Tuesday, February 23, 2016

Kiss-Lick-Bite

How’s the food playing going? Have you made progress in getting you little one to touch the different textures and explore new foods in a play setting without the pressure of eating it? If this is the first time to hear about this activity, please refer back to my previous post, here. It is so important for your picky eater to be exposed to new foods and new textures. If he refuses to touch anything in his plate, then having a fun play time just to explore is important.

What I wanted to introduce in this post is a game that has helped me many times. I use it when my son refuses to even look at the food. It takes practice, it takes time, but like I always say, patience and perseverance are important. You have to start somewhere, right!? To write you begin with ABC, to sing you begin with Do-Re-Mi and to eat, you begin with Kiss-Lick-Bite.

The Kiss-Lick-Bite (KLB) game

Now that you have practiced letting your kid play with food, you can move on to playing the KLB game. If your kid is more comfortable with a certain food that you introduced, you can ask her to kiss the food. You are still not trying to get her to eat the food this moment; you will work up to it. So grown up, please be patient! Kissing is a way to get the food close to the mouth but not threatening enough that your kid will run away from it. Slow steps are important here. Show your kid how you do it, give the food a little kiss and put it back on the plate or play table. Continue with your games you’ve been working on with food. It is important not to force too much, I can’t emphasize that enough. Put too much pressure and your baby will get on the defensive again. Keep practicing until you feel your little one is comfortable with the kissing part.
Use affirmative phrases like:
- Let’s play a new game, let’s kiss the food
- Give it a little kiss
- Now kiss it

Once you feel that you introduced a couple of foods to the kissing part of the game, move on to the licking part. Use a food that your kid is comfortable kissing. You don’t want to stall progress. Again, show how you can just lick the item you are playing with. They might barely touch the food, but just the fact that they are opening the mouth with the food in front of them is great progress. If your munchkin refuses to do it, practice more of the kissing game. Remember to obey the kid’s own time. Don’t rush through it, don’t force them to do it, and don’t get frustrated. This negative behavior will only set you both back so far.
Make encouraging remarks like:
- Now let’s lick it
- Touch this “insert food here” with your tongue
- Give a little lick

When you’re both tired of kissing and licking part of the game, move on to giving a small bite. Tell your baby to start with a tiny little bite. Again, use a food that has already been introduced thru play, then kissing, then licking. It is always a progression with the same food. You will get some no’s. But remember to keep your cool. Try again next time. The same language goes to try to get them to bite. You get the picture from the examples above.

As simple as the KLB game is, it does create results. As I mention in my previous post, you need to keep a very calm and pleasant voice. Raising your voice and creating the negative association with this game will only make matters worse. And remember to go slow, introduce one food at the time so your little one is not overwhelmed.
I hope you have some success using this game. Once you have played enough with the play food, you can start to introduce it at the table. I have gotten my picky son to eat foods that I would have never imagined he would try by using this game. I did not introduce this game to him. The therapists were the ones who did. But by observing them I saw their patience with my son and the attitude of “no big deal if you don’t kiss it (or lick it, or bite it), we will try again later” that they had with him. Sometimes when I am mad I try to think “how would a therapist deal with him now”. It helps me take step back and try again. Hard many days, I know you can relate. But we are doing our babies a favor by practicing our patience. I also need to tell you that many times he refused to take a bite. But I persisted and I knew that if he kissed and then licked, I could try to introduce it again next time to see if he would progress. Some foods were easier than others, but stay with it. It pays off in the end.
Picky Eater - From Picky to Eater
Kiss-Lick-Bite Game

Monday, February 8, 2016

Getting the Process Started

Once we got the whole evaluating out of the way, we were able to start on the journey that took us here today.  A few nights ago I was eating a salad for dinner and my son asked me if I was eating lettuce (he as tried wilted lettuce from the Mexican food leftover before and I guess he liked it).  I said it was kale, kinda sorta like lettuce, and he didn't immediately dismiss it.  I asked him, would you like to try it? To my surprise he considered it for a minute, then he said "yes." Shocking! I gave him a small piece of raw kale from my salad (sans the dressing, knowing him it would turn him off) and he made weird faces but ate it.  I know that because I respected him and didn't add dressing to it I opened the door for next time.  I told him next time I would cook some for him and he can try the soft kind of kale.  I'm excited about it, we are expanding the food options and they are healthy!  
As for how you can also get your little one to be more adventurous with food, here's a start.

5 Things I learned from over a year of feeding therapy with my son:

It takes time to see progress - From the first time we stepped foot into the clinic to this day, I learned to be patient when it comes to teaching my son to try new foods.  Some times he would just flat out refuse to touch anything we offered, and I had to learn to respect that.  I had to tell myself I can always try again another time.  We get eager to see results and end up hindering progress.  Each kid has his own time.  If you are persistent and consistent, with time, you will see results. You will learn as you start this at home that many days you will want to throw in the towel and just give up.  Stay with it.

Be calm and collected - use a calm, non emotional voice to ask your kid to eat.  I think this is so hard to do because we are emotionally attached to them and we want them to eat something so badly that it is impossible to be objective with your kid.  On the other side, when they do take a bite, praise them.  Show you are pleased.  No need to go over the top, use of praise is good at the right time.  

Use phrases like:
- You want to try X first or Y? (giving choices is important)
- Take a bite.
- Eat this one now. 
- Try this one now.
- Good bite!
You're directing them with positive remarks, you're not begging.

Avoid using phrasis like: 
-You don't like "......"? 
-Why don't you eat "....."
- How about you try "...." 
- Can you eat "..."
- You want to try "...."?(the choice is this case is Yes or No)
These phrases give them the option to say no as the answer.

Let your kid play with food - This is part of the occupational therapy. In a time when your kid is not expected to eat, say after a mid morning or afternoon snack, let your kid play with foods that she has aversion to.  Get some dolls, toy dinossaur, cars or any other cheap, easy to clean and small toys that you don't mind getting dirty with food, set up a spot on the kiddie table (or a spot where the kid is comfortable*) and let her use her imagination.  Or hide a toy inside a bowl of spaghetti, peas, flour, sugar, smoothie, or any other texture that sets off your kid's defense mechanism.  Make it fun, show her that you are having fun. Don't be afraid of getting messy, you can clean later. Encourage her to look for the hidden toy.  Remember, there's no expectation for her to eat anything during this time, but if she's feels like trying it, let her. 

Use a timer - to help things along, set a timer and tell your kid he has until the timer beeps to eat his food.  When my son does not want to eat the food in his plate, he uses many tactics to avoid eating it.  He says he needs water (and gets out of the table to go get it even though he has some next to him), he turns his back to the table, he talks, and talks and talks... However, I know he is capable of eating a meal he likes in 20 mins or less.  He is just using delay tactics. Therapists only had a limited number of minutes with my son, so they suggested I introduce that at home. I did, and he hates the timer with a passion.  Perhaps if you introduce the timer during food play time mentioned above, you can train your toddler to know that when he hears the timer, it is time to stop.  That way he will be used to it when you're ready to start using it at the table for meal time.

Offer a reward - Offering rewards to give your baby an incentive to eat is one of the tricks therapists use.  It does not need to be food related(by that I mean candy).  It can be, especially in the beginning to entice your little one.  My son LOVES playing Disney games on the iPad.  So I set the expectation, when we have a new food in his plate, that if he tries the new food, he will be able to play for 30 minutes on the iPad.  He is the one starting to say "mommy, if I eat my new food I can play my games." This tactic works only if you're consistent - if you say I will give you "insert reward here" after you eat "insert food here" then do as such.  That means that if your kid did not eat what you asked him to, you will have to explain, in midst of all the tears of protest, that he did not get the reward because he did not eat his food and that he will have a chance next time.

As we attented these sessions week in, week out, we started seeing progress in front of the therapists.  That is really good, my picky eater was responding to treatment.  Do the same at home. Schedule a time to do feeding therapy, otherwise your busy mom life will get in the way.  I was paying for it, so I had to go.  Be as dedicated to it as if you were paying for the treatment.  You will start seeing results. Remember, it took us over a year to be able to see results at home as well.
As for the kale I promised to make for him, I did follow through.  I made some a few days later for dinner and placed some in everybody's plate.  He gobbled it up! He asked about it at first, but did not hesitate at all to eat it.  You can only imagine how happy this makes me!

*note on table/chair size: To have a better chance of success, use a kiddie table that is appropriate for your kid's size or use a booster seat on a chair or a comfortable high chair depending on the age.  It is so important to have their arms above the table.  This is especially hard at dinner time when they are so tired and are more likely to refuse eating even preferred foods.  Toddler's upper bodies and arms are not strong enough and they get heavy when they have to keep raising them above chest level to get to their food and then bring it to the mouth.  Just think about it, when you try to hold your arms up at shoulder level for some time they get heavy pretty quickly.  This is just an FYI that I didn't even think about before I saw the teeny tiny table and chairs they were using. The right furniture height kept my son engaged in the task at hand and will help your kid as well. 

Delay tactics come in very different expressions

Pictured above: He just needed to try to fit his feet throught the chair slats right at that instant - delay tactic at its finest. I offered to feed him because I could tell it had been a long hard day, I don't mind letting him sit on my lap and help him with some spoonfuls every once in a while.  He did eventually eat it all and played with the iPad for a few minutes. Our dinner that day was rice/beans/kambocha squash with corn/beef roast (he didn't want to try the squash).

Sunday, January 31, 2016

Getting an Official Diagnosis

By the time my son was a couple of months shy of his third birthday is when we got him evaluated by professionals that deal with feeding issues all the time.  Part of me hoped they would say he is just plain picky eater.  But I really wanted help trying to figure out why he was so picky! It has been nearly 2 years since we went to that first evaluation.  I am much happier with the options we have.  Do I still have a picky eater? You bet! It is still really hard at times, but mostly we are able to convince him to at least try a new food.

Looking back at some paperwork this morning brought me tons of memories from that time a couple of years ago.  As you might also have the same experienced, once you go thru a phase with one kid you forget all the details and mostly think of this past time only in general terms.  It was good reminder for me to look at the evaluation results to share it with you because if I only based it on memory you'd only get half the story.

As a disclaimer here, I just wanted to say that I am fully aware that there are many different levels of sensory disorders and that my son only has a mild case of it.  I know there are parents out there that don't even consider this level of pickiness to be a problem because their kid's case is much more severe.  I am not a doctor or a therapist to evaluate a child.  I am simply a mom who has noticed some odd behaviors and wanted to seek help.  My goal with going to therapy was to aid my son with eating socially available foods and to teach him to try new foods.  If you feel your son or daughter could have some degree of sensory disorder mention it to your pediatrician so you both can find the proper course of action.

Things I noticed about my son at the time
Excessive drooling
Sensitivity to noises (even the washer and dryer noises were too loud at some point)
Aversion to certain textures
Aversion to getting hands/feet dirty (including touching sand)
Used to swallow soft food (like pasta) basically whole
Leaving the table/refusing to come to the table
Flailing arms/legs when seated at the table
Pushing spoon/food away
Diet was becoming more and more limited as he was getting tired of the same foods but refused to try new ones

What the therapists noticed about my son at the time
Had difficulty going from smooth texture to lumpy (this I told during eval)
Will grimace and tear up when trying new food
Showed ansiety when seeing mom prepare food

"He does present with mild sensory based challenges; however much of his difficulty is related to past experiences and learned responses leading to mal-adaptive behavior"
So basically he had a little bit of the tactile issues I was suspecting, but probably by my guidance had learned to avoid foods that he perceived as "not good." I always think I did this to him.  If I had only let him explore foods on his own.  I did what I thought was right at the time and if I could go back I would let him explore more from our plates, as opposed to offering baby cereal and baby food exclusively and jumping in to save him every time he gagged.  Looking back now it was a little over the top, but as a first time mom it scared me witless.
His official diagnosis was "Aversion to food items, Behavioral feeding disorder, and oral dysphagia."  When I read this part my thought was, "Ok, so it's not just in my head." I felt that once I new they could pinpoint the issue we could find a solution for it.

What we did to attempt to fix the problem
Both me and my husband were willing to be involved in this journey.  The therapists recommended Occupational and Feeding Therapy.  During Occupational Therapy my son got exposed to food in a non-threatning environment where he was not expected to eat any of the foods.  In Feeding Therapy, he learned how to overcome the mental and behavioral barriers that were preventing him from eating new foods.  For the first few sessions I was present, and then slowly started leaving the room earlier until he was alone with the therapist for that period of time.  The first few times he was invited to go back by himself he protested - kicked and screamed (as the therapist put in eval form) when led to the therapy room.
I was asked to bring foods I wanted him to try and they worked with him on one food at the time week in, week out.  Once he presented progress they would move on to the next.  This lasted for about a year.
At the very end we had a couple of sessions with a Psychologist who helped us with the transition from clinic to home (he was totally fine trying and eating all different foods in the presence of the therapist but I could not, for the life of me, get it to apply it at home). After only two times we were successful in getting him to try new foods at home (those last sessions were for me to learn the techniques, not for him).  We now have various games we play that aid me in getting the task done.  He respondes well to incentives - and I'll tell you about that next time.

From Picky to Eater Pancake
First Pancake - He ate a little on this first birthday, but after this I could not get him to eat any more of it

Saturday, January 16, 2016

From Picky to Eater

As any young lady growing up I would sometimes fantasize about getting married and having kids. In this dream my kids would seat down at the table and eat whatever we had as a family, one meal.  My dreams never involved having to cook special meals for my kids and beg them to eat the most mundane foods.  Fast foward to the present and reality is totally different.  Meal planning is challenging and what usually happens is me cooking two different meals.
I know many people can relate to this.  What toddler is not particular at picking their foods?  Just chicken nuggets is what my son eats says one frustated mother, only pasta is what mine will have says another mom. Yes, feeding a toddler can sometimes be the hardest thing you do, and if you are like most people, you have to do it 3 or more times a day.  It is exhausting!

With that said, going out to eat is even a more challenging feat.  Many a time we would have the idea of going out to eat but our options were limited to the places that my son would eat.  We cannot go here because they don't have anything LJ will eat, we would say often.  It got ridiculous for a bit there, when it came to meals (not just a snack in the morning or afternoon) we would have to bend backwards to try to find something that matched all the criterias.

You might think why wouldn't you just offer him different foods.  Doctors tell you kids need to try a new food a number of different times in order to start liking it.  Yes, that makes sense.  As if I never thought of that!  The problem was that every time I offered my son any food that looked anything different than what he was used to eating, he would throw the entire plate out on the floor and not eat anything.  I would add different veggies to his plate next to his preferred food and crying would ensue, tantrum central was unlocked and it was very difficult to expand the food options for that boy.  I tried people, I really did.  One day when he was about 2 years old I did this whole theatrics with him.  I got a piece of bread (something he would not even touch, literally he would make digust faces and he would recoil from touching a piece of bread), peanut butter and jelly to make a PB&J and I gave a voice to each of the items.  I was playing with all him and spreading PB and saying silly things that at the time made him smile.  Then I did the same with another piece of bread and added jelly, all being all playful and making very interested in what I was doing.  My intent was to have him have a bite of the bread with PB and then the one with jelly and put them together and say see, you're eating a PB&J.  Even with all that effort, I did not even get to my first goal of getting him to eat a piece of bread with anything on it.  It was so frustrated, he was liking what we were doing, but he did not like it when I asked to eat it.  He was basically mortified I had asked him that and ran away.

After noticing his aversion to certain foods, I brought that up to his pediatrician who was kind and said kids are usually picky at age 2 and to keep insisting.  I wasn't so sure that was the case so I still asked if she could refer us to a program that could evaluate if he was plain picky or if he had some sort of sensory disorder. Luckily that program was a mile from our house.  Apparently this one of the best places in the nation for feeding therapy.  I didn't know this at the time, but it is a hight sought after program that people even move from other states to have their kids learn to eat due to disabilities and sensory issues.  Yes, we lucked out. After a year of therapy (and many dollars later) we were able to at least get my picky eater to try new foods, even if he doesn't love them.

I know many of you can relate to some frustrations while feeding your kids.  I want this blog to hopefully help you with some tools to get your little one to eat a litte more variety.  I know kids have their favorite foods, and that's ok.  I will not insist my kid eat a burger or pizza because we like it.  My whole intent when I sought help from therapists was to give me tools to help introduce new foods, which before I went thru this journey was basically an impossible thing to do.  I still am not able to cook one meal for all of us to eat every evening.  But it has gotten better and I know in the near future as I continue to work on adding new foods we will eventually be eating the same dinner as a family.