hormones like insulin and growth hormones are optimized, our immune system is healthy. So felt safety is our bodies are are in, you know, calm and alert. And, and all of the systems including appetite and gut function are functioning their best. When they're not in felt safety, they're having a stress response. You know, I think parents know what that looks like. Heart rate, if it's a fight or flight heart rate is going up, they might be angry outbursts or anxious to see breathing rate go up. And what's happening in their bodies is their guts are shutting down. So now they can't access, hunger and fullness the same way. Curiosity is gone their their wear and tear on their bodies, the heart rate, you know, that's what as adults is that elevated stroke risk and heart disease and other poor health outcomes. A child conversely, might be in a freeze reaction, where they just kind of like zoned out or they're yawning, their heart rate tends to be lower. But they also can't access what's going on in their bodies, and its wear and tear on the body. So felt safety is just where our bodies worked best. And we're able to access all of the wonderful things that help children do better with eating.

Dawn Davenport  13:27  
Let me pause here for a minute to tell you about another free educational resource. Thanks to our partners, the chocolate being Family Foundation, we now have 12 free online courses for listeners, you can find them at Bitly slash J B F support that is bi T dot L y slash, J. B F support. We have lots of titles in there while 12. In fact, including one of them is how to avoid triggering and being triggered by our kids. Let me tell you, that's a good one in one, at least I for one need to hear frequently. Be sure to tell a friend about him as well. So how does we talk also about the responsive feeding model? How does that connect with felt safety? And then and then let's describe and what are the what is what do we mean by a responsive feeding model? Right. So

Unknown Speaker  14:26  
when we talk about responsive what I love about the word responsive feeding is that it's about the warmth and attuned relationship between the caregivers and the children. And we're responding to what we're observing in ourselves and in our children. And that to me is that flexibility in terms of you know, the child is having a meltdown and wants to have one kind of cracker over the other. You know, when I first was trained, I would have said like, no, the parent decides what to eat, and the child eats it or doesn't eat it. And that works for some children. But if you the child in front of you wants to have, you know, Wheat Thins instead of rips or the other way around, and you sense them tipping into that 90 minute meltdown, I, you know, get those crackers, get the other crackers that the child wants. And, and so we're prioritizing the child's nervous system and felt safety, rather than some of these feeding guidelines that that may not serve that child in that moment, or your family in that moment. So, you know, I used to say things like you, and generally still I say, you know, routine is, is very reassuring. So we offer food every two to three hours. But if you had a child who was not able to focus during snack time, and didn't eat much, and then 45 minutes later, they're tapping into a full on meltdown. And a cheese stick is what they need. In that moment, there's more flexibility to do what works for that child in that family in a moment. So so there's a little bit of that responsive piece that that you know, trusts parents and caregivers to respond to the child. But responsive feeding has some, you know, some main things that that in general we aim for, and then having that flexibility. So routine meals and snacks is super important to help them feel like they know they're going to be fed and can sink into that feeling of safety. So we offer food roughly every two to three hours. Now, when a child is first with you, or you have a child whose food preoccupied you might even offer it every hour. And you know, the message is you will be fed, you can let go of this worry. So we're offering food at regular intervals, including a food that the child generally eats. So a preferred or accepted food at every meal opportunity. So they know they can come to the table and have something they will enjoy eating. The other important piece about responsive feeding is when at all possible, preserving the child's autonomy. So that means helping children self serve themselves, or you know, letting them choose from what's on the table, what to eat. So if all they want is mashed potatoes and more mashed potatoes, we don't battle over two bites of broccoli to get them to eat it. So. So there are lots of aspects of responsive feeding, but felt safety is prioritized, helping the child have autonomy whenever possible. And you know, offering opportunities to learn to enjoy new foods. So again, my books, you know, 300 pages, so I don't want to go on for that long. That was a bit of an introduction as to, you know, what that might look like.

Dawn Davenport  18:00  
I'm curious about the opportunities to try new foods because I think the fear that a lot of parents have is that if we serve the macaroni and cheese as a food that we know the child will eat, and the child eats the macaroni and cheese and nothing else. And then the next night we serve mashed potatoes as their preferred food and they eat mashed potatoes and nothing else. And then the next night, peanut butter on a celery Well, probably not celery, peanut butter on white bread. And that's what they I think parents are afraid that they're setting their kids up for a lifetime of eating nothing but macaroni mashed potatoes and peanut butter on white bread. So that's the

Unknown Speaker  18:45  
thing is oh, that that fear is very real. And like I said I had my own feeding anxieties and fears to overcome and that's I totally get that. And you know, there's two long chapters on picky eating and in the book and so this there's a lot to cover here but that fear is understandable, but we just know that the alternative doesn't work. So that was one thing I would say it's just someone listening How is what you're doing right now working how does it feel for you and your child to you know, pre plate and say okay, I'm putting one slice of cucumber on your plate and you have to take one bite before you can have more mashed potatoes. I mean I have families that have been at this for three or four years and the children are not learning to like the mashed potatoes and the or sorry, the snail rubber or cucumber whatever. Their leads to battles and power struggles less felt safety. The kids we know from research, the more we try to get kids to eat fruits and vegetables, the worse they do, the less they eat of those things. And also they tend to grow less well when we have pressure so that's the first thing to understand is that probably what most have us have done or had done to us or doing with our children is not helping, and it's making things worse. So understanding that first is the key. And I think a lot of parents feel that intuitively like, oh, you know, this isn't working. And it feels like the only choice is to bribe reward pressure for that one bite or to give up and just let them eat mac and cheese all the time. But there's a lot we can do. So, yes, you're right, that fear will come true, that child who has been restricted to eating their favorite foods or had to earn, you know, dessert, or the mashed potatoes by eating two bites of broccoli is not likely to eat the broccoli in the beginning. So knowing to expect that I think is really important. And so it's really kind of just a leap of faith of hanging in there of putting the food in the middle of the table, the mashed potatoes, the broccoli, the bees, the rotisserie chicken, whatever it is, children served themselves, and then it's waiting. And I filled the book over and over again, with quotes from parents who just say, I never thought this would work, it did work. And when we can talk about other things, and children feel safe at mealtimes, because they know they're not going to have to lick or poke or take one bite, they can calm down and over time, it can be very quick for many children a week or two. For some it may take longer, especially if they've had sensory really pronounced sensory challenges. Over and over again, though, children want to learn to eat a variety, they'll get tired of the foods when it's not the focus, and they will learn to branch out but it doesn't seem like they will doesn't seem like we can trust them to do it. But I just hear over and over again with my clients even for those with feeding disorders anxious, really anxious and avoidant, eating less than 10 accepted foods. It it happens, some great interviews of a mom of a teenager who came eating five or six foods, and she'd had other children and feeding therapy and she just said I wasn't going to do it again with you know, fading and chaining and making them lick and poke and tasty foods. Because it was battles and it didn't work. And she said with this kid, she served his one of his five favorite foods at every meal and snack. And you know, one day he just picked up an orange and ate it. And within a year, he she said he was my most adventurous eater. Now he still struggles sometimes with choosing which foods so some of the ADHD stuff comes in in terms of meal planning or prep. But even these teenagers who seem to have really limited variety, when we take the pressure off and offer those foods in safe, enjoyable mealtimes. My experience has been they're much more likely to find their way to those foods and then enjoy eating them long term.

Dawn Davenport  23:01  
Are you enjoying today's podcast? Obviously, we hope so. But if you are it would help us if you would tell a friend about what you've learned, as well as about the creating a podcast. We love strengthening and inspiring more families to raise strong and healthy kids. And you are a vital part of that by spreading the word about this weekly podcast. Okay, now I want to talk about three specific issues. One is how do you handle the situation where you have a child who is cut who comes to you and remains significantly underweight now sometimes just after they things have settled down in their lives in their in a place of safety, that that problem resolves itself. But let's assume in a situation where that had did not happen. So let's talk with and then then I also then want to talk about the how to handle extreme pickiness that will be the second special type of circumstance. And then the third type of special circumstance is kids who are eating too much or are emotional eaters. So let's start with you have a child who is underweight and and obviously you're getting pressure from your doctor, as well as just your concern that this child is underweight. So what would you say? How would it speak to parents who are worried about their child being underweight enough, obviously, the nutritional components of that.

Unknown Speaker  24:35  
Yeah, this this is so difficult. We also know that with alcohol exposure in utero that we can sometimes see children who do grow, tend to be smaller and have a smaller head size. So if that's a suspicion, then knowing that can help avoid pressure knowing that this is you know, something that they're likely to be smaller can help avoid pressure. So the first thing I would say is these categories Have quote underweight, normal, quote overweight are so tricky. And and I don't think that a lot of doctors even understand the nuance that is in this. So I see parents saying, Well, my child is 20th percentile, they're underweight. But if they've always been 20th percentile, and they've been growing steadily, or 10th percentile or fifth percentile, even, we know that steady, low growth or high growth on the charts, even if they fall in the underweight or overweight range. And all of these are, you know, in quotes, because I find those labels really problematic. But if they've been steadily growing, and you know, they're eating a variety that covers their nutritional basis, which even most picky eaters do, they may just be smaller than average or bigger than average. And that may be okay. So the first thing to do is not, you know, be intervening where children are smaller than average. And that can be tricky to parse out, especially if you don't have growth charts from the first years where you can follow that. So the first thing I would say is start following and tracking growth to see what the patterns are doing. And still, even with very low weight pressure to eat backfires. And so this is really difficult when you say, Okay, well, I'm not going to pressure my quote, normal weight child, but this child has been labeled failure to thrive or underweight I have to get them to eat. And that is such a scary place to be because that pressure still backfires. So So we still have to have that faith of not pressuring. And that's scary. Everything I've said so far, holds true for all of the scenarios we're talking about. So that's one of the things I love about responsive feeding as well is you don't have to feed a bigger child or a smaller child or a child with brain based differences fundamentally in different ways. So we can feed them all the same way. So I would say the same holds true is work on making sure you're offering food every two to three hours. Try not to pressure even though it's really really hard. And focusing for it for a low weight child, you definitely want to make sure they have unrestricted access to their accepted or favorite foods, so that you know meal and snack time. So you have the mashed potatoes, you have the ketchup, if there are any condiments this child likes sprinkles, even if they're candy sprinkles, a child where you're worried about underweight, sprinkles, dips, sauces, help foods tastes better. And that's why children eat, be careful of the impulse. And I've heard some pediatrician say, Well, anytime you can get them to eat, just follow them around and get a few sips and bites in. But that actually undermines those hunger cues, and they will eat less so like almost all feeding therapists will say Nope, don't follow them around and let them eat whenever they want. I'm not a fan in that sense of for an underweight child or in particular with in general with like having a snack drawer or a yes drawer or something that they can eat whenever they want to. Now that depends on each child, but having those sit down meals and snacks and then having a little time where they're not eating so that they can develop that appetite is really, really important.

Dawn Davenport  28:29  
Okay, that makes that makes great sense. Yeah. For the so we've kind

Unknown Speaker  28:33  
I mentioned screens too, real quick. So yeah, so especially if early on, a child is more comfortable eating with screens, and that helps them to regulate their nervous system, especially if you're worried about low appetite, I would let them eat with the screens, or in their special beanbag, you know, really thinking especially if it's clear malnutrition, thinking about When did my child actually eat well, when did this child eat, you know that entire chicken nugget or a whole piece of bread or a whole pint of blueberries and do more of that. So especially in the beginning, if it's eating in front of a screen on the beanbag, let them do that if you notice that they're eating more, and then start with routine. So let them do that about every two hours, and then work towards more of the routine connected eating at the table. So, so figuring out where things went well in terms of them tuning into appetite, and do more of that.

Dawn Davenport  29:34  
Perfect. Alright, now, we've talked a little bit about it, but I want to circle back to it just to make sure we've covered it all. Now we've got a child who is an extremely picky eater, and generally that is not a child who is picky by insisting that they eat chicken and vegetables. They're usually things that they're that that we worry about nutritionally. So how are we Do what would you say to parents who have a child who is limited to a very small number of foods?

Unknown Speaker  30:08  
Yeah, so if it's really a very small number talking to either the pediatrician or a dietician who knows about responsive feeding just to make sure the bases are covered. So this may be a child where a supplement, or even a supplement drink may help to cover those nutritional bases. And if the child, let's say, only drinks, supplement drinks, or they get most of their calories from that, start by serving that at every two to three hour interval, so we can still incorporate supplements and supplement drinks. And often the kids are actually meeting their basic nutritional needs. So that that can be really important information to help us relax. And then everything I've said just about the low appetite, because often these two go together, also holds in this case. So again, it's not pressuring, even praise can pressure. So that's something to think about too with an extreme Picky Eater is praise rewards, sticker charts that can all be felt this pressure. And it can tip kids out of felt safety they might, or you know a child with you know the name, pathological demand avoidance or other labels, oppositional defiant. So these kids were any suggestion from an adult to try something and they're immediately pushing back, letting go of those reins and making it available without pressure, even asking the child sometimes, what would make this meal better for you? What would what what would make this better for you, they might say catch up, they might be distracted by the dog running around, it might be a screen. And so there are ways to have opportunities to interact and get more familiar with foods that aren't pressure. So things like planting some mint leaves, you know, if you don't have a garden, putting mint or basil in a pot, and they can pick them in and put it in your lemonade or your iced tea. I've often seen kids branch out with foods they're not expected to eat or at at times when they're not expected to eat. So one kiddo would bake treats for the neighbor's dog. And then he would lick the peanut butter or the oats while he was doing that, or I've had kids, you know, feeding, making bird seed crafts and start eating the peanuts from the bird seed because they've never been pressured or expected to eat those foods. So involving them with food preparation in ways that are joyful, maybe washing potatoes without the expectation to eat it, making food that they give away where there's no expectation to eat it mixing, say pancake batter or cookie batter inside a baggie with their hands. All of these ways of getting more familiar with food. Another specific piece of advice is having a paper napkin available, especially if children gag or vomit, sorry to bring that up. But to start of putting a paper napkin out and telling them once or twice. If you ever want to spit something out, you just put it in the napkin, and you know, ball it up, they're much more likely to put something in their mouth, if they don't have to swallow it, or spit it out, you know, or vomit to get it out of their mouth. So offering them control and opportunities. dip sauce is sprinkles again, sometimes children love food straight from the freezer. So just put out a bowl of frozen peas at snack time. I've had lots of families again, some of these will hit for some families, I put that tip on Facebook. And immediately three or four people said oh my gosh, my child has never had fruit, but I put out frozen chunks of mango, if that safe for them to chew. And my child just ate three pieces of frozen mango. So sometimes thinking outside of the box in terms of of what to offer can make a big difference. And often the first drying of new things is with sweets. So it might be a new flavor of ice cream. It might be a new drink, it might be yogurt, putting sprinkles on ice cream, and then sprinkles on frozen yogurt and then sprinkles on you know vanilla yogurt. So all of these different ways that we can offer foods. And again, the key is that they're in that mental space that felt safety space where their curiosity and appetite can be tuned into.

Dawn Davenport  34:47  
All right. And then our last special circumstance is how to handle children who are eating too much or emotional eaters. Sure, sure.

Unknown Speaker  34:59  
So I think one thing to start with is reframing the idea of emotional eating, and particularly where there's been food insecurity or neglect or abuse, chaotic home, I like to think of it as actually very resilient of children to have found something to access that might have helped them find a source of pleasure, or something that helps their nervous systems food and eating can be soothing. So it may have been a coping mechanism, it may have been all they could access to deal with, oh, I'm feeling something I don't like I'm anxious or I'm dysregulated. And food or something sweet or predictable, can help to help them feel safer or feel better in their bodies. So I think that recognizing that that was resilient is a is a new lens of looking at it. And we can also with felt safety, and with everything else we're doing, help them access other ways of coping, and feeling good in their bodies. And so I don't think we necessarily have to intervene and and worry and stop emotional eating. But focus instead on building other ways of coping and resilience and helping children find purpose and other ways of regulating and self soothing. And food. I don't know about you, but you know, I find food wonderfully soothing and a source of pleasure, I have other tools. But I'll tell you, when I threw my back out for four days and just was in horrible pain, I remember the third day wanting a Snickers bar and just saying out loud, and I was really curious about it, I just want something to feel good on my body or with my body. Because it was so painful for so long, or you know, for luckily, I don't have chronic pain. But so so I think accepting that it's, it's okay to eat when we celebrate. And when we connect with others, and eating for pleasure is okay. And that working on all those other things helps that go away. For kids who seem to eat a whole lot, there's often been that food insecurity. And there's a dangerous myth that children in bigger bodies were where we might say, well, obviously they had enough food, they weren't food insecure. And that's really dangerous, because that leads us to not then nurture these children with food in the same way that we might a child in a in a smaller body. And we know that food insecurity is very much tied to higher weight, and eating disorders. And so this is a really, really difficult piece in our culture that that really has, there's a lot of stigma around weight, we know that people in bigger bodies are judged even by doctors and by children as young as four, think of them as lazy and stupid. And and that's really painful to live in our culture in a bigger body. So we want to sort of protect our kids and, and try to prevent that. But a really important message, just like with low appetite is for kids with big appetite, the more we try to get them to eat less and control their portions to get them to eat and weigh less, the more that's going to backfire. So having a kid who shows up at age three whose food preoccupied, we need to feed them, even if they're in a bigger body the same way we would have sibling. So they might eat a lot at those meals every two to three hours. But that also tends to calm down that food production tends to come down with regular meals and snacks and unconditional love. So it's it's a really tricky thing, because our whole culture and the doctors are saying you've got to get them to lose weight. But we know if we restrict kids and teens who diet even sensible dieting, like pushing fruits and vegetables or trying to fill them up with water, we know that those kids end up heavier, more depression, more anxiety and more eating disorders. So this is another really, really tricky issue and kind of a leap of faith but loving your children unconditionally, no matter what their bodies look like, is really the best thing that we can do for them. So very, very tricky issue. I hope that answered some of your questions.

Dawn Davenport  39:27  
It did. I was sitting here thinking on, you know, some of the tips for just getting your kids to you know, to try a variety of things. I would be assuming that you wouldn't be suggesting that we would be feeding ice creams and different flavors and putting sprinkles or maybe would put sprinkle some food because that's really not very caloric anyway. Would you do would you change anything from that respect if you've got a child who is overweight?

Unknown Speaker  39:54  
Now not Not particularly? I mean, I think that depends on the family too. If you have a child who is underweight and a child who's quote, overweight, feeding them differently sets up major battles and battles between the kids. And I want to just mention, you know, it's very rare that you need to be feeding ice cream to any child, you know, five times a day. So I don't see that scenario happening. But I would let you know all of the children have access to dessert and dessert with mealtimes. That's another piece of this puzzle that I haven't gotten to. So the two pieces of advice that are the most helpful to decrease power struggles, and help kids to decrease preoccupation with those sweets that we worry about. Number one is serving foods family style, letting kids serve themselves, and not have to, like eat certain foods before they can have dessert. And number two is serving a portion of dessert with the meal. And it just takes the sweets off the pedestal. And yes, they'll eat dessert first for a while. But then fairly quickly, I often see kids having dessert and then going back to having a bite of chicken and then a lick of the popsicle. And then they might eat a bite of carrot stick. So serving sweets with the meal is very helpful. So again, this is a really tricky thing for kids in bigger bodies, we feel like we have to get them to eat less or different foods. And most of those efforts will backfire. So it's I hope that answered that

Dawn Davenport  41:27  
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Unknown Speaker  42:33  
Why is that? Well, we've talked a little bit about food insecurity. That's a big one. So again, food insecurity is linked with five times higher odds of being higher weight in the studies. So it makes sense. This is absolutely a resilient strategy. If you're a kid. I mean, think about if for those listening, when you last dieted, what did you think about I mean, I my last diet. So trigger warning for dieting, we've talked about my last diet was, you know, 18 years ago, it was South Beach. And all I wanted was that darn bowl of cereal that I wasn't allowed to have for two weeks, I was completely focused on that at work. And imagine that focus for a child who doesn't have control doesn't know when it's coming doesn't have the cognitive framing. So if they weren't fed for 812 hours, when that food shows up, they're going to eat as much of it as they can and as fast as they can. And that's, that's good. That's our body's survival mechanism that's resilient. So, so we see patterns of eating lots of food, the food insecurity piece of it. And when we don't have reliable access to food, especially if there's been a time early on where they had malnutrition, that also impacts hormones. So again, when children are in fight, flight or freeze, their insulin is acting in different ways. Cortisol levels are way up. So the cortisol, the insulin, the gut motility, I think leads to higher weight. And so adverse childhood events, that's Asus scores, food insecurity. Children in bigger bodies also tend to get teased and bullied. And there's shame. A third of kids are teased by family members. So when there's shame around it, we see more sneaking of foods and more eating when they're not hungry. And attempts to try to get kids to lose weight leads to higher weight. So that may be part of this too if a child has been restricted, or there have been dieting messages that they've gotten as well. So lots of reasons for this, the trauma, the food insecurity, lots of environmental reasons. Some kids, some kids are just going to be in bigger bodies, and we also have to accept that. It doesn't mean we ignore health, we can do a lot to promote health without the goal of losing weight. So I'll talk about that in a minute. But I want to also mention One piece that's really important to reduce the fear because I had a child in a bigger body with a huge appetite, who was food preoccupied, so I had to do a lot of reading around this. And as a physician, you know, I treated diabetes and heart disease and all of these things. A lot of what we attribute to higher weight is more convincingly linked to adverse childhood environment and trauma. So a lot of what we blame on being in the bigger body is really from the early difficult environment where the body had all that wear and tear, the immune system changes. So I want to just if that helps anyone to take a deep breath that, that addressing healing the trauma, building the child's resilience, social connection, love, when we look at public health, social connections, and love has a far more impactful presence for health than the BMI or body mass index, or even, you know, then smoking. So it is a health intervention to focus on felt safety, love, and connection, it helps their bodies helps their heart, lungs, immune system, energy storage, all function in better ways. So I'm not saying to ignore health at all. So I just wanted to make sure that was clear, too.

Dawn Davenport  46:26  
Yeah, that makes sense. So we like to end with tips, you've already given some great ones. Are there other tips that practical tips that you would like parents to know, as it relates to feeding their children and nutrition in general? Yeah, so

Unknown Speaker  46:45  
I mean, so many, but I'll try to limit it.

Dawn Davenport  46:50  
You don't have to I love her too. So

Unknown Speaker  46:52  
well, you know, and I, again, the book is full of them. And, you know, my also on my, on my website, there are some stories from children and, and just to help with that fear, like serving dessert with dinner, I get a lot of resistance on that. So I did a whole blog post, maybe you can link to it called parents on serving dessert with dinner. And it just quotes, you know, probably a dozen parents who were reluctant and what their experience was with it, because that's what we as other parents, we want to really hear from others who have tried it and where it works. So I wanted to share that. Now when I said, so here's again, where the flexibility piece comes in. I think this is important. When I said family style serving, I get a lot of questions. And so I've started talking about modified family style serving. I'm also on Instagram, by the way, sharing lots of reels, and really quick bites of these kinds of tips. But let's say you have three kids at the table and you put down I always use tacos as an example, there's taco meat, or maybe you're using, you know, vegetarian version of that. But there's something that most of the kids like, and it's expensive. So there's a limited amount. And they're fighting over it. And you see their anxiety rise, particularly food preoccupied kids, if they sense that scarcity, they're going to just be focused, and it's going to trigger that food preoccupation. So you might do things like serve the taco meat for them. So if they're worried about everything being fair, you get a third cup scoop, and you put that amount on the plate, and everyone gets their share. And then maybe the table is more full of rice and beans or tortilla chips or dust and the other things that they can also fill up on. Some children within basic differences, may find it really anxiety provoking to serve themselves, whether it's motor planning, or they have decision fatigue at the end of the day. So it's okay to serve children, food, or if they have, say, a motor deficit, or they eat very slowly, you can serve them and do it in ways that preserve their autonomy. So you might hold up the serving spoon and say this much. And they can say more or less and then point to me on your plate where you want it. So they have a sense of control along the way. So So that's the kind of thing when I talk about flexibility and following them. If you have a child, this rarely rarely happens. And usually it's with fetal alcohol, or lots of letters behind the name. Some children will want to be told how much to eat. And so if you have a child, where you're suddenly saying you can have as much as you want, and they're crying and saying, Tell me I can stop or can I stop now, again, I've very rarely heard this, but absolutely prioritize that felt safety and say, yep, you can stop now or would you like me to serve for you? So again, it's that flexibility of what's working for the child in front of you. So that's a little bit about modified family style because I get a lot of questions about that. Also, there are ways to support nutrition while you're working on all this other stuff. So if your child like school fish crackers. There are you know, wholegrain fortified goldfish crackers, there is protein fortified pasta or fiber fortified juices, calcium fortified juice if they're not having dairy. So if there are foods that they enjoy, and it doesn't change the flavor or bother them, you can get some of these fortified foods to boost nutrition. You know orange juice, some of them have DHA, you might, if they're not eating any chia seeds or fish, you've might do a DHA dummy, too. So there are different ways of supporting nutrition while you're waiting for these skills, and okay, so here's a couple of things to avoid. Sneaking, to me is a big no, no. So sneaking more nutrient dense foods, I've seen this blow up in people's faces terribly. I remember a mom said, I tried putting riced cauliflower in his scrambled eggs. And of course, they'll find it because they have little detectors. And now he won't even eat the eggs anymore. It breaks that trust. Now they don't trust that you're not going to mess with their food. So mom was disrupted, said you know what scrambled eggs were the most nutritious thing he ate. And now he won't even eat those. So really preserving that that trust with kids is important. So I definitely think avoiding sneaking is important as well. So another tip is to serve foods many ways. Many times. I think that's just a good mantra to remember. So let's take blueberries for example, if that's something you enjoy, taking them blueberry picking is is awesome. You might have blueberry jam, you might make some pancakes where half of them have blueberries in it. You might either purchase or bake muffins that have blueberries, children who enjoy sensory input, you can have crunchy freeze dried fruits and vegetables now. So a freeze dried blueberry, maybe you put blueberries in a smoothie, you serve a little bowl of frozen blueberries. So there are lots of ways to serve foods and serving them over and over again because they might not really be interested the first five or six times but especially if it's something you enjoy to keep serving those foods many ways many times and that is often a really helpful tip. So you know, I think excellent, I could go on and on but I think I'll stop there and see if you have any other specific last questions.

Dawn Davenport  52:33  
No, it was excellent that type so appreciate. I was smiling at the sneaking I be here all the time. You know, those are the parenting tricks. So how you you put spinach in the in the smoothie, which I happen to like I will think it's actually a good sneak However, having the child see you do it. I totally appreciate it. Thank you so much. Dr. Cardio Royal. I really appreciate your wisdom, author of the book. Love me feed me the second edition. So thank you so much for being with us today.

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