One of the team members - Nutritionist/Dietitian

When I evaluated a child for the first time, I ask the parents what other therapies or specialists that their child has seen or are scheduled to see. Often they have been referred to a gastroenterologist. One specialist that has been a must on a team is the nutritionist/dietitian. A good one. That listens to the family and is compassionate, as well as passionate, when it comes to nutrition. No judging, just recommendations and suggests for the family. I have been fortunate to find one in Orange County in Melanie Silverman, MS, RD, IBCLC. I have not met anyone equal in her passion for nutrition but based in reality of family life.

What can a nutritionist help?

A nutritionist can really look at your child's food intake as well as the family food intake and really dig deep and analyze if your child is getting all the nutrients that they need to grow and thrive. Which is what as parents we need to hear. They can assist in making slow changes in food choices to improve overall health and wellbeing for all the in the family, not just the child with feeding issues. They should be a coach for good food choices.

Interested in contacting Melanie?

Here is her contact info:

Melanie Silverman, MS, RD, IBCLC

(949) 607-8248

Breastfeeding weaning

I had an interesting conversation with a friend of mine who was at her wit's end with her one-year-old nursing. This is her third child and in her mind her last child. She believed that she "HAD" to wean him. She needed the sleep. She was moving and had to take care of the move plus her two older children. She felt that her sleep deprivation was because of her nursing at night. She was determined to sleep train her youngest. She had done this in the past but went to visit family and to deter him from crying, fell back into the same routine of nursing at night.

She dreaded the training. She felt that having him cry was just heartbreaking. So I asked her, why not just co-sleep without nursing? She loves to cuddle with her children. She loved to have her one-year-old beside her, it was just the nursing. I pointed out that the nursing was his comfort. His way of settling down. If she took the nursing away but slept with him, she could teach him to settle himself in other ways. Weaning is a delicate balance. Nursing/Breastfeeding is not just for nutrition but for bonding and comfort. The hardest for most moms is to find that a replacement for something that started from day one of their relationship with their child.

Co-sleeping, like breastfeeding, is a choice and it is not for everyone. But for those in this situation I point out that weaning and sleeping by yourself (your child) are two separate "battles". You won't win either if you fight them both at once. I have the parents/moms pick which one is most important. Then go from there.

It takes longer but like most things in life there is not quick fix without some serious emotional struggles.

The culturally picky eater

My oldest son is turning 9 at the end of this month. He does not like to eat: sandwiches, hamburgers, broccoli, carrots, salad, potatoes (unless they are fried), anything with tomato sauce. SO when we go out to eat or eat with our extended family there is always a fight or a struggle to get something for him to eat. He will eat PRETTY much anything that is, drumroll please, beige! french fries, chicken nuggets, cheese pizza, crackers, plain noodles.

So my husband says about once a month: your a feeding therapist, fix your kid! (in jest).

Here is why I don't worry: most of the food he rejects are mostly foods that I consider in the American style of cuisine.

Here is what he does eat: Gailan (Chinese broccoli -it is greener than american), Onchoy (Water Spinach - so wikipedia tells me), pea sprouts, and most other Asian vegetable that is green. He eats most meats stir fried in soy sauce, garlic, and ginger. He does like rice (white and brown).

He also eats sausages and potato balls that are from his German side.

Overall, he does eat a variety of foods from another culture. So, what is a true picky/limited eater? Someone that would not eat anything from ANYWHERE no matter what. Most limit eaters won't even want to be in the same room as foods that they cannot eat or tolerate.

So try different foods with your child. See if they just need to tap into their cultural taste buds.

Physical Therapy: an alternative to reflux med?

Majority of my clients that I see for feeding therapy have GER also know as reflux. They are on a variety of reflux medication from Reglan, Prevacid, Prilosec, to Zantac. Some are also on low grade antibiotics to help motility.

I have found in my practice that most children with reflux demonstrate some weakness overall. They are functional in their environment but are not quite where they should be for their age. One could argue that they are weak because of their reflux and lack of nutrition. It is a cycle - overall body weakness, reflux, decrease nutritional weakness, then back to weakness, etc. I noticed that when a good strengthening program is involved, most of my clients have a decrease in reflux symptoms. It is not a normal pathway of feeding therapy but one that I have found helps decrease reflux episodes and has helped with feeding therapy in general be a rewarding experience.

New Beginnings

Well it has been WAY too long since I last posted. Reading my past posts I think I was trying to hard to capture a very complex process. I hope that this reboot will be better and more consistent. I am more confident in my skills and feel ready to share a different view on feeding therapy for children with feeding issues. I hope that I can put on paper what I have learned in practice. Here I go, again!

Building Trust

Gains in therapy, any therapy, are built on a foundation of trust. The best way I have found to build trust is to go SLOW. The majority of children I see in the clinic have little to no control over what they can do. They are limited by external (adults) or by internal (limited mobility) forces. When parents come to me, I give my speech explaining why feeding therapy is a slow process: "Your child has to trust me. I need to touch their face, go in their mouths, pull and tug. I'm going to introduce foods to them. This maybe no big deal or it may be the most negative thing in their life at the moment."

I'll give the example of the dentist: "Most people do not like going to the dentist. Why? because he is in your mouth, pulling, tugging. You have no control over when you can close your mouth, when you can swallow. It is scary. Then there is the noises - the drill, the suction."

Initially therapy can be the same thing. Especially feeding therapy. A vibrating toy to the face and mouth can be like a drill. A NUK brush like a suction machine. It is all new and very different. When I can build trust, and the child knows I am not going to do anything harmful, we have progress. And we make progress faster, happier and easier then if I had gone straight to the mouth.

What have they tried.

Now I find out what the parents have tried. This helps since I want to know what has worked and what hasn't work. Even if it worked for a little while. It is a piece of the puzzle. It also helps to know where the child is coming from as well as the parents. Desperate parents will try anything when they are told that their child has to eat. If they don't their child/baby, will be malnourished. This can lead to so many things such as decreased brain growth and overall developmental delays.
So what have they tried. I have heard it all:
1. We don't feed him/her until they ask. - they never do.
2. We only let him/her run around and we follow him/her around and feed them.
3. We put him/her in a high chair and just opened his/her mouth and made them eat.
4. We distract him/her with toys or T.V.
5. We just let him/her have milk.

the majority of parents will tell me these things with guilt in their voice. More than once I have hear a parent say how they are just a bad parent because they have tried one or some of these methods. I always tell parents: there are bad parents in the world...they are the ones that don't care...you care, you try these things for your child. For THEIR best." And that is why they are here with me.