133 - Is It Just Picky Eating... Or Something More? with paediatric OT Rachael Smith

0:00We acknowledge the traditional owners of the land on which we work and live, the Awabakal and Wurrimei people, and pay our respects to Elders past and present. We celebrate the stories, culture and traditions of Aboriginal and Torres Strait Islander Elders of all communities who also work and live on this land.

0:17Rachael Smith:You're listening to Boob to Food, the podcast with Luca McCabe and Kate Holm.

0:31There is so much noise in the parenting space and we don't mean the tantruming toddler. We understand it can feel confusing, conflicting and overwhelming. That's why we are bringing our

0:42Rachael Smith:years of experience as a midwife, nutritionist and naturopath and of course mums so that you can confidently navigate the roller coaster of motherhood from boob to food and beyond. Each week you'll hear practical wisdom, expert advice and inspirational stories of other mums in the depths of this parenting journey. Let's dive in. Today's episode is brought to you by Nourished. Hello and welcome to Boob to Food, the podcast and welcome back to Boob to Food, the podcast, Rach. We are going to pick your brains today about, actually that was so unintentional, my pun not intended, pick your brains about picky eating, which is definitely a question we get a lot of here and something that causes a lot of concern for families too.

1:24Rachael Smith:And there's such a wide spectrum, which I know that you'll get into in the episode of what's considered normal. I'm doing air quotes, picky eating or a phase versus when it is perhaps moving into that problem feeder territory. But before we dive into that, would you like to let listeners know a little bit about who you are and what it is that you do? Yeah, absolutely. Thanks for having me back, guys. So I am an occupational therapist. I'm the OT here at Boob to Food. I also work with the pediatric private clients here in Brisbane. And I am mum to Olive, who's almost four, and Theodore, who is 11 months old.

2:02Rachael Smith:I still can't believe that. I know you've said it so many times, but in my mind, he's just been born. I know. I feel the same way. It goes so fast. Rach, what does normal, fussy or particular eating look like? What can parents expect to be considered normal developmentally in toddlerhood? It is such a broad spectrum. like you guys have mentioned, you know, picky eating, selective eating, cautious eating, there's lots of different terms that you might hear thrown around. And I would say the chances are higher that you will experience a phase of this than not. So it is, you know, probably to be expected.

2:38The research is perhaps still catching up with what I feel is, you know, the experience that I, you know, see in, you know, my caseload, but also just talking to all my mum friends. But the research shows that between 25 and 33 % of children will experience some sort of feeding and growth challenges, you know. So, it is a common experience that many parents and little ones face where their adventurous eaters suddenly become very cautious or perhaps what we would describe as very picky. K.A. Tumi, a pediatric psychologist, gives us some helpful language to understand what typical picky eating is.

3:12So, the kind of things you'd be looking for typical picky eating would be, you know, perhaps wanting something slightly different from the rest of the family, eating less foods than they used to or perhaps less than what the rest of the family eats, but we'd still be expecting that they eat at least sort of 25 to 30 different types of foods in their food repertoire. You would probably be seeing some distress at mealtimes. You might be seeing some mealtime behaviors, but for the most part, their growth would be relatively on track. So, you might see some different sensory preferences or taste preferences, you know, like we all have, but you would not be seeing them, you know, rejecting entire food groups or entire textures when we're thinking about sort of typical, you know, toddler fussiness.

3:55Just thinking about that statistic you mentioned, Rach,

3:57Rachael Smith:and it seems really low, like 25 to 30%, did you say, of families will experience some picky eating. Are the remaining 70%, I was recalling Jamie Oliver's, you know, when he went around like the schools and did the things in America and they looked at the typical diet a lot of families had. And I think if our family ate that like standard American diet with like heaps of ultra processed foods and fast foods, I would not describe my family as having picky eaters. My kids would be like, yes, I will eat those hot chips. And yes, I'll let you back. So I wonder if, I don't know, I haven't actually read that research in great detail to know, but I wonder if that's a variable in the remaining 70 % that the dietary choices that they're making already are, I don't know, like.

4:45You're right. A lot of this is parent reported and, you know, parent experience. And I think oftentimes it's when our expectations don't match our experience with our toddlers that that's when we can feel, you know, increased stress. And I think a lot of the families that are a part of our group to food community do have some pretty, yeah, high goals and some values that can make it more challenging or perhaps even just more apparent when our toddlers go through these phases. Or even be like lower socioeconomic, third world countries, I'm sure their kids probably don't complain about because they're probably really hungry and just want to eat, whatever.

5:22Whereas, I don't know, I always say to my kids, you're too spoiled. Too much choice. Yeah, lots of different factors that I think would go into, yeah, the way a parent describes and what a parent reports of, yeah, their perception of their child yeah yeah and I actually have I often reflect this with Will because I think for a lot of people if they had him as their child they would say they had a very fussy child or a problem not a problem feeder but a really fussy eater but I actually don't call him that I think I've said this so many times but I think his is definitely just an autonomy thing and just depends what mood he's in but I know he's not inherently fussy or particular because sometimes he will eat that food without any issues and he doesn't you know neglect whole food groups like you were saying and he will touch the food and he will sometimes eat it I mentioned in another episodes you know preparing food with him and cutting up veggies that he would never normally eat on his plate but he would suddenly eat it raw so I know that he isn't fussy but I think if I didn't have this knowledge uh or wasn't doing these other steps to keep him exposed to food that I would think he was fussy.

6:32Rachael Smith:Yeah, mealtimes are still challenging but not necessarily because he's like truly fussy. Yes. Or you know how you hear those stories of a child that goes to daycare and they'll eat like a fish curry and their parents think, what? Like they would never touch one, a curry, two, anything touching each other and three, fish in my life giving it to them. But at daycare they eat it. So I think sometimes it's hard because it's what our perception, like you said, or fussiness or particular eating is rather than it actually being a problem. Yeah. I think you're drawing there on, yeah, just the fact that there are so many factors that can go into, you know, not wanting to eat a particular food at a particular time.

7:13Yep. And it can definitely be a, you know, a feeding skill issue. It can be a sensory challenge. It can be an appetite thing. It can be an environmental thing. Or yes, it could also just be that toddler autonomy and we often hear lots of parents yeah ask that same question why do they eat it here and not over there um and yeah I think that's some really helpful reflections Luca and so if

7:36Rachael Smith:we are in this phase and we're hoping it's a phase with our child how long could we expect that it will last for like I mean you're probably not going to want to hear this but anywhere from you know a few weeks up to a few years um and depending on the reason for the particular particular eating or fussy eating that you're seeing in your little one will probably sort of impact on you know how long it hangs around for. And so when does picky or particular eating then cross the line into something more serious? Again I'll come back to K.A. Toomey's definition because it's really helpful. She categorizes picky eaters versus problem feeders and we know from some of the research that we've got that about a third to a half of sort of parent reported picky eaters will just grow out of it.

8:24But for a large number of the remaining kids, they will go on to have some ongoing challenges around food and ongoing challenges around mealtime and they'll need that extra support to move through it and to be able to nourish their bodies and navigate family dynamics with those challenges. And that's when we'd start to talk about a problem feeder. So these are the kids that are eating a really limited range of foods. So we're thinking sort of less than 20 foods on their list. They're probably kids who have gotten to the point where they're consistently refusing entire food groups and consistently refusing entire texture groups.

8:57So perhaps eating nothing that is mushy or eating nothing that is wet. They're probably almost always eating something very different from the rest of the family. They're often probably having big distress and big meltdowns when faced with new foods. There's often probably going to be some impacts on their growth, not always, but oftentimes you will see impact on their growth. You might see them gagging, you know, really frequently at mealtimes. And this is, you know, well beyond that starting solids phase. And you'll probably also just experience some general stress as a family during mealtimes.

9:33We'll be back after this short break. Today's episode is brought to you by Nourished. I think about a year ago, one of my friends told me about this amazing online company that makes pre-mix meals and how amazing that they were and making her life easy and i have to say i was a little bit skeptical of what the ingredients would be but i had a look into it because i just found especially for me with lunches i was just really falling short and i just wanted something healthy that was in the freezer that i could just grab and go anyway i looked into them and i was so pleasantly surprised by how amazing the ingredients how clean they are.

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11:39Rachael Smith:And so then if we're feeling like our child is more in that problem feeder category, is that a situation where you would always need to have external support and what sort of like what would happen next or what would families expect there? Yeah, I would say if you're feeling like you're meeting a fair few of those criteria, definitely don't struggle alone. I feel like I used to probably have a higher threshold for when I'd, you know, encourage friends or, you know, people I was chatting to to reach out for support but now I just say like keep the threshold low. If you're unsure, reach out for help, get a little bit of individualized advice.

12:14The term problem feeder in itself isn't a diagnostic term in any way. It can just sort of be a helpful category to consider so there may not be sort of any ongoing diagnosis or perhaps even really long-term support needed but short-term support an individualized plan is is always awesome to get that help and not be left wondering you know what if or what what else maybe could I be doing but for many families if they do reach out for support they may go on to receive a diagnosis or work with a broader feeding team a pediatric feeding disorder is a term that we now recognize under the ICF and that's been really helpful for parents that are really struggling long-term and this is, it's defined as an impet or intake that's not age-appropriate, lasting at least two weeks and affecting either medical, nutritional, feeding skill and or psychosocial areas or dysfunctions.

13:07And so sometimes getting a support and being, you know, having that sense of, oh, there's actually really something going on here can be so affirming and validating for families who are in the thick of it. Some of the other things that sometimes children will go on to be diagnosed with ARFID, avoidant restricted food intake disorder and this is more of a psychosocial diagnosis and you'd work with a different sort of feeding team here or dysphagia is something else that can sometimes be impacting on mealtimes and support from a speech pathologist would be necessary here and this is something more associated with oral motor function and structures.

13:44Rachael Smith:Sounds like it's, I mean not only for getting the stress off your plate, which like we always really encourage families, like you said, Rach, to keep that threshold low, just outsource if you're feeling concerned. You don't have to figure it out as a parent. You've got enough on your plate. But it sounds like it's important in this instance as well so that you perhaps can get an appropriate diagnosis to be supported then by the right team because the approach may be different depending on what your child's actually presenting with. Yeah, absolutely. And I mean, diagnosis aside, feeding therapists and feeding therapy teams are able to offer strategies and support and intervention in, you know, playful, creative ways for the little people who might be struggling, but also for the parents who are probably struggling with figuring out how to support them.

14:30Rachael Smith:I feel like even with just a normal level of picky eating, it's so stressful. Like you, you know, spend time shopping and preparing these meals and you're conscious of food waste and you've spent$7 ,000 at the grocery store because grocery prices have gone through the roof and then only for your child to refuse to eat it and then you're worried about their nutritional intake and their energy levels and all of the things like it's so stressful and that's not with a pediatric feeding disorder so I just think in any instance wherever you sit on the scale if you have stress around the topic of feeding then reach out for support because there is a lot that you can do and so many strategies that I think we as parents and even as maybe I don't know if you feel the same Rach like as a professional in this space and a parent sometimes you can't see it as clearly for yourself and it's great to be able to offload that to someone who can zoom out and yeah get an unemotional look at what's going on in your family yeah absolutely I definitely say yep I relate to that as well you can easily get lost so lost in the details and lost in the emotion and the intensity of you know any of the things our toddlers go through but yeah food being a really big one yeah and I think food just has added stress because it impacts every area of their life if they don't eat then they're cranky then they don't sleep properly then they might lose weight and it's like not one of those normal toddler tantrums that you can sort of bypass through the day and doesn't affect a lot of your life this is and it's something that we have to think about for three meals a day every single day that never ends so super stressful I think it's probably also important to know because we've talked about talking to an OT or a feeding therapist or a speech pathologist but also if your child has a very limited dietary intake talking to a dietician or a nutritionist can be super helpful too because obviously there will probably be some nutrient gaps that need filling and whether your little one might require some supplementation or just some strategic ways of getting in nutrients through foods that they do like so we can also help with that in our online clinic as well because yeah it's often a team approach with these things it's definitely the team approach is gold standard I think parents will often say like who do I go to first or how do I know if I should see a dietician or an OT or talk to the GP or a speechy or nutritionist and I think my advice is always you know pick pick one and they will have the skill and the um the knowledge to know who perhaps to refer you to if you do need to see someone else as well so usually just starting with one modality and then that referral can be made and you can build a little bit of a team and perhaps you know you'll just see um yeah you might see a dietitian for a little while and just get started that's often where um I love to refer families if they come and see me I you know refer them to a pediatric dietitian and then they can get a little bit of a plan and then we can be a little bit more creative with that plan in OT.

17:27Yeah and I think a GP can be a really good first stop too because then if you are eligible and your little one does have a diagnosis, you can get a healthcare plan as well, which, because all of this is expensive. Sometimes it's easy to say, see this person, see this person, but a lot of appointments can cost a lot of money, which is hard for a lot of families. And so, yeah, I can understand. I'll just point out, you don't need to have a diagnosis to be eligible often to receive some of those Medicare referrals and receive a bit of a rebate. So, yeah, even if there's, you know, not a diagnosis at play, you can definitely still touch your GP and often get a bit of a rebate.

18:03Well, that's good to know.

18:05Rachael Smith:So Rach, just with like the different diagnoses that you mentioned and maybe the different drivers behind them, you spoke about like some of it being more a sensory issue and some of it being more like the motor skills. Can you just explain a bit more about how that might look or be different for the child? Yeah, so I mean lots of things can contribute to the feeding challenges that we might see at the dinner table, but sensory sensitivities and oral motor challenges are probably two of the most common reasons. And they can be separate issues. They can also often be overlapping challenges for our little ones.

18:41But a sensory sensitivity is usually what we see if a child's nervous system is over-responsive to a particular type of input, making it feel uncomfortable, overwhelming, you know, sometimes even painful. and I think as a society we do a really good job at understanding you know sensory sensitivities for example um to noise so we're quite familiar with understanding that some of us are really sensitive to loud noises others you know are not some of us can work in a quiet space and do best others you know need to be you know in a really busy noisy environment to be able to focus that we all have different sensory preferences but this is the same with food and for a little one who is sensitive to a particular texture you know there's a really broad spectrum here but for some it can almost be absolutely painful for them to be asked to even touch or even look or definitely to eat that certain food.

19:29So, it can make touching, looking, smelling, tasting, you know, a challenging experience. And then oral motor challenges, this is where we can see a lot of breakdown and it can kind of have a bit of a knock-on effect for our little ones if they're struggling to move the food around in their mouth, if they're struggling to chew the food, If they're lacking oral motor awareness, they're not quite sure where the food is in their mouth, we can see things like food pocketing, you know, that extends beyond just that starting stolid's phase. We can see, you know, even you'd probably be seeing lots of drooling.

20:00You might be seeing, you know, gagging or perhaps, you know, even the choking episodes or lots of sort of coughing and spluttering and difficulty perhaps with different sort of textures. So you might see a child that's able to confidently eat soft textures but might struggle to progress to different sort of types of textures. as they get older. So they'd be sort of some of the, so yeah, a little bit of an explanation about some of the drivers behind some of the feeding challenges we might see.

20:26Rachael Smith:Awesome. Oh, thank you, Rach. I know it's such a complex topic and yeah, one that can be very emotional and very stressful for a lot of families. So I think, I mean, there's a lot to take away from this episode, but probably the number one thing is get support and get somebody to guide you individually if you have concerns at all. And like we mentioned, we have a team here at Boob to Food and we'll link lovely Rach in the show notes as well. And if you're listening and you're wondering if you do actually need to reach out for support, we do have an extensive blog that just goes through all of the points Rach mentioned as well.

20:56Rachael Smith:And you can have a look at that table and a bit of a comparison between a picky eater versus a problem feeder. And that might guide you a little bit further in terms of your next steps. So thank you so much, Rach. It's such a pleasure to have you here. Thanks so much, guys. Thank you for listening to Boob to Food, the podcast. We hope this episode made you feel inspired, confident, and less overwhelmed in your parenting journey. Head to the show notes for all the resources mentioned on today's episode. And if you loved this podcast, please remember to subscribe, rate, and review. See you next week.

21:28Rachael Smith:Bye.