Latest / Talking FACS / Episode7: Phoning Friends for Professional Support with Feeding Concerns

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Episode7: Phoning Friends for Professional Support with Feeding Concerns · Talking FACS

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Music
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Big Blue Book Club presents SNACK Club with Courtney Luecking and Anna Cason, featuring
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Raising a Happy, Healthy Eater and How to Raise a Mindful Eater. Now, here are our hosts.
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Feeding children is an adventure. And at some point or another,
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you might have had questions like, am I doing this right? Or is this normal?
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Headlines, things we see online, things we hear from family and friends,
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and even unpacking what we see in the store can have us questioning what to feed our children.
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We want children to have what they need to lead happy, healthy lives.
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And it seems like as soon as we figure something out, it changes.
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That's where we come in. My name is Dr. Courtney Luecking. I'm a registered dietitian
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and extension specialist for family and child nutrition.
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This means I have lots of training and expertise about child nutrition.
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I also have two littles of my own. This combination allows me to talk through
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practical science-based strategies for creating a nourishing feeding environment for your family.
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And my name is Anna Cason. I'm a registered dietitian and Extension Associate in Food and Nutrition.
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I don't have kids of my own, but my interests and passion lie in supporting
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healthy food-related behaviors which begin in childhood.
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In partnership with the University of Kentucky Cooperative Extension Service,
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we present SNACK Club, where we share bite-sized bits of information for Supporting
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Nourished, Active Children in Kentucky.
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So come for the SNACKS and stay for the SUPPORT.
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Hi, Anna. Hi, Courtney. How are you? I'm good. How are you? I'm doing well.
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So it looks and feels a little bit different today.
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We've got some special guests with us. We do, and we look like the Brady Bunch on our screens.
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So it's a super fun day, you all, because we have phoned friends.
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And this is like personally and professionally interesting to me.
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And I think because my daughter's habits have been changing gradually over time.
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And now I'm like, hmm, I'm wondering if we're at that point where I should reach out to some support.
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So today we are thrilled to have three guests with us. We have Jamie Adkins, Dr.
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Suzanna Attia and Sarah Estill.
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And so we are going to let them introduce themselves to you to tell us a little
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bit about how they interact with children and families, both professionally and personally.
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So I'll just point to you all as we see you on our Brady Bunch screen.
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And so, Jamie, would you like to introduce yourselves to our crew?
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Yes. Hi, my name is Jamie Adkins. I'm a speech-language pathologist and lactation consultant.
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And currently, I'm working in Kentucky Children's Hospital with our pediatric patients.
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And I'm also the mom of two boys. I have a seven-year-old and a two-year-old.
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And I will say I have a personal investment in this topic as well because my
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two-year-old is starting a picky eating journey of his own. So I've been very
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interested in these books and this topic as well, personally,
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as well as professionally.
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Wonderful. Thanks for joining us. Dr. Attia, let's hear from you next.
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Hey, everyone. It's great to be here. Thanks, Dr. Luecking and Una for the invitation.
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So I do pediatric gastroenterology, hepatology, nutrition, so guts,
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poop, vomit, feeding, nutrition, liver, all that good stuff.
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Also at Kentucky Children's Hospital slash Kentucky Clinic, University of Kentucky.
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And I also have maternal experience with two girls under the age of,
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well, one's three, one's one.
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So under the age of five. So quite a journey indeed.
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Going in strong with experience here. All right, Sarah, and we'll have you round out our introductions.
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Thank you. Thank you again, Courtney and Anna for having us. My name is Sarah.
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I'm one of the registered dietitians at Kentucky Children's Hospital as well
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in the Department of Pediatric Gastroenterology.
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My journey has been interesting. I started not in PEDS and my end goal has always been to be in PEDS.
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So I actually just completed my master's in maternal and child nutrition with
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a focus in clinical lactation.
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So I've had a very strong interest in introducing new foods,
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working with infants and allergens, breastfeeding all the way up through picky
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eating and to adolescence.
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I also have some great maternal experience.
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I have a stepdaughter who is 10 and my son who just turned four.
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So my adventure continues with, you know, navigating parenting and picky eating
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and things like that as well.
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So I think we have these challenges to make us more prepared and empathetic with families.
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So yeah, so very happy to be here.
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Yeah. Thank you all so much for joining us once again. We are thrilled you're
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here and just thrilled to hear your expertise, both personally and professionally
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about some very specific topics.
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So we'll get started. We'd like to start by talking about eating behaviors across childhood.
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So what is considered normal and when might it be time to seek professional help?
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You know, Anna, that's a great question. So, you know, as we think about normal
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feeding behaviors, they, of course, change over time.
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So in early infancy, one of the main aspects of normal versus not normal feeding
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would be if the infant can actually suck down enough liquid nutrition,
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whether that's human milk or formula,
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in order to grow properly.
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And so, of course, as we move into the introduction of solids and trying to
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wean off of milk, whether human milk or formula,
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that becomes increasingly important to pay attention to growth still,
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but as well as are they able to start introducing more diversity in their diet over time?
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So, are these children able to have a reasonably pleasurable eating experience
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where the food is going down into the stomach?
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It's not causing significant distress to them, and hopefully neither to you.
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And they're able to grow and maintain their developmental milestones,
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as well as being able to do that with introducing more and more different textures
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and types of foods in their diet.
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So then over time, you know, as kids reach the toddler age, normal,
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it's normal to start inserting independence if a child is developmentally at
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a toddler age and wanting to.
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Bite you a little bit on what they are and are not eating.
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So we get in this age range a lot of picky eaters.
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However, it's not normal when they're refusing to the point of inability to
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gain weight, or they are having difficulty actually chewing or swallowing the
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food and getting it down,
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or they're having significant vomiting or regurgitation with all of their meals,
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coughing and spluttering with all of their intake,
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or in general, you just think something's not right.
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So I'm going to pass it on to Jamie to give us a little bit more perspective
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from the speech-language pathology standpoint.
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Thank you, Dr. Attia. I think I'll just give a little bit more detail on what
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we're looking for when we go in for speech-language pathology and we're assessing
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kids in these different age ranges.
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So in that very young age, kind of that zero to six months range,
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we are looking a lot at just the motor skills, like can the baby physically
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take in the food that they need?
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And on top of that, we're also looking at, because we're speech-language pathologists,
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we're looking at it sort of from a communication standpoint.
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How engaged is the baby in the food? Are they starting to communicate to you
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as the parent or the caregiver that they're are interested in feeding that they want to eat?
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Or are they starting to tell you that this is difficult, it's not fun for them,
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or there's something that they're not interested in?
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And for very young kids, those are often our first red flags,
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is if they're, what are they telling you?
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Are they telling you this is fun? Are they telling you it's not so fun for them?
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As they get a little bit older, that's going to get a little bit more clear and easier to see.
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In the beginning, it may look like, they're just not excited.
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But then as they hit that six to 12 months and toddler age,
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those behaviors can really pick up and they can start being pretty strong in
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their refusals and telling you what they're interested in and what they're not interested in doing.
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Jamie, I had a quick question for you when you're talking about communicating,
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you know, not into this or I am.
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Can you give us some examples of what that would look like for those infants
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and then kind of how that might change as we get into toddler age?
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Yeah, absolutely. And I think it's easiest to see when a baby is interested.
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And anything that doesn't look like that is a red flag. So babies that are interested
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in feeding and find it fun and enjoyable and easy, they're going to let you
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know when they're hungry.
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They're going to start queuing, rooting around, maybe crying,
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getting fussy and telling you that there's something they want to be doing.
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And then when you give them that food, you see them instantly get excited and
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relax. relax, excited, attach the bottle, attach the nipple,
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and then they just relax into it.
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Their faces get calm, their body gets calm, and sometimes they'll eat until
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they literally just put themselves to sleep.
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So if you have a baby who doesn't look excited at the beginning and relaxed
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towards the end of feeding, then there's probably something that they're not
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enjoying about that that experience.
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And that can be like either pushing it away, shutting down, getting more fussy
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as the feeding goes on, just anything that doesn't look like a baby that's starting
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to get calmer and happier as the feeding progresses.
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That's really helpful. Thank you.
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Sarah, did you want to take it from there and give some more information from your perspective?
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Sure. Yeah. So again, I'm Sarah. So I think it's just important to remember
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that the first year of life, that growth is so rapid.
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You know, infants are going to double their weight gain within just like the
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first, you know, six months to triple in it by the first year.
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I think it's important to know that after that, things do slow down.
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So I think sometimes parents have this expectation that, you know,
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this, the frequency of feeds and how rapid they're going to grow and that should always continue.
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But I think it's important to know that the first year of life is very busy.
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It's all about exploration. exploration so monitoring those
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feeding cues monitoring and you know allowing
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them to kind of make messes and tolerating those messes can
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be really hard but that exploration around six
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months up to that first year of trying those new foods can really set us up
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for the next year and years to come but I think that first year it's a learning
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experience for everyone right so it's really important just to stay engaged
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and kind of going off like what Jamie and Dr.
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Atiyah were saying that But looking for things that don't seem comfortable,
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listening for audible swallows and things during those first six months and
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seeing that weight gain, I think the most important thing that really determines
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what we would consider normal from a nutrition perspective is growth.
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So what we're looking for is, you know, some babies eat every two hours,
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some eat every three to four.
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When they get a little older, they may pace themselves differently than your
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first child or your friend's child does.
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But as long as we feel confident in the foods that they're consuming and you
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feel like they're safe foods and you have plenty of access to those foods and
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babies are growing, I think it's really important to just pat yourself on the
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back and know that you're both learning and growing together.
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And the years to come are just going to continue to be exciting and introducing
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all those new foods. Yeah.
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I love how you all have kind of talked about embracing the mess and some of
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the things, like I'm thinking as a parent, you're like, oh my,
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I have to clean that up on the back end.
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But really that opportunity to engage with senses and experience foods in different ways.
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So we've talked a lot about our youngest of children.
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So our infants and our toddlers, when they start to express that autonomy,
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what about like kind of our elementary school age children or thinking about that middle school?
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And this is where I'm personally interested Because I'm like,
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huh, it seems like my toddler autonomy assertion is coming later in life. Is that normal?
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Or like, yeah, tell us about what to look for in that space of life. Let me start there.
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So from a medical perspective, some big red flags would be choking after eating.
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So swallowing and then after swallowing, food is getting stuck and requiring
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sometimes vomiting it back up or drinking a ton of water to get it down.
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And it's happening more than once, like not just one or two times, but a repeated basis.
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Pain with swallowing or pain after swallowing or immediately during eating or right after eating,
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as well as a stepping from a behavioral perspective, like stepping away from
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the food routines of the family.
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No longer having comfort being
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watched when or observed when eating or
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eating like restricting eating like going from having a fairly what you would
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consider in your family normal diet to over time suddenly or slowly no longer
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accepting food that were previously accepted especially like one or two,
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okay, but dramatic difference in that.
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So that would be restricting eating. And then on the other hand, binge eating.
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So having like excess consumption of food in a single serving,
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especially when it's not observed or when the child is starting to do that secretly.
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So those would be some like medical red flags that I would definitely recommend
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should be brought to the attention of your primary care physician.
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Jamie, did you want to take it from there? Yeah. From our perspective,
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I think the old way of thinking about things, and old as in maybe even just
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five years ago, our assumption for a long time has been that by the time kids are in preschool,
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they pretty much have all the motor skills they need to eat,
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and they're pretty much good for the rest of their lives.
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But as we've learned more and people have actually done more research on this,
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We realized that the development of eating, just the motor skills for eating,
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continued to develop throughout most of childhood up until almost middle school.
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So when in grade school, kids are still learning how to eat.
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So we can still start to see changes throughout grade school.
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Anytime that we notice that kids start leaving out whole groups of foods, or like Dr.
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Atiyah said, you notice them begin to avoid certain mealtime activities or avoid
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going to food parties with their friends,
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or even just, she said, maybe instead of eating with people,
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maybe they're going somewhere else to eat in secret.
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Those are red flags that we're seeing with some of the kids that we work with.
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And it's interesting, too, within these ages, because kids have a wide variety
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of skills and a wide variety of comfort levels with how they're able to express themselves.
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So sometimes it's very clear and obvious, you know, your child's coming to you
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telling you that something's difficult to chew or that something doesn't feel right when they eat it.
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But other times you still have to be a little bit of detective,
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do a little bit of detective work with them and say, well, something is just
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not working right. Mealtimes just aren't fun anymore.
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These snacks just aren't easy for us anymore.
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What's going on? Maybe we need to reach out and get some help and see if there's
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something going on underneath here that I'm not, that I'm not able to pick up on.
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Great. Sarah, do you have anything to add to that? Or otherwise,
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I'm like, oh, I want to ask then who we reach out to if we're if we are thinking
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some of this applies to us. Yes.
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So I will definitely, in support of all of what they have said,
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I think the consensus is that children are going to develop their own positive
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or negative experiences around food.
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So I think discussing food culture and talking about what is normal and what's
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not normal and having consistency with mealtime. And in today's society,
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that is like the number one thing that we all struggle with, right?
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Having that consistent mealtime where we have dinner on the table and we're
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all sitting together with no distractions, no screens going on.
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And I think ultimately, as long as we can instill those goals earlier on when
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they're young children and they're infants,
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by the time you hit that elementary school age, middle school age,
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you've sort of already created the foundation of what a positive meal experience
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should look like, right? Right.
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So kind of like what Jamie was saying, when you start to notice these things
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or they do start avoiding foods, they may have the confidence to speak out and
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say, hey, this isn't right.
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Like something feels weird. You know, I feel like I'm having a hard time chewing
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or swallowing, things like that.
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I think ultimately you have kind of two spectrums. We have the overeating and the undereating.
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So I think if you, you know, in conclusion, feel like your children are,
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you know, erring on one side or the other, it is important to reach out and ask those questions.
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You know, I would say starting with them first is the best place because sometimes
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we have positive peer pressure from schools, but then sometimes we have negative
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peer pressure from school.
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So we can kind of see where the root of the problem is on our own.
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If we're not able to do so, that's when we should reach out and get counseling
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and guidance to kind of catch it as soon as we can and start those interventions
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to, you know, promote just longevity and healthier eating habits and things like that. Yeah.
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If I can, I know you'd want to segue as a beautiful segue to the next topic.
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But I do want to just add something before we move on that, you know,
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as you've heard a little bit today, eating is an emotional experience,
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as well as a physical and sensory experience.
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And a lot of learning healthy eating and avoiding picky eating to some extent,
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not completely, is also what behavior we model and how much we introduce a diversity
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of flavors, especially more complex and bitter flavors earlier on in life.
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And I think that's a really big challenge for a lot of us.
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So you heard us mention trying to have family meal time, trying to avoid,
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you know, screens and other distractions at the table.
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I would add to that also, like we as adults sometimes don't realize how we're
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modeling negative reactions to food that our kids may actually,
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without our input, enjoy. joy.
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And so we need to be careful not to show a negative reaction to a food that
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they're still developing an experience to.
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So I think that's important as well, trying to introduce like.
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Complex and bitter flavors, especially vegetables, like broccoli,
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cauliflower, Brussels sprouts, the types of things that are often missed later
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on earlier in life as early as we can.
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So I just wanted to add that. And it's really important to also know how and
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when to reach out for help.
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Yes. I'm laughing because broccoli was the first food I introduced to my youngest
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and her face and the video where I was like, I have ruined her for life,
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you know, and I know I haven't because we continue to offer it.
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It's slightly less dramatic reactions when we offer broccoli,
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but yes, those are an acquired taste for sure.
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And actually I'd be remiss. I don't think we'd hit on our adolescence,
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which is a unique stage of life.
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So what can you point out to us.
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Or kind of what's normal, what might be concerning during that adolescent age?
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Oh, just keeping the order we've kind of started, I'll just go ahead and start with that.
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So a lot of the things you mentioned, abnormal or red flag behavior in the younger
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school-age child really do apply to the adolescent group as well.
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So in adolescence, the pro is that kids are a little more self-aware and can
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talk more about what's going on.
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The con is that the emotional and social experience of eating is,
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especially I would say for girls, but also for boys and those who might identify
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as a different gender, is actually intensified.
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And then just piggyback on that comment,
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as I'm alluding to the possibility of the development of eating disorders,
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There are a lot of eating disorders that actually stem from having an actual
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problem in the gut or the esophagus or a part,
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something that a doctor like me would take care of that can often go missed.
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So it's important to really understand what is your child feeling if they're
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exhibiting any of these red flags we talked about. out.
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So that's adolescents as well, like kids tend to get busier and busier,
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depending on the resources you have available to you, the school system and
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extracurricular activities you may have available to you.
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And also depending on your, you know, how busy you are as a care provider and
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how much time you actually have to check in with your child.
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So at this point, what's really important is to look out for these restrictive
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eating behaviors that we talked about, the of binge eating behaviors,
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hiding shame or disgust related to food and modeling as much as possible within
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the constraints that you have in your family, trying to model,
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you know, good feeding behaviors,
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eating a diversity of vegetables, fruits, proteins,
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starches, as well as trying to have mealtime together.
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And then really try to open that channel of communication.
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If you're concerned about something, try to just provide a safe and open forum
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without judgment for your child to share how they feel about their body,
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how they feel about their food,
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how they feel about meals with family or friends, and as much as possible to just listen.
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And that might really give you a lot of insight into what's going on if you're
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noticing some concerns.
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Great. Thank you, Jamie. What else can you add? I don't have a whole lot to add with that.
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I think that was very well said, Dr. Atiyah, and I would agree with all of that as well.
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You know, from our perspective, when we're looking at it through a therapy lens,
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we're also looking at the development of just autonomy because there,
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you know, you've done most of your job teaching them how to eat at this point.
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You know, you're just sort of fine tuning things with them at this point.
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So we're looking to make sure that kids also are they able to manage the foods by themselves?
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If they are home by themselves for a day, are they picking out fairly reasonable meals for themselves?
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Some exceptions. I mean, teenagers
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are going to have a day. They're going to binge on pizza for fun.
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But in general, are they able to manage their own hunger?
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Are they remembering to eat meals? or as a parent or a caregiver,
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are you still having to step in and remind them to eat or to prepare all the
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meals for them or to plan everything that they're going to eat throughout the day at school?
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And if you're running into problems with that, then as a therapist,
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a lot of that's where we might step in and offer a little bit of extra guidance.
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And I think the last thing that I would add is I think just the influences that
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are around that age of adolescence is the biggest, you know, influence.
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So whether it's social media and they're seeing other people who are eating
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all kinds of fast foods and Starbucks and different things that they may or may not have access to,
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sometimes that can almost be, you know, very negative and encouraging them to,
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when they have the means on their own to have these things, they kind of over-consume
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it versus the opposite side of that.
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You know, if we're only getting meals at school and things, I feel like it can
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be really challenging for them to differentiate if they've not had that influence
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from you first on what does a healthier meal look like?
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You know, are there proteins and fruits and vegetables at every meal?
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I think it's very important at that age, like Jamie was saying,
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at that point, we're sort of fine tuning those skills.
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But I think it is important that we still include them in the grocery shopping,
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in the preparation of the food, putting the food away,
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chopping it up, putting it in the skillet, washing the dishes,
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because you would be surprised how many adolescents we see that I'm like,
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oh, well, what do you pick out with your fruits and vegetables during the week?
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And they're like, I don't go to the store, you know?
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So it's like, they're so shocked that you would ask. So I think we just sometimes
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need to not overthink it as parents and just say, Hey, look,
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you're going to go with me.
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You're going to help me pick these things out. We're going to do this together.
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I think that alone, them feeling included by you or whatever,
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whomever the caregiver is, is going to be supportive enough for them to help
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them have the courage if something is wrong to stand up and say So I think sometimes
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they just need you to be in their corner, but instilling those skills and fine-tuning
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them, kind of like they were saying,
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in those later years is going to be really important for how they're going to
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continue to develop as adults later on in their life once they're on their own
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and in college and things like that. Yeah.
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Thank you all. Yeah, I think that's great advice, Sarah, to just keep them included
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at all points of their life so that they can carry them on into the future.
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So if we have noticed some of these abnormal eating behaviors or if that line
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of communication has been open and our child has expressed some concern,
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what type of specialist should we look for or should we reach out to for some
26:07
of these different concerns and where can we find them?
26:10
Yeah yeah so
26:13
this is a really important question and of course your
26:16
availability or access to different
26:19
providers we're going to talk about may differ according to
26:22
how far or close you are and your type of insurance but generally the people
26:27
you're going to have in your arsenal your team are going to be first your primary
26:33
care physician who should be kind of your first point for any concerns about
26:38
eating growth, eating behaviors.
26:42
And sometimes, you know, it may, I guess my top tip in that would be,
26:47
if you have a concern, try to bring it up at a separately scheduled appointment,
26:53
if you can get one instead of at a well-tiled tech.
26:55
If you think about it from the perspective of how the appointments are scheduled,
27:00
in a well-tiled tech, there are many things that it has to be done.
27:03
Whereas if you have a concern and you bring it up at that time,
27:07
if it's a mild concern and you just want to know, is the kid growing?
27:10
Okay, sure. No problem. But if you have a large concern that actually needs
27:13
to be explored a little further and needs more time to talk about,
27:17
it might be beneficial to just try and schedule a separate appointment for that,
27:22
like a visit. That would be step one.
27:25
And then with your main doctor's agreement,
27:29
then you may be referred to someone like Jamie,
27:33
a speech-language pathologist, if you can talk a lot more about what that sounds
27:37
like and looks like, or someone like in our clinic, being a pediatric gastroenterologist
27:43
slash hepatology nutritionist.
27:44
And we also may incorporate services of a registered dietitian like Sarah.
27:51
So sometimes your clinic might have access to a dietitian on its own without
27:56
a referral through a pediatric gastroenterologist.
27:59
Pretty uncommon in the Kentucky area for that to happen, especially with Medicaid.
28:03
But if that's a resource that you have available to you and you want to work with, that's great.
28:08
It does help. Maybe, Sarah, you could talk more about kind of pediatric versus
28:13
non-pediatric trained dietitians. But, you know, you can speak more to that.
28:17
And so I would say that those are kind of the first areas.
28:21
It is important just to be careful about where you're getting information from.
28:25
So other places, if you just want some more information, you can look at Sprite
28:30
Features, you can look at the American Academy of Pediatrics website.
28:35
We can give you the name for that because I'm blanking at the moment.
28:39
You can look at the GI for Kids website, which is from the North American Society
28:45
for Pediatric Gastroenterology, Hepatology, and Nutrition.
28:48
Of course, you can ask your peers, your friends,
28:52
Facebook groups, just a small level of caution that sometimes things are certain
29:01
disease states or maybe attributed to what you're experiencing and actually
29:06
not be what's going on with the kid, your child.
29:09
So just maybe take that with a grain of salt. So those would be my suggestions
29:13
about where to start looking and how.
29:17
Awesome. Thank you all. And Jamie, do you want to talk to us about all things
29:20
speech-language pathology and a little more about your services? Yes, I'd love to.
29:25
So if you go to your pediatrician and you talk about some of the difficulties
29:30
that you all are experiencing with eating, you might get referred to as either
29:35
a speech-language pathologist or an occupational therapist.
29:38
Both disciplines work pretty heavily in feeding.
29:41
It is important to know that not every OT or occupational therapist or SLP,
29:47
speech-language pathologist, not everyone is trained in feeding.
29:51
So it's important to ask and it's
29:54
okay there's there are so many different ways
29:57
that you can take both of those different disciplines and so many different things
30:00
that that your therapist can learn they are not going to be offended if you
30:04
ask them if they have experience or an interest or extra training in this area
30:08
so just just ask the speech language pathologist is going to look at things
30:14
from a little bit differently than different perspective than an ot will so speech
30:18
language pathologists were trained first in the motor skills,
30:21
which means just physically, do you have the ability to chew,
30:25
to swallow, to move food in your mouth?
30:27
So that's one thing that we're really going to focus on.
30:29
And a lot of other SLPs do also have some training in establishing mealtime
30:34
behaviors and habits throughout the lifespan.
30:37
And a little bit of training in some of the sensory processing,
30:41
sensory processing that goes into eating.
30:45
OTs, that's going to be one of the main areas that they look at.
30:49
And that's one of the areas that they are just so very skilled in.
30:51
So if you have a child who is, has a lot of difficulty processing sensory information,
30:57
so the way things feel or the way things sound, then an OT is really going to
31:03
be very helpful to help you figure out what's going on and to problem solve.
31:07
They also have experience in working with establishing mealtime behaviors and
31:11
working with the motor skills in moving food to their mouth.
31:17
So if you have a child who is having difficulty picking food up off their plate,
31:22
which we do see a lot of times, I've seen toddlers come in that they're not
31:27
gaining weight or they're just not transitioning to eating solid foods.
31:32
And we find out actually everything is fine except for the grip.
31:36
They just can't get the foods up to their mouth. you can go to a wonderful OT
31:40
that can help you problem solve that and figure out how to start gaining that weight at that point.
31:47
As far as insurance, I know Dr.
31:50
Atiyah had mentioned that that can be a restrictive issue for many people.
31:55
We do see that most insurances that we work with here in Kentucky will cover
32:02
at least a limited number of visits for speech-language pathology or for occupational
32:07
therapy, and sometimes for both.
32:09
You just have to check with your specific insurance company.
32:12
But we have had fewer and fewer denials from insurance over the years.
32:20
I think there's been a lot of good work behind the scenes that's gone on over
32:24
the last decade that the services are becoming more and more accessible all the time.
32:29
And I also wanted to mention another really good, reliable resource that we
32:33
often use as therapists, and that is the feedingmatters.org.
32:39
So the Feeding Matters organization is a fairly young organization,
32:45
but it's been established by some of the leaders in the field.
32:49
It includes speech language pathologists, OTs, gastroenterologists.
32:56
Registered dieticians, psychologists, family members of people with feeding disorders.
33:02
Orders, and they collaborate together on this group and have regular meetings.
33:06
And they put out very, very good resources that have information on how do you
33:13
find out if your insurance will cover this service.
33:17
They have information on their website about how do you talk to your doctor
33:20
if you're concerned about feeding problems.
33:23
And they have just wonderful definitions on what a feeding difficulty actually could look like.
33:27
And so I think that's a really nice resource to look at if you're just trying
33:34
to figure out where to even get started and who to start talking to.
33:40
That's great, Jamie. Thank you. And I will just put a plug out there for our
33:43
listeners that any of these resources that our guests are mentioning,
33:46
they will be linked below and we'll also house them on the Snap Club website.
33:49
So if you're like me and trying to take mental note of these websites,
33:53
we will link them there for you.
33:55
Sarah, do you want to touch on registered dietitians role in all this?
33:59
Yes. Thank you so much, Anna. Jamie, that was, as you can see,
34:03
we're a very interdisciplinary network.
34:05
So like Dr. Attia was saying, starting with your PCP, I think is the most important.
34:10
Step if, and you know, you're able to have that resource and then finding those
34:15
supportive people, whether it is like a gastroenterologist or a speech or occupational therapist.
34:20
But from a nutrition perspective with registered dietitians,
34:23
if you're really not sure and you you don't have a direct outlet or a referral
34:27
to a clinic with a dietician, I would suggest starting at your local health department.
34:32
So especially with children under the age of five, there are programs outside of Just WIC.
34:37
There's one called HANDS program, and I think it stands for Health Access,
34:42
Nurturing, and Developing Services.
34:44
So they give, you know, great information on each of the monthly and like yearly
34:49
milestones that we should have from birth until like five years of age.
34:53
So that seems to be when it's one of the most challenging periods, right?
34:57
And then outside of that, when they are a little older, you know,
34:59
at UK, we do have an adolescent medicine team that focuses more on behavior with eating,
35:06
you know, behaviors and things and picky eating and stuff that aren't necessarily
35:10
correlated or a comorbidity of a GI condition.
35:14
And so we do have that option as well. I think it is important when you're doing
35:20
research on your own and you're looking for someone that we do keep in mind.
35:24
We always want to look for a dietician or like Jamie was saying,
35:27
like speech therapist or provider-led blogs.
35:30
We see lots of stuff and misinformation out there on social media about baby-led
35:36
weaning and what's appropriate and what's normal. And this is what I did for my baby.
35:40
And that's okay, but we do want to make sure that it is supported and fact-checked. So.
35:45
The CDC has a monthly milestone and yearly milestone. I think that's a great
35:49
resource, and I will share that with them as well.
35:51
There's another dietician-led blog that's called Kids Eat in Color.
35:55
She has some amazing work. And Courtney makes me laugh because when you were
35:59
talking about the broccoli, she sends out a weekly or monthly,
36:02
I think, picture and newsletter with that child of the month trying broccoli.
36:07
So it's these really fun reactions and faces of these kids all trying broccoli.
36:11
And it's just a nice reminder that like, you know, as parents and providers,
36:15
we're all figuring this out together, right?
36:16
So if you start with your PCP and then you go to a therapist and you see a dietitian
36:21
and you're feeling overwhelmed or you're still not sure, always ask,
36:25
you know, just let us know where your head's at.
36:27
Let us know how we can support you because we're really here for you guys.
36:30
And so aside from, you know, private practice,
36:35
your dietitians are most often going to be found within your hospitals or your
36:39
clinics or, you know, maybe in, you know, cooperation with like a speech therapy
36:44
or OT, like a special feeding place. So, yeah.
36:48
Oh, you all, I'm like feeling so much more relaxed after talking to you today.
36:53
And so I hope other people who are joining us feel the same.
36:57
And so just one final question to round us out.
37:01
And Sarah, I think you kind of started to hint at this,
37:04
but, you know, as a parent who, or just a caregiver in general,
37:09
who maybe isn't familiar or comfortable in healthcare spaces,
37:13
or just really feels at a loss, but recognizes that we want support with what's going on,
37:19
what tips or words of wisdom or just,
37:23
you know, affirmations do you have for caregivers when communicating with healthcare
37:26
providers about what we think the concerns are, or even if we just don't know,
37:31
you know, We can't put our finger on it, but something's just not right.
37:34
So any tips or words of wisdom for us to wrap up?
37:39
Do you want me to start, Dr. Attia? And then you can finish. Yeah, go for it.
37:42
Okay. So kind of touching on what we've all said.
37:46
So knowing what is normal for your child is probably the most important part
37:50
in identifying what is not normal, right?
37:52
So, you know, keeping a food diary or just taking little notes of like,
37:56
well, today he only ate this or didn't eat that or any concerns at all,
38:00
you know, just keep track of it.
38:01
So you have a mental note. Because I think what happens a lot of times is we
38:04
have all of these concerns and
38:06
we're We're so worried and we're passionate because we're parents, right?
38:09
And then we get to the office and we're like, okay, so what's going on?
38:12
And it's kind of like brain freeze.
38:13
You know, you're like, well, I had this list and I'm, well, this one time.
38:18
So I think just giving yourself the benefit of the doubt and writing down any
38:23
little thing that seems out of place, it's not going to hurt to ask because
38:26
there are things that we are asked all the time that I'm like,
38:28
oh no, that's very normal.
38:30
I actually had a conversation with a parent today versus another thing his child
38:34
was doing was not normal. them.
38:35
So, you know, and he didn't really know the difference between the two.
38:38
So I think, you know, what we don't know, we don't know.
38:41
So I think writing down your questions, keeping a list of things.
38:45
And if you're having a conversation with one of us and our medical terminology
38:49
is just above your head, say that.
38:52
Say, okay, I know what you're trying to say, but that word, I don't know what that means.
38:56
And we can kind of, you know, tone it back, be more personable and just make
39:02
it to where you feel like you really are part of your child's care and you really
39:05
understand what's going on,
39:06
without that piece, we're not going to see as much progress as we want.
39:10
So we can give advice all day and we can come up with this plan.
39:13
But if you don't feel confident and comfortable with that plan as well,
39:17
we're only going to get so far, right?
39:18
So I think it is important to just use your voice, take notes,
39:22
and don't be afraid to ask questions.
39:25
Hey, I love that advice too. And I love the idea of just don't be afraid to ask questions.
39:30
And I know we say that all the time in the medical world and the therapy world,
39:33
we say, you know, there are no stupid questions, but this is really one area
39:36
where I think it holds so true.
39:39
Touching back, we've mentioned a little bit that there is kind of a lot of misinformation
39:42
floating around out there.
39:44
And most of that comes from a very good place and a very understandable place.
39:49
Just to give you some background on our field, we've known that for a very long
39:53
time that kids have trouble eating.
39:56
But really, until even the last 10-ish years, we didn't have a good way to define
40:02
that, even in the medical community or the therapy community.
40:05
So the most common names for the diagnoses that we have were not even defined
40:12
in our literature until the last 10 years.
40:16
So it's understandable that you have questions. We still have questions.
40:21
So just don't hesitate to ask. We know that the things that you're concerned
40:26
about are coming from a good place.
40:29
You are trying to care the best you can for your children. And I know a lot
40:34
of parents come in and I can just tell by the look on their face,
40:36
you know, they come in and they say something like, I can't get my kid to eat.
40:41
And you can just see how embarrassed they are to say that or sometimes how much
40:46
guilt people have if their child isn't gaining weight because we care so deeply for our kids.
40:53
And we really feel like, you know, sometimes we can feel like if our child isn't
41:00
eating and growing the way that they're supposed to, we can feel like that we've not done our job.
41:05
I very much hope that when you leave my office, you don't feel that way because it is so complicated.
41:12
You could tell by just by all the different professions that are involved in
41:17
eating, all the different names that we've thrown out, that it's a very complicated thing.
41:21
And it's okay if you just come in our office and say, something's not right. I don't know what it is.
41:29
What do we need next? And we will start from right where you are and try to
41:34
help you figure out what's going on.
41:36
Ooh, this is like therapy for the soul. Dr.
41:40
Attia, do you have any final thoughts or recommendations or words of wisdom?
41:45
Yes. So I think part of something I just want to add is also keeping things in perspective.
41:52
So sometimes when our child is fighting us in terms of their choices,
41:56
it can just feel very distressing and overwhelming.
41:59
And it's okay to just take a break from that.
42:02
As long as your child is maintaining their hydration, they're peeing,
42:06
they're not like fainting, you know, they're ultimately they're not going to
42:10
die from what is happening in that moment.
42:12
So sometimes you just need to step away and like let go of that struggle for a little bit.
42:17
And sometimes even just taking the fight out of it can help.
42:20
I also wanted to, in terms of framing, having perspective and maintaining expectations,
42:28
one thing just to be aware of is these resources that we've talked about are not numerous.
42:33
We don't have many pediatric gastroenterologists, many speech language pathologists
42:38
or OT or pediatric trained registered dieticians.
42:42
So there is going to be a bit of a wait to get in to see these providers.
42:45
Providers so just keep that in mind as you're
42:48
exploring kind of what you're doing that don't lose hope you will get in eventually
42:53
and you know we are here to help you so yeah I can't I I think that in terms
43:00
of speaking to your providers and what to say Sarah and Jamie really summed it up really well.
43:07
Goodness, we cannot thank you enough.
43:10
So one of our, you know, we have re-elevated the African proverb,
43:18
it takes a village, kind of framing it around feeding children.
43:22
And so really recognizing that it is messy.
43:24
And I can't remember who, but you said we're still, we're constantly learning
43:28
or relearning or sometimes unlearning things that we've learned growing up.
43:33
And so knowing that we are not alone, that we have resources,
43:37
we have people like our friends from UK Healthcare that are available and their counterparts.
43:43
And so we'll be sure to link those resources so that you all can check out.
43:48
We've checked out some of those websites and they look amazing.
43:50
So, Anna, any final thoughts? I don't think so. Just again, saying it one more
43:55
time. Thank you all so much for joining us.
43:57
We really appreciate it. And hearing your perspectives again,
44:00
both professionally and personally with your littles.
44:04
Our pleasure. Thank you. Thanks for joining us for another episode of SNACK Club.
44:10
Resources related to the topics discussed in this episode can be found on our
44:14
website linked in the show notes.
44:15
Your local Cooperative Extension office is also a wealth of information and
44:19
can provide links to local resources.
44:22
If you have other topics you would like to hear about, send us a note at snackclub@uky.edu.
44:29
That's S-N-A-C-K-C-L-U-B at U-K-Y dot E-D-U.
44:35
And as a reminder, the digestible bits of information we share are like navigation
44:40
signs for your feeding journey.
44:41
But you may need to contact a health care provider for more personal advice.
44:45
And last but not least, special thanks to our team behind the scenes.
44:49
Mindy McCulley for bringing this audio and video file to life with her technology
44:53
skills and to the people through her marketing magic and to Kelli Thompson for
44:57
her creative ability to turn one conversation into our SNACK Club symbol.
45:01
We hope to see you again soon.