Meal time could be tricky for 9-year-old Maddie Wallingford.
Apples and bananas were good. Chicken nuggets were OK — but only from specific brands. Oranges were a definite no.
School hot lunch was out. Mashed potatoes were great. Most other vegetables were not.
“It was super challenging and frustrating,” said Mari Wallingford, Maddie’s mom. “You feel horrible because you send her to school with apples and chocolate milk and what else? She won’t eat anything else.”
Maddie’s pediatrician wasn’t too concerned about her selective eating but, even if he was, he said he wouldn’t know what to do or where to send her for help, Mari Wallingford said. Fortunately, Wallingford mentioned her frustrations to the speech therapist treating her youngest daughter, 3-year-old Annalynne, at Innovative Services NW.
And Innovative Services had an answer: feeding therapy.
Over the course of several months this spring, speech therapist Debra Jablonski worked with Maddie on her food aversions. And, slowly, Maddie started trying new foods and tolerating the ones she was sure she hated.
Warning signs
Speech therapist Debra Jablonski offers these warning signs that a child may be more than just a picky eater and need intervention:
• Textures: Kids should be eating foods with a variety of textures. If a child won’t eat crunchy foods or only eats squishy foods, there may be an underlying issue.
• Chewing: Kids who don’t chew foods but gulp or swallow food instead, could have oral structural issues that need to be addressed.
• Texture advancement: Kids should progress through all of the food textures by the time they’re 2 to 3 years old, beginning with purees and soft foods and progressing to chewy and crunchy foods. If they haven’t, there could be an issue.
Now Maddie is more adventurous. She eats school lunches several times each week. She tried shrimp at Olive Garden — and liked it — and ordered a cheese quesadilla at Taco Bell.
While Maddie’s diet still isn’t quite what Mari Wallingford would like it to be, the situation has improved dramatically.
“It’s taken some of the stress off,” Wallingford said. “I feel like I don’t have to worry about her as much.”
More than picky
Maddie had always been a picky eater, but over the past year, Wallingford noticed her daughter was becoming even more selective. As Maddie approaches her tween years, Wallingford grew concerned her daughter would form an unhealthy relationship with food.
“This is setting her up for an eating disorder,” Wallingford remembers thinking. “I didn’t want to do that. … I wanted to be proactive.”
One of Maddie’s biggest food issues was with oranges. She couldn’t even be near an orange without melting down.
With Jablonski’s help, though, Maddie has controlled her negative reactions to oranges. She still won’t eat an orange, but she can watch someone else eat one without reacting.
Jablonski started by just having Maddie in the same room as an orange. That progressed to having it at the same table, then poking the fruit with a toothpick, then touching it with her finger and finally touching her tongue to it.
Through the course of her treatment with Jablonski, Maddie had homework: a list of foods to try throughout the week. Through that process, Maddie learned she actually liked some of the foods she wouldn’t touch before.
She loves snacking on peanuts and raisins sprinkled with cinnamon. She also discovered she loves shepherd’s pie, especially when it’s heavy on vegetables. In addition to eating new foods, Maddie now enjoys helping to make dinner — something she never would have done before food therapy.
“It’s a huge improvement,” Wallingford said.
Tailored therapy
About two years ago, Jablonski and Stephanie Zaepfel, an occupational therapist at Innovative Services NW, took a course in food therapy. With that background, they built the program at Innovative Services.
The therapists at Innovative Services most often see children with sensory aversion — they don’t like foods with certain textures. But parents also come to them with concerns about their children being picky eaters, not eating enough or low weight. In addition, some kids come with oral structural challenges, such as low muscle tone in their face or their tongue resting in the wrong position.
The therapist and child work one-on-one for about 12 weeks, meeting once a week for about 45 minutes to one hour. The program is tailored to the needs of the child.
For some kids, therapy will look like it did for Maddie — desensitizing to a food through phases. For others, it may just be exploring new foods and allowing kids to do it on their own terms, Jablonski said. For kids with oral structural issues, the therapy may involve exercises to build muscles needed to eat foods.
In addition to the work at Innovative Services, the therapists also encourage family therapy meals at home. During those meals, the whole family sits down together and everyone gets one offering of each food. The offerings includes preferred foods and foods the child may not like. Then, the family talks about the colors and textures of the foods.
The goal of those meals is to expose kids to foods and remove the pressure around eating.
“The focus of therapy meals is just about fun,” Zaepfel said.
The therapists also often talk to families about the eating environment. At mealtimes, kids should be in an environment that’s not overstimulating and offers seating that supports their bodies. The focus should also be on the food, which is why the therapists suggest plain plates rather than plates with cartoon characters.
“As much as it’s feeding, it’s not just feeding,” Jablonski said.
The risk of not addressing an eating issue can range from simple inconvenience when dining out to nutritional deficiencies that can impact a growing child’s health and development, she said.
If parents are unsure if their child’s eating habits are unhealthy or problematic, they should seek advice from an expert, Jablonski said.
“Just because your child is eating doesn’t mean they don’t need therapy,” she said. “And just because they’re not eating doesn’t mean they need therapy. There’s a lot of gray area.”
