This will make a lot of people mad:
Feeding clinic may be a waste of time and money
Not at all to diminish the important work and skills of occupational and physical therapists. They work hard at helping kids learn to chew, swallow, touch, and tolerate the act of eating – kids who are tube fed, kids who’ve never mastered chewing by age four or six years, kids who only drink but can’t eat, kids who gag and vomit to different food textures, kids who stop eating at the slightest interruption or sudden sound, kids who are in growth failure because they can’t eat. This is important work.
But there are important underlying triggers for these feeding problems to rule out and repair, before you spend thousands on sessions in which you sit behind a two way mirror and watch your child try to touch whipped cream, corn chips, and broccoli with peers, before the rigorous home sensory protocols before each meal (trampoline, Nuk massage, Wilbarger protocol), not to mention stringent food routines at the table.
If your child has had a traumatic brain injury, a spinal cord injury, began life on a feeding tube, or has a physical or developmental disability that impedes feeding skills, then of course rehabilitative therapy is in order.
And, after you’ve been through challenges unimaginable when you became pregnant – that is, the challenge of your kid actually not being able to eat, gain, and grow – and your child has suffered, you’ve been to every specialist, and you know your local children’s hospital hallways backwards and forwards, it can feel downright offensive, insulting even, that there may be something simple, overlooked, that could fix this. Wouldn’t your team have told you?
A lot of parents get stuck right there. They outright reject that a solution as simple as correcting nutrition and digestion first could be a thing. Unless this is a complex, inscrutable drama that requires ivory tower specialist care, and week after week with an occupational therapist, a lot of folks feel like bad parents. So they turn away from the simple.
Forgive yourself for not knowing. Forgive your care team. Occupational therapists, GI doctors, and even pediatricians are not nutritionists. This isn’t their purview. If they had known, they would have told you, of course!
For kids who go from infancy to preschool with a mysterious lack of progression for feeding skills, screen for underlying physiological triggers that can keep your child from being able to swallow, chew, and eat normally. Even for kids with physical disabilities and complex conditions who benefit from feeding therapy, footwork on these underlying interlopers can make eating work even better.
Also, know this: I had one of these kids. Been through it, seen it, worked with OTs and PTs (some fabulous, others not so much). I know the trauma, cost, and stress that accompanies this situation. And, yet another mom just left my office today, telling me with deep exasperation what a waste of time (and money – thousands of dollars, not covered by insurance) it was to send her young son to a renown feeding clinic, for months, carefully following instructions for the home plan too, only to get feeble progress out of it at all. Is this you?
Before you go through costly, strenuous therapy that may inch your child forward, but not quite produce the progress your child deserves to grow, thrive, and just plain enjoy food – investigate these problems. Your child will be healthier, because they will be able to digest and absorb food more comfortably.
Nutrition and digestive problems turn kids into picky eaters
Fix these, and their appetites can quite abruptly improve. If you need help fixing these, schedule an appointment with me. You may see changes in as fast three to four weeks, depending on your child’s condition at start, and your compliance with a nutrition and gut health care plan tailored to your child. Here we go:
1 – Fungal Dsybiosis: Your child may have had thrush, you may have had a C section, maybe there were antibiotics in the mix for you while pregnant or breastfeeding, maybe you have a lot of yeast infections in your past, or maybe your child needed antibiotics early, often, or both. Whatever. Somehow, your child may have been left with a fungal burden somewhere in the digestive tract. What this does is (a) buffer the stomach so it is less acid, which makes you never feel that hungry (b) constipate you so you never feel like eating because you are always full of ______ (c) give you serious cravings for very few foods, namely, starchy sweet stuff, or dairy food and (d) bloat your belly. Solution: Screen for fungal dysbiosis with stool or urine testing; ideally include Candida and Saccharomyces antibody testing too (blood tests). Give a protocol to drop the fungal burden and restore healthy gut bacteria balance. Your kid will feel more hungry, poop more regularly, and will want new foods, usually in about 3-4 weeks. Other nutrition measures may be needed, but this is a foundational piece that can relentlessly dog kids’ appetites. Note: Probiotics can help, sort of. The stuff on store shelves is usually too low potency to make a dent for kids who truly have a significant fungal burden in the gut. If you’ve used them and your kid is still picky, they’re not working, and you need a deeper strategy.
2 – Bacterial Dysbiosis: Your child may have a bacterial imbalance in the stomach, upper small intestine, or colon. This can make eating very uncomfortable. The small intestine normally harbors little bacteria; when too much is there, kids can have a lot of trouble eating. This will continue until these infections are treated. This is called Small Intestine Bacterial Overgrowth (SIBO), and your doctor may need to prescribe antibiotics to treat it. Some herbal treatments work well also; probiotics can make it worse. Kids with bacterial dysbiosis feel full quickly. They may gag, or vomit violently, even to the point of shock (they go limp, become pale, you may have even rushed them to the ER where they needed IV fluids – this is FPIES) if they eat the wrong foods. Pressing children to eat when an infection is active in the gut is truly unnecessary and will be unsuccessful too. Solution: Talk with your GI doctor or pediatrician about possible SIBO. And, do functional stool testing such as GI MAP (one of the tests I use in my practice) to identify what microbes may be interfering. This test can give detail on what your child needs to balance bacteria in the digestive tract, so they can eat and digest food more normally.
3 – Reflux Medications: These drugs, which are not approved for use in children by the way (with one exception), diminish digestion by reducing acid in the stomach. Great for an initial reprieve from what may (or may not) be a painful reflux, but bad longer term. The more stomach acid is reduced, the less your child is able to digest food, and the more food will sit in the stomach and – you guessed it – reflux up to the throat. Many kids in my practice end up on highest allowable doses of these drugs, but still have feeding problems with weak appetites and texture aversions. Reflux medicines also exacerbate fungal infections in the digestive tract, creating even more dysbiosis and difficulty with feeding and eliminating. Solution: Unless your child needs “mercy” dosing of a reflux medicine to ease pain, talk to your doctor about weaning off of it. For more help with that process, check this blog and contact me for an appointment.
4 – Weak Iron and Zinc Status: These minerals have a lot to do with what we feel like putting in our mouths. Even adults with poor iron or zinc status will do weird things like hang around, sniff, or even lick gas pumps, chew on paperclips, or refuse to eat vegetables. If your child is mouthing objects beyond early toddlerhood, or insists on eating non food items into school age years, it’s time to straighten this out. It could help normalize eating “behavior”. Solution: Have your pediatrician run labs for ferritin, serum iron, transferrin, iron binding capacity, and serum zinc. These should be solidly in the middle of the lab range – not near either end. If these labs come back looking a little weak, get guidance on supplementing these minerals. Iron and zinc won’t be well absorbed, by the way, if your child takes a reflux medicine – so this is another reason to get off that stuff. It reduces absorption of minerals and B vitamins. Not what your child’s developing brain needs.
5 – Opiates: Wow, what WHAT? Yes, your kid might just be a little high on opiates all day long. Common signs: Do they wake up from 1 to 3 AM all silly or active? Are they constipated? Do they have a crazy voracious appetite and a big head (above 90th percentile)? Are they verbally delayed? Do they bang into stuff and never cry about it? Do they really, really seek proprioceptive input, to the point of endangering themselves? Are they hyper? Do they meltdown fiercely when hungry, or if you don’t hand over that favorite mac and cheese, yogurt, or noodles and butter STAT? Addictive, opiate-like neuropeptides can form from wheat, dairy, and soy protein in a gut with certain digestive impairments. This will make a child relentlessly, extremely, fiercely picky for wheat and dairy food (maybe a little soy too). Yes, food proteins can be misappropriated into compounds that look like opiates to the brain. This happens when digestion is weak and the gut is too permissive; that is, the intestinal wall lets bigger-than-it-should molecules across into circulation, something a healthy intestine won’t do. These opiate-like compounds have various names: Dietary peptides, polypeptides, casomorphin, gliadorphin, or exogenous opiates. Urine screening is available to identify these. These will cause a lot of problems, including stunted language development, social delay, some crazy, even violent or aggressive behavior – and, uber picky eating. Feeding clinic will go nowhere if your child is swimming in opiate like peptides from milk, yogurt, Pediasure, bread, pudding, crackers – any wheat or dairy food. It’s all your child will want to eat, and anything that looks or feels different will be a non-starter. Solution: Start with my e book on milk addicted kids. If you need help getting your child out of this hole, set up an appointment to get started. Your child may need a strict gluten, casein/dairy and soy free diet (the prime opiate offender foods).
Get your kids clear of these five physiological problems and you may be amazed at how swiftly they graduate out of feeding clinic. Ignore any one of them and it is going to be a longer haul. Check out my quick video recap, click here. Thank you for stopping by.
What brand of iron and probiotics do you recommend? Thank you.
Hi Anna, I choose from a few high quality brands to find a formulation that will best work specific to each child’s case. I look for guaranteed and higher potency, and few to no fillers. Some products have pre-biotics in them which can work well or fail, depending on a child’s circumstances.