Clinic helps parents cope with kids' eating woes
|
SCOTT
ANDERSON/Courier-Post
PICKY EATER OR
PROBLEM FEEDER? |
Wednesday, April 4, 2007
By
BARBARA S. ROTHSCHILD
Courier-Post Staff
EVESHAM
While many young children can be described as picky eaters, the annoying problem becomes more complex when it is a symptom of an underlying disorder.
Ellen Lowenberger's 3-year-old son, Andrew, diagnosed with autism and pervasive developmental disorder, will eat pasta, chips and some cheese, but he has many sensory issues with food.
As an infant, he would refuse baby food. Colors and textures can upset him, as can something as seemingly innocuous as seating arrangements.
"He has challenges eating with more than two people in a room. He doesn't eat in restaurants," said Lowenberger, who lives in Voorhees.
When she and her husband, Mike, wanted to increase Andrew's eating capabilities through a feeding-therapy program, they found few in the area. There was a seven-month waiting list at one children's-rehabilitation hospital.
Lowenberger was trepidatious anyway, thinking the program there might be too rigid.
"I wanted a natural environment where Andrew wouldn't feel pressured to eat something," she said.
Andrew was already undergoing speech therapy at Jody Schechtman's Communication Station, a Marlton clinic that specializes in treating children on the autism spectrum and offering resources and support for parents.
While the Journal of Pediatric Psychology reports that 25 percent of typically developing children refuse to eat some foods before age 4, Schechtman said that number is much higher among children with speech and sensory issues. She estimates that 80 percent of the children she sees for speech and occupational therapy also have feeding issues.
"The feeding concerns were a missing link in treatment. We were having to send children out for that, and there were these waiting lists," Schechtman said.
"We decided we really wanted to take a look at the whole child and provide that missing link."
In February, Schechtman formed the area's first private outpatient multidisciplinary feeding clinic. Children are screened, evaluated and treated by a team that includes a pediatrician, a pediatric nurse and a nutritionist as well as occupational and speech pathologists.
A social worker monitors treatment, and parents are actively involved with weekly "homework" as they observe their children and offer new foods in different settings.
Andrew is one of the first children registered for weekly hourlong sessions in the 12-week program, but there are many children with similar issues, Communication Station speech pathologist Rizza Miro said.
"We had a 3-year-old who only eats pureed foods. Some can't have their food too hot or too cold. Some have very regimented feeding patterns and don't get the nutrition they need," Miro said.
Some autistic children could starve because eating is just not a priority for them, while others can't eat sitting at a table or out of a bag on a class trip. When feeding behavior interferes with a child's daily activities and with family dynamics, it becomes a problem, Schechtman said.
Feeding therapy at Communication Station is tailored to the individual child's needs, but includes a food hierarchy moving from preferred foods to more difficult ones.
Unlike in more traditional programs, there is no play food or toy reinforcements.
"We don't say, "Take a bite and we'll give you a toy.' We just talk food and eat food. We want food to be the reinforcement for itself," Miro said.
By Andrew's fifth session, Miro had introduced him to about a half-dozen new foods through a nonforced, primary desensitization approach.
The foods included sweet potato chips, cranberries, Colby-Jack cheese sticks, mixed berry applesauce and peanut butter.
With the brand new foods, applesauce and peanut butter, just getting Andrew to put the food close to his mouth signaled progress.
As Miro read him a book on opposites, she spooned some purple mixed berry applesauce into a dish. While engaging Andrew with the book, she also introduced concepts that included kissing the spoon and swirling the applesauce.
Next, Miro consulted Lowenberger about her homework. In the past week, Andrew had requested cranberries and Colby-Jack cheese, and also ate pineapple but would not touch kiwi.
"Last night, he had a waffle and cranberries. Two foods on the same plate is a big step for us," Lowenberger said.
In the week to come, she'd try introducing peanut butter and jelly on a cracker that would dissolve in Andrew's mouth without chewing.
Getting children such as Andrew to tolerate more foods will improve their quality of life and lend more freedom to family lifestyles, but the road is a long one.
"We can work through these issues, but the kids don't outgrow them," Miro said.
Reach Barbara S. Rothschild at (856) 486-2416 or brothschild@courierpostonline.com.