303.842.8255 | 400 McCaslin Boulevard, Suite 210, Louisville, CO 80027
Flunked Out Of Feeding Clinic? Hope For The Super Picky Eater

Flunked Out Of Feeding Clinic? Hope For The Super Picky Eater

Kids needing feeding clinic intervention are the pickiest of the picky. Their super picky appetites have frustrated their parents to no end. They tend to have more dental problems, get sick more often, and can have more developmental delays or behavior problems. They don’t eat well, have a very short list of acceptable foods, and don’t grow well as a result.

Why are they doing this? The feeding clinic approach doesn’t ask why, but operates from a cognitive approach – that is, it’s assumed kids are doing this by some choice on their part. Feeding clinics are part behavioral intervention, part social group (peer pressure is leveraged to help kids try more foods), and part occupational therapy. They try strategies to get little ones eating more, by pressuring them to push through texture aversions, gagging, squirreling food in their cheeks, spitting food out, or rigid beliefs about foods.

I’ve met a lot of feeding clinic flunkies – kids who stumped teams of psychologists, speech and language pathologists, GI doctors, and occupational therapists. What went wrong?

In some cases a swallowing issue is found, and an occupational therapist as well as a speech and language pathologist can help this. Otherwise, it’s often assumed that there is no physical rationale for the child’s eating pattern, that it is purely psychological.

But that’s rarely the whole story, in all the kids I’ve met with feeding problems this deep. I often end up finding a physiological backstory. And when that is defined, it can be fixed; when that is fixed, appetites can improve. Eating becomes a non-issue, stress for the entire household drops several notches, and the child can begin eating and growing normally again.

What physiological gaffes can create a picky eater monster? Here are the usual suspects:

1 – Reflux medication. These lower appetite over time, and make everything harder to absorb from the gut. My opinion? These medications are rightfully earning a bad reputation. They are over-prescribed for infants and children. They are associated with lesser bone density (and fractures in older adults), and lower digestive capacity in general. They make it harder for many nutrients to be absorbed, notably, minerals like calcium and iron, and vitamin B12. Reflux medicines also let fungal infections (Candida or yeast) flourish at the expense of healthy gut microflora. I have seen at least one case of stunting due to long term use of reflux medicine. Leaving a baby on this medication during crucial developmental years means optimal levels of nutrients will not reach brain, bones, and body tissues.

Reflux medications leave food sitting longer in the stomach, because they reduce digestion. Food will remain poorly digested. The result can be constipation or loose stools, bloating, gas, more reflux, and – never feeling very hungry. Strategies to wean off reflux medicines – and how to avoid them in the first place – are discussed in detail in Special Needs Kids Go Pharm-Free. Be sure to tell your doctor if you would like to wean this out of your child’s regimen.

2 – Intestinal candidiasis. This is a Candida (yeast) infection in the intestine or GI tract. While Candida microbes are a usual resident of a human gut, they can take over and grow too much. This makes kids more picky for sugary, starchy, smooth foods. A yeast-heavy GI tract also tends to have a pH that weakens digestion. The result is a little like too much reflux medication: Bloating, gas, constipation or loose stool, and picky appetite. Treating the yeast infection with the right medication, diet, herbal tools, or probiotics can move your child to eating healthfully and heartily. In my practice, I use stool and urine tests to detect how much yeast is growing in the gut, and to see what might herbs or medicines might best clear it out.

3 – Food sensitivities. Food allergy is not so hard to see: Usually there are hives, rashes, eczema, stomach pain, tingling at lips, tongue or throat, or vomiting. But food sensitivities can have few obvious symptoms, other than weak picky appetite. I test for these in my practice with a blood test called ELISA IgG to specific foods. We find problem foods, and figure out how to rotate them. This can help your child feel less discomfort when eating, and can help reduce the texture aversion part of the story.

4 – Mineral deficiencies. Picky eaters usually have poor mineral status in their blood and tissues. Iron, zinc, and other minerals all influence appetite. These can be checked with blood tests, but there are also easy to check clinical signs for mineral deficiency states too. See Special Needs Kids Eat Right for a table on detecting mineral imbalances without drawing blood. Restoring good minerals can lift a picky appetite.

If you have an epically picky eater, take heart – there are many nutrition strategies that may crack this nut for you. See either of my books for details.

Nutrition Solutions You Didn’t Know: Being A Pharm-Free Kid

[/caption]We’d all nod in agreement if asked, “…does nutrition matter for babies and kids? Is it important that they have enough to eat?  Does it make any difference what they eat?” I bet any pediatrician would too. So why don’t we tap that when it comes to helping special needs kids thrive to their potential? After all, these kids are at higher risk for nutrition problems than typical peers – problems that often go unnoticed, and have the power to impede progress.

We can, and this is what I have done in my pediatric nutrition practice for over ten years, working with kids who have asthma, severe food allergy, autism, Down’s syndrome, arthritis, growth failure, feeding problems, ADD or ADHD, clinical depression, and more. On top of that work, I’ve written Special Needs Kids Go Pharm-Free – because even after a decade working with kids, I am surprised that parents still have so little reliable information on how to leverage nutrition-focused tools for a child with a chronic condition or disability. Just as they can for any child, nutrition tweaks can make or break the difference between staying well or getting sick a lot, succeeding versus struggling at school, growing as expected or being stunted, and relying on symptoms-only drug treatments versus ditching the drugs altogether to feel and function even better.

Pharmaceuticals are not a bad thing. But our health care system may be stacked to make these too much of a good thing for our children.  For example, prescriptions to young children for stimulants (like Ritalin) and proton pump inhibitors (reflux medications) – just two types of drugs – have skyrocketed in recent years.  Children are now more medicated and more immunized than ever before – but are more chronically sick and disabled too.  Between 1980 and 2000, a 57% increase occurred in the rate of children with disabilities served by government programs.  In our public education system nationwide, about one fourth of learners are served under the Individuals with Disabilities Education Act (IDEA) – and the increase in number of children served under IDEA has grown at twice the rate of the general pediatric population.  In the same time frame that Americans have used more medications than ever, our overall health related quality of life has declined.

What this means is that our children have become more sick and disabled in the last thirty years, not healthier, and that prescribing more medications may not be helping. Physicians aren’t trained in non-pharmaceutical strategies for disease management in the US, as they are in several other developed countries.  Controversy continues regarding the influence the pharmaceutical industry may wield here on medical training, clinical trials, even medical journal publications – making good information on strategies like nutrition almost invisible.

Gluten free noodle bowl and gluten free pot stickers. No sweat.

I’m not sure how to eat these. Anybody? Beuller?Special Needs Kids Go Pharm-Free to the rescue. Affected children are often assumed to be presenting in a certain way because of the condition or disability itself, rather than because of a fixable, nutrition-related impairment.  Here are just a few examples of how nutrition can impact a child with a learning difference, developmental disability, or chronic condition. More examples with strategies to address them are found inSpecial Needs Kids Go Pharm-Free. These spotlight nutrition problems that have been linked in myriad clinical trials and public health data to learning deficits, growth or developmental impairments, insomnia, psychiatric disorders, or behavior problems in children; others abound in my case files:

–        Children with Down’s syndrome may have gluten sensitivity or celiac disease more often than typical peers. Even in the absence of celiac disease, untreated gluten sensitivity in itself may impede growth, stooling, and functional abilities for a child with Down’s syndrome.  A gluten free diet may help a Down’s child make unexpected leaps.

–        Over a third of boys with Asperger’s syndrome tend to be clinically underweight – that is, their body mass index (BMI) is <10th percentile.  This is a growth pattern deficit that may impair infection fighting, sleep, continence, and cognition.   The only correction: More food!  Healthy fats, easy to absorb proteins that are not inflammatory, good carbs – and plenty of them all.  In some cases, specialized formulas or custom made smoothies can help too.

–        In puberty, low BMI in boys is linked to low total cholesterol.  This is inversely related to testosterone level, meaning that testosterone will rise when cholesterol is too low. Low total cholesterol has been linked to psychiatric disorders, suicidality, and aggression.  Excess testosterone has been noted in about a third of boys and girls with autism; aggressive or obsessive compulsive behaviors showed improvement, in early work treating high testosterone with medication in these children.  Keeping a child’s BMI above 20th percentile, plus allowing ample daily healthy organic fats and oils, are nutrition measures that may help.

–        Any child with a self-limited diet (eats just a few foods) or mechanical problems with feeding (tube feeding, swallowing disorders, oral tactile defensiveness) can quickly become depleted for minerals like zinc, which allows normal appetite, growth, and immune function; magnesium, which helps nerve cell function; chromium, which helps control blood sugar; and selenium, a key antioxidant.  Children with Down’s syndrome in particular should be screened for zinc status.  While a high potency supplement can help, so can slow cooked stews and broths, chock full of vegetables and gluten free carbohydrates like quinoa (a grain that is also high in protein), black rice (higher in iron than regular rice), lima or kidney beans (to add zinc, protein, fiber) or breadfruit and potato (great for potassium).  Adding grass fed beef or free range poultry – organic if you can afford it – will further up the mineral, protein, fat, and calorie content of a crock pot meal.

–        Any child with a self limited diet or chronic inflammatory condition like cystic fibrosis, rheumatoid arthritis, Crohn’s disease, food allergies, or asthma may have sub-optimal iron status – which will make them more susceptible to infections, more cranky, hyper or irritable, less able to focus at school, and less likely to sleep well.  Entrenched iron deficiency (anemia) can leave your child tired, averse to exertion or typical play activities, showing shiners at eyes, and prone to eating non-food items.  Have your pediatrician screen serum iron, ferritin, transferrin, hemoglobin, and hematocrit.  If a supplement is needed, use one that is gentle and well absorbed, like ferrous bis glycinate instead of ferrous sulfate – but only with supervision, as iron quickly becomes toxic to children.

–        Copper is a metal we need in extremely small amounts, and a potent neurotoxin, if too much circulates in a free, unbound form.  High serum copper level has been linked to several psychiatric diagnoses.  Some children with autism may need treatment to reverse copper toxicity and should avoid copper in daily multivitamins; special formulations are available for this purpose.

–        Several studies have documented the presence of opiate-like polypeptides from poorly digested food proteins in autism; these have neurotransmitter effects that can impede language, pain tolerance, stooling, cognition, sleep, and behavior.  Special diets or digestive enzymes that target these proteins have shown promise.

–        Children with autism were found to have four or more GI issues, including histological changes, diarrhea, reflux, constipation, and abnormal endoscopies, about 40% of the time, compared to 5% of the time for their neurotypical siblings, in a study published in Pediatric Gastroenterology.  While some studies countered this finding, debate centers on methodology weaknesses in those studies that “bury” evidence of gastrointestinal problems in these children. In clinically standard nutrition screening in my own practice, I routinely find these problems in children with autism. If your child has a picky, weak, or rigid appetite, vomits undigested food, is dependent on medications for constipation or reflux, has undigested food in stool, can’t move bowels at least three times a week, has more than three loose or foul stools/day, or often presses his stomach on pillows, knees, or furniture for comfort – these signal atypical digestion and absorption that may mean lessened health or functional ability for your child. Several nutrition interventions may eradicate these uncomfortable symptoms and improve the flow of crucial nutrients to your child’s brain, muscles, bone, and organs.

–        Food allergies and sensitivities may go undetected in kids with Crohn’s disease, rheumatoid arthritis, autism, asthma, or other conditions.  Help can be had with correct screening for these, plus plug-ins of hypoallergenic formulas, special diets, or supplements to diminish inflammation.

–        Children with seizure disorders may improve with dietary measures beyond the traditional ketogenic diet.  Lessening inflammatory foods, avoiding neurotoxic trigger ingredients like glutamate, glutamine, phenols, or colorings, or treating undectected bowel infections for Candida or Clostridia are measures that have helped children in my practice with seizures.

Changing how your child eats, using a special diet, or adding targeted nutraceuticals may be a long term commitment for a person with a chronic condition or disability.  But it is a critically worthy one, if it means a child can improve beyond expectations, attend a regular school with no aide, avoid residential care or placement as an adult, have independence or have a job, and contribute to society in what ever way their unique talents and gifts allow.   I have witnessed all of these outcomes in persons with disabilities because of nutrition interventions.  This is not new, not novel, not even alternative – it’s simply engaging what we already know to be evidence-based in child nutrition. Any parent can start tapping these tools anytime, with Special Needs Kids Go Pharm-Free.

Orange Poop and Purple Crying: Halloween Colors Haunt Kids With Autism

Orange Poop and Purple Crying: Halloween Colors Haunt Kids With Autism

Orange and purple. Pumpkins, Frankenstein, cute goblins. It’s Halloween.  When I was a kid, October was my favorite month. Not only did it bring my birthday (still does), it felt like the most fun time of the year to me. Hurtling around outdoors with neighborhood friends on blustery, chilly fall days was my idea of heaven. We spent hours unsupervised and untracked, roaming woods and fields, and playing til our fingers were so cold it was just time to go in. New England’s blaze of colors was my backdrop. Leaf forts, leaf piles, leaf-filled scarecrows with my dad’s old clothes. Carving pumpkins, coloring decorations. Costumes, candy, staying out late to trick or treat.

It’s so different now, as kids spend less time outdoors with unstructured activities, and trick or treat traditions have faded out as we’ve become a more fearful society. Even less of this autumn joy might apply for kids with autism, sensory processing disorders, epilepsy and seizures – not to mention food allergies. It’s bad enough that this can be a traumatic week for kids on the autism spectrum and special needs. Routines and rules run amok (see Autism and Halloween: A Sometimes Scary Mix with Kim Stagliano). Behavior norms that parents work all year to teach their kids on the spectrum flip upside down. At Halloween, for some kids, confusion and anxiety mount as there are treats you can’t eat, and it’s loud, and random. But I’ve learned of news this week weirder than any Halloween trick, news that makes the autism journey at this time of year even stranger for me as a clinician.  It’s called Purple Crying.

The CDC and American Academy of Pediatrics are putting some spin together to convince new families, obstetrics nurses, and NICU staff nationwide that it’s normal to have a screaming, trembling newborn. And that colic is a “a normal developmental phase, not a medical condition”.  It actually says that on the Purple Crying website – yes, there is a Purple Crying Website.

Here we have a well funded effort afoot to systematically rework your thinking on this, right down to giving CDs about it to new parents, to take home with the new baby. The tag line on all this sends chills down my spine: “A new way to understand your baby’s crying”.

I did not understand my son’s crying as a neonate. Though the Purple Crying site does not intend to say purple babies are happy babies, my son’s crying turned him purple, and blue, and even left him unconscious for fleeting moments. It rocked his body into spasms. It kept him awake for as much as twenty straight hours, unhealthy and extremely costly for a newborn, who must eat and rest a lot, in order to survive. His limbs quivered, shook, and straightened. Yes, we called the doctor. Yes, we went to the emergency room. No, the physicians did not do anything. In fact, they were annoyed with us, because my son’s diagnostics were inconclusive. Once there were no clear test results, we went from being treated as proactive smart parents to being treated as nervous foolish parents. I should count my lucky stars: Nowadays, this scenario might land me in jail. I would be scrutinized for shaking him, in the absence of a clear cause for his symptoms. As it turned out, his symptoms were caused by an adverse event to newborn heptatitis B vaccine. But nobody told us that. We didn’t even know he’d been vaccinated in the nursery at birth. But that’s another story.

Prolonged, inconsolable screaming and crying is a serious sign of distress for an infant. It is a common feature of an adverse vaccine reaction. Is this what the purple crying public relations campaign is really about? CYA for the CDC? Like this: Your baby is suffering, maybe from a poorly tolerated vaccine we want you to use, so just ignore the crying, please.

Well, okay. Let’s acquiesce that babies can just plain cry their nuts off, boys and girls alike, for no particular reason, through the first three or five months of life, and it’s all right. Let’s make that leap of faith, and presume that we evolved to cry for no reason. We somehow got to the twenty first century, and never noticed this about human infants (but not other mammals?). Let’s presume screaming for hours on end is simply not related to a possible vaccine reaction (that may trigger lasting developmental effects, by the way), or any sort of painful inflammatory response to anything in shots or foods. Besides, the CDC reassures us that babies can look like they are in pain when they are screaming, but they’re not. Amazing creatures – they can do this for hours a day, and it’s fine. If you saw a newborn deer shrieking ceaselessly, would you think it was not in pain? Or that it was behaving “normally”?

I hate it when the CDC contradicts itself, and they’re doing it again. Here’s why this is not fine. First, obviously, it is not fine to tell parents to ignore possible signs of a vaccine adverse event. Second, for newborns, crying is exquisitely spendy. So is insomnia. It is not safe, normal, or healthy for young infants to spend hours awake and crying, week after week. Newborns are growing so fast, they need to eat two to three times more calories per pound than older kids and adults, just to stay alive. If you ate what a newborn needed, and you weighed 150 lbs, you would need to eat about 8500 calories/day just for baseline wellness. Add screaming all day and never sleeping to that, and, well, how long could you last? Just breathing inefficiently or suckling poorly can cost a newborn precious small gains in weight at the the start of life, if energy balance skews week after week into the red. This lowers nutrition status, and that in turn lowers disease resistance. Nutrition status directly correlates with immune function. Why is the CDC saying it’s okay for babies to endure something that threatens their ability to fight infection?

My next family arrives for consult in about thirty  minutes. Was their nine year old child one of the “purple criers”?  After taking nutrition histories on special needs children for eleven years, I have noticed that they usually are. They usually have more difficulty than their typical siblings did as infants, with screaming, crying, colic, and the orange part of this post: Explosive, copious, loose, orange-gold stools.  These often fill the baby’s diaper, pants, and shirt.  Stool to the neck and ankles, three or four, maybe even eight or nine times a day.  My pediatrician back in 1997 did not say it was normal for my son to have bowel movements like that. But he did tell me it was probably coming from my son’s diaper (no joke – see this memoir I published on this back in 2002). Here in my office, too many years later, pediatricians are still giving parents some peculiar feedback on this: Now it’s “toddler diarrhea”, and it’s “normal”.

No folks, purple crying and orange poop are not normal or benign.  My clinical observation is this: The more purple and orange there is in a child’s history from age 0-3, the more developmentally delayed, disabled, or challenged with inflammatory conditions the child is later on. These colors may haunt these kids for years, with lasting inflammation, developmental impacts, learning problems, or growth problems.

Colic is not a “developmental phase”.  Colic is often milk or soy protein intolerance, and it is painful. This pain is avoidable, much of the time. Food protein intolerance is not the only reason why an infant would cry, but it does account for a lot of colic in babies. It has been over-treated with reflux medications or drops to reduce gas. I give this topic a lot of ink in Special Needs Kids Go Pharm-Free, and in this blog too.  Please don’t start believing that in addition to regarding it as normal for your child to have crazy explosive poop several times a day, it’s normal for your baby to scream in pain for hours on end, months at a time.

When I was trained in public health nutrition and completing rotations as a dietitian, I never heard the phrase “toddler diarrhea”. It is now so common, no one blinks as children struggle through infancy and toddlerhood without potty training until they’re four years or older, stop growing as expected, or develop multiple food allergies and asthma. For kids with autism, it’s practically a rite of passage – often one that never ends: I have ten year olds with autism in my practice who can’t potty train, who struggle with impactions and constipation so bad they need regular hospital admissions for clean outs, and school aged kids with ADHD who can’t join sleepovers because they still wet the bed and have stooling accidents at school on a daily basis. Maybe the CDC will join up with the American Academy of Pediatrics to call this normal too. There will be a website, a CD from your pediatrician, a TV ad campaign. Followed by, no doubt, the drug of choice to fix it (mostly, it’s Miralax – another over-prescribed, non-FDA-approved-for-kids drug).

Here’s to young parents out there who are too smart to go there. Listen to your instincts and make safe choices around your child’s health care. Keep orange and purple for the fun parts of Halloween, not the horrors that can haunt your children for years.

Subscribe To Our Newsletter

I invite you to sign up for my newsletter. Every couple of weeks I will share tips on how to help your child learn, grow, and thrive through nutrition.

You have Successfully Subscribed!