Functional Goals: Chaining Ideas for Older Children and Adults

Working with teenagers and adults can be easier in some ways and it can also be more difficult than children. It is often easier because older teens and adults see how challenging it can be not to be able to eat in social environments, communication is less of a challenge, learning about food can be accomplished quite easily and they are usually motivated to change. It can be more difficult at times because the selective eating patterns have been disordered for so long. It may seem like an overwhelming challenge.

But the truth is anyone can learn to eat a new food at any time in their life. You are never too old. The good thing is there are so many nice surprises out there and there are foods that may be very enjoyable.

So how do you learn to eat a new food? It is best to pick foods that match your sensory preferences/profile, but you can also target a new food you want to learn to eat. For some people, salad is a very functional food. You can eat it anywhere, with other foods you may like very much, such as bread or rolls, there are many dressings in a wide range of flavors, from oil based to creamy and you can control the amount. So break it down into achievable steps. Iceberg lettuce may be easier than mixed greens.

Explore the food, start with small pieces and work up to a level where you can take a few bites each day. The more you eat a new food, even in tiny amounts; the less sensitive you will become. Alternate a bite of lettuce with a bite of a food you enjoy. Take a bite of lettuce, take a bite of a favorite food or take a drink. Work up to two bites of lettuce between bites of a familiar food or drink. It is important that you pick a food that is functional for your lifestyle.

College students may find that learning to eat pizza is very functional. If you like bread or rolls, you may start with breadsticks, garlic toast or cheesy bread and in time be able to eat thin crust cheese pizza. If you are a business person and challenged by business dinners, explore menus for other items to add to your plate that you enjoy. Put a small portion of a target food on your plate. Desensitize yourself to the food item in a progression. Just having it on your plate or a side plate, is a start. Some people want to learn to eat a very challenging food like Sushi. That is a tall order. If you are going to go for it, again take it a step at a time. But start small, breaking it apart with a fork or utensil or exploring the sauces to mask flavor. Don't force it, give yourself time.

Spit Happens...

As the mother of a cyclic vomiter and chronic refluxer and as a feeding therapist who has worked with a pedi GI for a decade...I know something about this subject. How do you know reflux is a problem or not?
Signs of uncomplicated reflux, the baby refluxes, but is a "happy spitter"
Random spitting-5 minutes or 2 hours after a feeding. In infants, the lower esophageal sphincter is not mature yet and it opens in a random manner. If there is something in the stomach, it will come up. Remember, the stomach has gastric juices in it, it doesn't "empty" like pouring liquid out of a bowl. Many times, people think a baby has spit up a huge amount of a feeding and actually it is not as much as it seems.
Good health, no significant respiratory history
Good weight gain
No feeding refusals-this means that the baby is likely not experiencing pain from esophagitis while feeding

Complicated Reflux...in other words, needs some form of treatment
Blue spells, apnea, respiratory complications
Poor weight gain
Feeding refusals
Pain signs while feeding
Patterned reflux (example: baby spits up 30 minutes after feeding on a consistent basis, Luke had cyclic spells every 6-12 weeks, this is a pattern as well)
Vomiting at night
Gagging (reflux related)
Eczema or rashes
Enamel changes

What can you do to help? Elevated bed while sleeping, making sure the baby is being fed the correct amount each day and not over fed, a bottle that does not lead to excessive air intake while feeding (try a Dr. Brown bottle), pacifier that seals the mouth well. If there are signs of complicated reflux, the baby should be seen by a pediatric GI for assessment. The doctor will determine if medicine is needed or if it is already prescribed, he will see if is the dosage correct. There also may be additional tests needed to further evaluate reflux/vomiting.

Food Chaining Book was reviewed in St Louis Newspaper

Hi. I just read a review of our book in the St Louis Post Dispatch. It is funny because it sounds like Eliot is my son and that you magically go from french fries, to hash browns to breaded veggies. Hee hee. I told the book people not to put that type of food chain on the back of the book, but no one listens to me....the girl who thought this all up in the first place. But I am just tickled pink that it was reviewed. It still makes me want to throw up, but in a good way. Check it out, the link is under my music.
PS Loved Ewan's stories and new breakthroughs. He is doing so well.

Don't Eat My Fruit Head!

Today was one of those days you wish you could push rewind and do all over again.

So Ewan's therapy session today was supposed to be modeled after his younger brother's session last week: making pieces of fruit look a little like Mr. Potato Heads using various kinds of fruit. Sounds simple enough. Oh yes, deceptively simple!

So Vaughn had a hey day, thought it was the funniest thing in the world to make little fruit like people and then eat them. Stacey and I thought since Vaughn had so much fun, surely, surely Ewan would have an equally great time with the same kind of session. Or so we thought...

We get to session and Stacey and Ewan jump right in with a quick scavenger hunt to find the fruit around the room and divvy up toothpicks to Ewan for each fruit he finds. Ironically enough, the tougher fruits to look at and smell required large amounts of toothpicks as rewards. Armed with enough toothpicks to hold off a small gorilla force, Ewan, Stacey, Vaughn, and I set off to make some Fruit Heads.

Ewan chose an orange, Vaughn an orange, Stacey a banana, and me an apple. We carefully chose pieces of fruit to make eyes, ears, arms, noses, and hats. Then we named them. Oh yes, we named our little Fruit Heads.

That's where everything went astray in that little therapy room.

After we settled on some nice names, we said OK, now it's time to try all the new fruit we used to make our little Fruit Heads. Ewan was HORRIFIED that we were going to eat our new little Fruit Head friends. He may be scarred for life, I'm not sure yet.

Seriously though, this is the kind of thing that can happen when you're 5, when you're a literal thinker, and well, you're Ewan. You just don't eat your new Fruit Head friend creations. Rather, you should be taking them out to dinner, giving them a bath, and finding them a place to sleep at night but whatever you do, you DON'T eat them!

Hint for the day: Next time we decide to make a fruit friend, we won't eat him but rather we'll take him out for dinner and a movie.

Happy Chaining,
Alicia

Fruit Cups!

So my husband and I are doing flips today over fruit cups. Yes, I said fruit cups. It's a little like Jeff Foxworthy's You Know You're A Redneck When.

So today ours is You Know You're Raising A Selective Eater When...You are calling friends and relatives because your child ate fruit from a Dole fruit cup AND they get just as excited as you do!

Here's the deal. We have been working on fruits and vegetables for quite some time and have made incredible success; except that all the fruits or vegetables had to be raw, they could not be in a can, they could not be cooked, they could not be anything but how the good Lord made them (if I add a Sam I am in this paragraph I've got a new Seuss book!). Ewan's fruit also could not be too juicy or too wet. Accepted foods included fresh, raw fruit like apples, grapes, bananas, maybe oranges and a few other seasonal ones.

Well, little brother Vaughn has been chaining fruit and made the jump to canned and packaged fruits in syrup. He began eating peaches and pears and cherries out of the Dole fruit cups a few weeks ago and big sis also eats these for snacks or in lunches. So one of my goals lately has been to get Ewan to explore the whole fruit in a cup idea and to expand his understanding of how else fruit can be prepared.

We basically have been focusing on Vaughn and opening up the fruit cup, swishing and stirring the fruit, dumping the juice into another container and mixing it with something else, using toothpicks to eat some of the fruit, drinking the syrup that it comes in, and more. Ewan was the quiet, unobtrusive observer throughout all this and if I've said 100 times, I'll say it 100 more...peripheral vision is a huge tool for kids on the spectrum and just when you think they are not looking, they are and they are able to take the information in, in a safe and measured way.

Last night I broke out the fruit cups at dinner and I gave one to Vaughn and one to Ewan. Vaughn hesitated and Ewan looked a little unnerved at this and so I just asked the boys to smell the fruit cup and they did. I asked how they rated the smell, both rated good. So I then asked them to lick something on it and they did. I asked how they rated that, both rated good. So I pushed further and focused on Vaughn for a minute to remind him of his bite chart (works for Vaughn not so much for Ewan!). Vaughn went on to take a bite and I asked him how he rated it and he said good. Once Vaughn gets going using the bite chart, he can actually take off on his own in terms of independently eating. Ewan needs a little more prompting.

So I am trying to be very careful with my language with Ewan and I'm just observing him to see what he does. He is watching Vaughn out of the corner of his eye and watching Vaughn use his bite chart. Then he starts to explore the food a little more with his fingers and licking. I can see that the visual aspect to this fruit in syrup is a little unnerving to him. But I don't push for him to take a bite, I just wait it out. If I push he's just as liking to throw it all up on my table, and yesterday was not the day for cleaning that up!

Finally, Ewan takes the tiniest bite of the fruit on his own. I quickly ask how he rated that and he said good. So I borrowed Vaughn's bite chart to see if it might work with Ewan in this situation. I asked him to take off a symbol and have another fruit. He did, albeit a little hesitantly, and I asked him again how he rated it and he said good. We took the symbol off the bite chart and I said have another fruit (there were four bite symbols on the page, very easy to see how much and where to start and end). He did and again rated it good. We went through this until all the bite cards were done. I then asked if he would like more and he came up with his own number and said three more, so to help him visually I put up three more symbols on the bite chart. Eventually we ate and rated through this bite chart and I asked him if he would like any more and this time he said two more. Again, I put up two more symbols on the bite chart. We went through this until the fruit cup was half gone and Ewan said, "I'm done".

So as I sit down this morning and play Monday morning quarterbacking on a Sunday, I sit and analyze what the heck happened last night and will it play out again. For one, I believe language has to be very careful and I've learned to avoid the loaded word 'bite' with my boys. I either say lick the food, smell the food, taste the food, explore the food, would you like more, are you all done, but I try to avoid saying take a bite. Sure, it still comes out every now and then, I am human after all, but I've learned that for Ewan at least, 'bite' and 'eat' have a connection that he's not entirely comfortable with. Words like smell, taste, explore, lick, more, and all done give him the tools he needs to learn more about what is in front of him in a controlled way with a little less pressure.

Now, if at any time Ewan had rated anything bad, I would have known it's time to move on. I used the ratings that Ewan provided as my guide. I watched his facial expressions and there were times that if I had to rate his experience off his expression alone I would have said bad. He scrunched up his face, shook a little, and his eyes got really big. I think, if I had to make an educated guess here, that what Ewan was reacting to was the texture of the fruit all wet and smooth, the mixture of the fruit with a syrup in his mouth and dealing with chewing and swallowing all that without losing control of any of the steps. So when he rated the food good, I think the flavor is what reeled him in to keep exploring past the textures and multiple layers of fruit in a syrup. The fruit like flavor that we have been chaining for so long with either real fruit, fruit flavored fruit chews, and icees, and juices has helped us.

Now if some of you remember, a few weeks ago we were at a Chinese buffet (the mother of all restaurants for a feeding kid!) and we got Ewan and Vaughn one peach each in a bowl. Ewan was not quite ready to eat it as he plainly told us but he was willing to smell and lick it. He rated both good but plainly was not ready for more. Since then, we thought that peach might be an option if we could get past the textures so we looked for peach fruit chews, peach flavored drinks, and more. We talked about peaches, read about peaches, and thanks to the Smash Day idea, we smashed the crap out of peaches! For all of these he all rated as good and great or fun, so I am very excited to see Ewan actually move on to the real McCoy and rate the actual peach as good.

Maybe Cheri will offer some more insight for us all! ;)

Happy Chaining everyone,
Alicia

Dazed and Confused Babies? The truth about Nipple Confusion...

Baby Friendly? The pacifier can be a powerful tool to help infants with feeding disorders. Our bias gets in the way of intelligent treatment plans. Medical research helps clarify garbage pail terms like 'nipple confusion.' A term like that tells me nothing as a feeding specialist about what is going on. Feeding Aversion is the same. Children are not aversive to all food, just foods outside their sensory systems tolerance level. Define a problem and use the tools you have to help infants, use a pacifier as a treatment tool, not a plug. Be wise and don't be fooled by rules that do not make sense.

Pacifiers are actually encouraged during gavage feedings and use results in better GI transit time, an increase in fat breakdown and better weight gain.
Pacifiers also calm an infant and result in better state and organization and less energy expenditure.
Nipple confusion is a broad term that does not encourage the therapist to define what is occurring with the infant or the mother
Medical research defines two types of “nipple confusion”
Type A refers to the infant’s difficulty in exhibiting the correct oral configuration, latching technique and suckling pattern necessary to extract milk from the breast after exposure to an artificial nipple.
Typically this occurs when the artificial nipple is introduced before the successful establishment of breast-feeding. It is most likely to occur due to differences in flow rate. Type A is the infant who successfully bottle feeds but has difficulty breastfeeding.
Type B refers to the older infant who is proficient at breast-feeding and then refuses the bottle. This is actually “bottle refusal” instead of nipple confusion.
It can also describe infants who turn to the bottle and then start to refuse the breast. This may actually be related to decreased maternal milk supply or lack of interest in nursing.
The notion that a single bottle will result in breast-feeding failure runs contrary to experience.

Studies to support: Cronenwett, et al, in a study of 121 breastfeeding couples found that single daily bottle use had no significant impact on duration of successful breastfeeding.
Study: (Neifert, Lawrence and Seacat) There is no research that shows using a pacifier with a preterm infant interferes with breastfeeding.

Building the Core

When you analyze the core diet, study it to learn about what the child is likely to accept next. If you are successful and the child enjoys a new or modified food item, rotate that food into the core diet. This is very important. Sometimes a child will eat a fruit or vegetable but it is not offered often enough to become a true core food. You want the child to become familiar and comfortable with the new food. That builds the foundation of the core diet. Variety is how children develop new tastes and build their tolerance of new and later diverse textures. Teach children how their teeth smash food (boys love this stuff). Crush food in baggies, Alicia, Stacey, Ewan and Vaughn did it with toy trains. Be creative, pull from your language therapist side and watch food change as it gets wet or is dipped in a liquid. Talk about the water your mouth makes (saliva) to soften food. Compare, teach, demonstrate...but do not push the child to do more than his sensory system can tolerate. If it feels pressured, it is. Remember, once the food is in front of the child it belongs to him. You can comment about the food but not direct him to eat.

Empty

Boy do I need my batteries recharged. I have worked 60 hours in 6 days, I have a course to write and finish prep for by May 1st and one lost one to re-write (computer died, birthday curse continues) and I am still dizzy and feeling weird from my latest near death experience/virus. I feel like there are weights attached to my arms and legs. I have a sense of my balance being off. I always have vertigo (from a previous near death experience.. 'Chen' lives on the edge...). So I want this to go away before I get on an airplane in two weeks.
I am teaching an internal two day course at work and I have to clean my house for small group tomorrow night. Luke has track all the time now. We are pretty busy. I need a nap and time to get my head on straight again. I am off on Wednesday and have a few things to do, but hopefully I can get some rest. Dr. Fishbein has diagnosed me with exhaustion. He may be right.
I just feel empty. It will pass, it always does.

New Look to the Blog

Hi. Check out the changes and let me know what you think. There is music to listen to if desired. We will keep updating new ideas and helpful products. Check out Rate a Plate website. This one if a lot of fun and very educational. The Bionex bottle is a good product. We have just started using this bottle in treatment. If you want to watch a very moving video, watch 99 Balloons. Good news recently, Matt and Ginny are expecting.

American Idol

I am very upset about American Idol. If you wish to hear my rant, go to my other blog, "A Day in the Life." Just wanted to protest here too.

Bionix Bottle

The Bionix bottle has settings from 0 (no flow) to 5 (same as a slow flow nipple). Alex is using 0 or 1 for single drops of liquid. I like this product. I wish the nipple was shorter, but I see a lot of potential for using this as a method to give therapeutic tastes (much like we do with pacifier and syringe). We met the therapist who designed the product at ASHA. I like this product. It also makes me very happy to see Alex develop these skills. Bottle feeding is the foundation of all feeding skills and should not be by-passed if you can help it.

Marsha Dunn Klein

What a wonderful weekend we had in Phoenix. First of all, the sun was shining and it was beautiful. What a treat. We attended Marsha Dunn Klein's course in Phoenix and it was wonderful. The second day is just full of ideas and we had such a good time. Of course we were our typical giggly selves, but we learned so much and it was so great to meet this amazing woman who has done so much! We get to go back to Arizona (Tucson) and do a course for her in May. Very exciting.

Rate the Plate!

What an interesting weekend for my two little problem eaters. As some of you may have read, my youngest, Vaughn, is also utilizing feeding therapy, food chaining, and sessions with Ms. Stacey.

In fact, the boys actually fight over who's turn it is to see Stacey in the car as we drive out to the hospital.

So last week Vaughn worked on Smash Day with Stacey and they took army guys and smashed up different types of food, some sticky, some fruits, and some vegetables. All in all a good day for Vaughn and the army guys as Vaughn licked the feet off the soldiers and experienced some new tastes. Some he thought tasted good and others not so much. And really there are two pretty important things about Food Chaining in that little example: licking and rating.

As Cheri has mentioned before, anyone off the street can combine two foods together and see what happens--but the beauty of food chaining is that it examines so many aspects of the diet, of the accepted foods, of the child's behaviors, and combines that with ratings the child gives in order to provide direction of what to try next or when to slow down.

The other day, Ewan so eloquently told his brother, "Vaughn, you're not doing it right. You HAVE to rate the plate or I'm telling Stacey!" Yes, the rule master, that wonderful part of his autistic brain that enforces the routines, rituals, and rules actually works in our favor every now and then; and that includes food chaining. Ewan is also very, very good about knowing what he is and is NOT allergic to and will gladly share all the details of his allergies with you.

By the way, Vaughn did end up rating his foods that night but promptly shoved his brother for being told what to do. Oh a day in the life with those two!

The other important part to all this is in reality, not always taking a bite. Sometimes, it's about everything but the bite and it's almost counter-intuitive for us parents. How many times do parents and caregivers catch themselves saying, "Just try it, just take a bite, just eat it, just, just, just." We also say things like, "It tastes good, you should try this," when in reality we don't KNOW what a food tastes like to someone else--we only know how a food taste to ourselves.

What we do with phrases like that is bring on the stress for that little guy or gal. The words bite, try, eat, do it, just one, all have this underlying sense of stress and anxiety for some children. Sometimes we need to take a step back in order to take a step forward. Sometimes, it only needs to be about smelling the food or licking the food and not yet taking a bite. And certainly, if we tell a child a food tastes good or sweet and the child takes a bite and finds the food to be not so good or not sweet at all but salty, then we may have even set the child up for some confusion.

Smelling and licking can be two very important parts to eating. Have you ever been to a restaurant where something is served and you're not quite sure what it is? What's the first thing you do? You SMELL it! You smell it to determine if A) you can figure out the contents of the dish and B) if it appeals to you. Smelling provides the same kind of feedback for the child. Smelling is a good skill and cues that child in to a few things such as 'can I handle this' or 'can I figure out what this is'.

Licking is no less important. So the smell has given the child some information, maybe even enough to where the child is interested in licking to find out more. So the child takes a small lick and determines a little more information about the food. Maybe he or she isn't ready for a bite yet, but licking is something they can handle. It allows the child to get accustomed to the taste and that can definitely work in everyone's favor.

The other day, we took the family out to a Chinese buffet--which by the way, is a great place for some kids who need to branch out a bit. I decided to follow up on some therapy goals for Vaughn as they had tried canned mixed fruits for Smash Day and he did very well with the pears. So I got both boys a small bowl of one pear each and another bowl with one peach each. Ewan loudly exclaims, "I'm not ready to eat this, but I will smell it and lick it!"

So he did, several times he licked the peach over and over. Still, he did not take a bite but rated the licking a "Very good" and Vaughn rated his OK.

Is that a failure because Ewan did not actually take a bite? No way, not at all!

Now we have some more ideas about flavors for Ewan as he did appear to and he himself rated the peaches so highly. Time to take some ideas from Cheri and Stacey and think about all the different things you can do with peach flavoring!! So rather than being disappointed with the experience, I am hopeful about what may come next!

As for those of you dealing with a child who cannot verbalize a rating yet or maybe cannot yet point to an identifiable rating scale: don't despair. Body language and facial expression, even limited expressions, can be very valuable. I've always said the power of observation is one of our greatest tools as parents and clinicians. Know what is normal for a child in different situations, excited, scared, upset, anxious, happy, content, curious, mad, sad, etc... until you know what the baseline is for all these emotions. Then, when the child is getting ready for a meal, even well before sitting at the table for eating, watch him or her for clues to how they might be reacting to the environment or the food while it is cooking or being served.

Happy chaining everyone,
Alicia

Core Diets

There is so much that can be learned from looking at core diets. The core diet refers to the foods a child eats reliably. Studying the core diet gives clues about the child's taste, texture, temperature preferences and helps you see what may be successful in the future.
For example, a core diet of grilled cheese, french fries, cookies, chips, chicken nuggets, plain pasta (usually with spray butter) and cereal....these foods break down easily in the mouth when chewed, they are of a "uniform texture" which means there are not major changes in the texture of the food while the child chews it and before he swallows it. This is the child who usually does not like dips or sauces, who will not eat fruits or vegetables and refuses many types of meats. Why? These kids like liquids but don't like the feel of a thick sauce or liquid in the mouth. The foods are rejected because of the more complex mix of textures and the consistency of these foods. Think about biting into an orange. There is the surface of the orange, still has part of the white peel attached, it is bumpy and has a skin with stringy sections as well. You bite in and you must contain the juice and swallow it before you start chewing. When chewing an orange you are still dealing with the outer and inner texture. An orange is a difficult food to chew and form into a bolus before swallowing. Sometimes you can choke on the stringy parts. Now compare a regular orange with a mandarin orange, which many of our kids will accept. Learning about what your child will be likely to learn to eat by studying what he does eat is how food chaining works.
Grilled cheese may become cheesy bread, Texas toast, Garlic bread, breadsticks, cheese quesadilla. Later you can work on adding tiny amounts of sauce as you work toward goals of a more complex food like thin crust cheese pizza or cheese dip/salsa and chips. The child is not overwhelmed by the amount of sauce or salsa and is already familiar with the tastes/textures of some of the food items in small amounts he can handle. Chips can become all flavors of chips, sweet potato or veggie chips, fruit chips and eventually other potato products like tator tots or sweet potato fries. Each food item is expanded based on the child's ratings/reactions to foods. Higher rated foods help us re-assess preferences and we are then likely to choose even more foods that will be accepted based on what we know about a high rated novel food item. The ratings and the core diet give you the road map for successfully selecting new foods to offer.

Holidays Are Hard

Today was tough. Holidays in general are a bit much to get through with three children and one on the spectrum. For Easter this year, I thought it would be a nice change for everyone to come to our house. Everyone in my family means about 8 extra people in the house so nothing too overwhelming.

Or so I thought.

For the most part, Ewan could not be pried away from the Wii to come and socialize. In fact, it seemed more of a refuge than anything today. Too overstimulating by far for him.

His older cousin is a gamer too and even he could not keep up with Senor Ewan today and would come and take breaks to hang out with everyone in the living room and poor Ewan simply could not understand why on earth anyone would choose talking over playing Wii.

Simply unfathomable in his head!

For the most part both boys, both with their own set of feeding issues, could not eat with the rest of us. Vaughn came in and snacked on fresh fruits and vegetables before the meal, but had to do so in the privacy of the kitchen by himself. Ewan could not even remotely handle eating at any point that people were here.

When it came time to sit down, Vaughn found a spot outside of the dining room by himself. Of course, everyone would ask him to come and eat with us, but he said, "No it's the smell" and refused to join in. He continued to eat some fruits and vegetables and bread but had to do it alone, in his own time and in his own way and with an arm load of wet wipes for his face and hands.

I've learned to take whatever the boys can offer in terms of being 'together' at large family gatherings and meals like this. Vaughn was much more at ease with 'living room' time than he was at 'meal' time.

Ewan, however, was uncomfortable with the whole enchilada.

It's not that he doesn't enjoy his family members, he does. But it is in small bursts and the art of conversation is not something he gets nor enjoys. He will settle for a quick, "I love you" to let you know that he does indeed feel connected to you, but not in a way most would understand or interpret as 'loving' or 'involved'. It's simply too chaotic to compete with people talking and he cannot process information while others are talking or moving about and he shuts down. Eating at this point, is darn near impossible.

After everyone left today Ewan settled down for a simple meal of fresh fruits and vegetables, fresh bread and fake butter and a big glass of Soy Milk. No mashed potatoes for him, no casseroles, and no cakes or pies either. Those foods are either too texturally advanced or too overwhelming visually or in terms of smell at this stage.

My goals for holidays have always been for Ewan to sit down with the whole family and eat a modified meal that is similar to our own. However, it may be that for Ewan, this kind of situation is less than ideal and may even be painfully uncomfortable. I've decided this year, that as with all other things in Ewan's life, we will follow his lead and learn what he can tolerate and what he cannot and find a balance.

As always, Happy Chaining and for today, Happy Easter everyone!
Alicia

One Sick Pup

Hi. I have been very, very sick this week. Started on my birthday, I have a birthday curse. The Ides of March thing....but I started going into symptoms of pneumonia and my doctor gave me cough medicine to make me cough. I mean "horrible" scratches the surface of the taste of this medicine. The after-taste is even worse. I also have antibiotics that leave a terrible taste in the mouth all day. So yuck. Now the nurse told me I am in a "battle" between breaking up the stuff in my lungs enough in time to allow the antibiotics to successfully treat it. Translation: Swallow this stuff 4 times a day or you may be in the hospital or pushing up daisies if you don't.
Now, I have flavor masked my way through my repertoire of food chaining tricks to get the medication down, I am also doing postural drainage and CPT's. My lungs are my weak point. But I cannot describe the aversion and pre-occupation I have had each day knowing that soon I would have to take that stuff again. At least I know it is for a short time and soon I will be better and this will stop. I wonder how many of our kids suffer with medications and do not know what it is for and how long they will have to take it. I am a good patient and do what I am told because I know how important it is. Now, Randy is also starting to get sick, they just started his treatment and he tasted my cough syrup and absolutely refused to ever do it again. He was in complete shut down, no matter what, he wasn't going to take that stuff. We will need something else for him or I will just have to wrestle him to floor and pour it in!
Funny, how we are all like the kids we treat.

Latta Watta?

Hello...Stephanie here! We've had a wonderful day and I wanted to share.
Eating out = Nightmare when you have a selective eater. Eating out as a family means we eat at McDonald's. If we don't start out there, we end up there. I remember the first time Jase actually ate a Chicken McNugget...I'm sure Cheri and Sibyl do, too because I left an ecstatic message for them to call me which came across to them as panic when they received the message :0) You see, this was Jase's first ever meat so I was elated! But, let me tell you...if I have to buy one more Chicken McNugget Happy Meal, I might scream!

Enter: Latta Watta Creek, O'Fallon, IL Cue: Music, Balloons, Confetti!
Jase didn't just eat at Latta Watta Creek, but he ate the food that they serve! Of course, it was chicken, but it was chicken strips! He had fries and they had the skin on them...another first! They also had a seasoning on them! Oh, and he also ate some of the bread loaf with us!!! This is the first time he's ever tried a kind of bread that wasn't sandwich bread! Yippee!

And to keep up with the "yippee" theme...Jase still eats broccoli! It wasn't a fluke! It must be fresh, not frozen...that's the key with him. As long as there's a bit of a crunch he'll eat it and seems to genuinely enjoy it! Makes a mama's heart proud!

So, there's been a "Latta" going on here with us! I know, I'm a bit giddy ;) I'll stop...just had to share!

Food Education

Loved Alicia's post about doubting my sanity. Actually, I recall our very first conversation about food chaining. Alicia said in our clinic (we had a reporter observing us that day), "We have tried that food chaining approach, it does not work." I asked her several questions about what they were doing and how and what the ratings of food items were and after all that, I knew they were not doing Food Chaining my way. I always tell people, "any moron can put similar foods together." Ha.

It is about so much more than that. So I started talking to her about my vision of things and that this is a long term, ongoing learning process. Ewan needed to learn about food to learn to eat food. Food is such a powerful learning tool. How many things can you experience like food? It can be frozen, sliced, peeled, steamed, melted, pureed, cut in shapes, colored with food coloring, touched, smelled and tasted. A great way to expand vocabulary and concepts. You can learn about farming, agriculture and a whole host of things that focus on food. I get really excited about this but I do know that many people have given me that same blank look when I talk about food education.

Never fall for someone telling you your child cannot learn. All children can learn. The child that examines food, looks at labels, can detect the slightest difference in appearance, shape, size or smell of food is already demonstrating his ability to learn and what he has already learned about food. Unfortunately, many kids learn to not eat.

The Educational Leap

You know, I remember the first time Cheri told me that a major part of our food chaining program was going to be food education.

I thought she was totally nuts.

I mean, why on earth would I have to go around teaching Ewan about food--he was only 3 at the time. How much can you really teach a 3 year old about food? But determined to try, off I went back home to ponder all these new found fangled ideas of Miss Cheri.

I asked everyone I knew and people at the local university about food education programs for children, and they looked at me like I was totally nuts!

Which left us in kind of a rut. I knew we were supposed to be doing it, but I had no idea how to do it and what to talk about. And there we sat in food education limbo until Ewan put a big ole spotlight on what food education meant to him (something I talk about in the Food Chaining book and my website).

Here was our AHA! moment and our chance to pounce on the food education wave and ride that wave all the way to eating casseroles and spaghetti with meatballs!

Ummm, well, not exactly.

Food education was a springboard for Ewan to experiment and to learn but it didn't always equate with him adding some new food to his diet right away. Sometimes it would take months to get from a sandwich game or sandwich activities to actually combining bread and meat together to EAT a sandwich.

It's a foundation and from this foundation he could build, he could learn, he could expand. What it did was allow him to explore foods in a very safe and non-threatening way, without the expectation of him having to take a bite. He was building a veritable library of food products, characteristics, and properties in his head, in a way that allowed him to trust me, trust food, and to trust himself.

I think someday Ewan could have the capacity to be the next Gordon Ramsey or Anthony Bourdain with a life long love of food and cooking, and certainly he's got the fiery and smart aleck attitude to go with it! He's definitely got Emeril Lagasse's "BAM!" down pat! Ewan definitely has things he loves about food and things he doesn't love but making the food education leap has brought him closer to his family, to his friends, and to his culture.

Ultimately, for Ewan, it came down to the fact that his sensory issues prohibited him from experimenting with food in the appropriate developmental ways that an infant, toddler, and preschooler does. He missed those very important stages of experimentation and we had to go back and start from scratch so that he could build that foundation.

I honestly consider this type of food education on par with reading books to very young children in order to prepare them for independent reading later. Let them play and experiment now in order to prepare them for independent eating later.

There are teaching moments left and right in a child's day, even for 3 year olds. Start small and think big, use the tips here, in the Food Chaining book, and on my website at www.theautismlife.com and combine those with who your child is and create something new and exciting. Never assume your child cannot learn something or does not want to learn something. Be excited about the whole process, if mom and dad and siblings think this is some fun stuff, chances are the child may find something interesting about what you are doing too.

Happy Chaining and Educating!
Alicia

How to Introduce New Foods

I think a lot of people really struggle with what to do and how to do it in a session when trying to introduce a new food. In our clinic, children usually see speech and OT together for sessions. We set up the room for snack after playing with The Dole 5 a Day website, cosmeo.com website or reading books about eating. Sometimes we play with puppets that eat. We get out our placemats, cups, utensils and divided plates. We have a routine throughout including washing hands. We offer a food or liquid the child likes to eat on the plate and we also offer a new targeted item. We offer the new food in the "looking place" on the divided plate. We do not have the expectation or give that underlying feeling of pressure to have a child bring the food to mouth during this part of treatment. (But if he wants to taste it, it is fine)
Once the food is in front of the child, it is his food and that is important, he gets to choose whether or not to eat. We do not tell him to eat the food item. We have a plate and the child has a plate. We talk about the food in fun ways.
For example, we have had children in clinic who eat peanut butter cups but don't eat peanut butter. We had a goal of moving to peanut butter. There are several things you can do in a treatment session. Here are some ideas...we might cut open peanut butter cups and scoop out the peanut butter inside. We also scoop out peanut butter from a jar. We talked about how the two types of peanut butter are the same and how they are different. We compare the peanut butter cup/regular peanut butter. We talk about how it smells and tastes. We put a toothpick in both and the therapists taste a small amount. (You could also add a bit of real peanut butter to the top of a mini peanut butter cup.) The child can taste anything if desired throughout the session. Sometimes we get out a few peanuts and talk about how peanut butter is made. We may sing the peanut butter and jelly song. We may put peanut butter on other foods on the therapist's plate...apples, banana, crackers, pretzels or mini bagels that we put on our plate and model that for the child. This also exposes the child to additional foods. Just demonstrate how you can eat peanut butter in different ways. We may put some peanut butter on toast and talk about how peanut butter melts and gets thin when it is warm. We may add a drop of chocolate sauce, honey or jelly and have the child mix it up for us or the parent/sibling. We may put a small amount on our tasting utensil (either a straw, a chop stick, a Duo Spoon, a Nuk brush, textured or regular spoon)to keep tastes small. Find some activities that appeal to the child and have fun during your sessions. The main points are, don't do too much all at once, don't talk too much, too loud or too often. Just have fun and act like the food item is something to learn about, not eat. Many times the kids will taste the food too just because they are given a choice.

Possibilities

Building on what Alicia had to say...preferred foods are your platform for expanding the child's diet. A child that eats only snack food all the time feels horrible. He is undernourished. But you cannot just say to him, "Eat this from now on." It won't work. Food Chaining gives you a plan to expand the diet. You really have to study what the child eats and how it feels in your mouth all the way through the process of chewing and swallowing. That is why we wrote up the food chaining intake in the back of the book, you mark what your child eats and it gives you a description of his
taste/texture and temperature preferences. We then give you ideas of how to expand his tolerance of new foods. Studying what your child eats well is very important. How does it feel to touch it or feel on your tongue? Taste? Sound? How does the food item change when chewing begins? Does it have an after-taste? Keep going back to the child's individualized eating profile and study the ratings of food to keep expanding the diet. We don't really look at food as junk food. We look at those foods to find cues how to expand the diet because for some reason, these things work.

Candy (chocolate) can become chocolate milk shakes, chocolate chip muffins or pancakes, a chocolate fondue for fruits, chocolate covered pretzels, peanut butter cups can lead to eventually eating peanut butter

Gummy bears..can become fruit roll ups and be a platform for talking about fruit flavors, fruit filling inside PopTarts can be compared to jelly or jams, you can make your own fruit puree to finger paint with or eat, fruit flavors can be expanded to end up in frozen fruit bars, smoothies, shakes or breads/muffins. Dips such as caramel that at one time your child may have liked in a candy bar can be used to mask the flavor of fruits. Powdered sugar can be used as well. Gradually reduce the amount of these dips/condiments and help your child adjust to the tastes of fruits.

Chips can become Veggie Stix, sweet potato or vegetable based chips or apple chips and dried fruits. Potato chips or french fries can become sweet potato fries and you can expand potato products to work your way toward a variety of baked fries, or even baked potato (maybe with cheese sauce or french onion dip or seasoned salt or garlic salt to make it more palatable). Some children never get to that type of texture but there are many ways to expand the diet based on that individual child's preferences.

Soda can become an ice cream float and gradually reduce the amount of soda to work toward a healthier drink and eventually work your way to drinkable yogurt or flavored milk...the possibilities are endless

Build Upon Success

A few days ago a parent and I discussed a feeding related issue that is quite honestly, one of the most difficult parts to food chaining we feeding parents deal with: NOT taking the successful foods away. Often, the foods that our children are successful at are not the healthiest foods in the world. Generally they are chips, crackers, chicken nuggets, fries, and other less healthy choices. As parents, it has been ingrained in our brains, that our children should be eating fruits and vegetables and baked chicken all day long. When the feeding child before us insists on living off chips and popsicles our instincts tell us to yank the chips and popsicles from the diet and only offer those fruits, vegetables, and baked chickens. Well, if you've ever lived for ONE day with a feeding kiddo, you know that strategy is like banging your head against the wall. The phrase 'he will eat when he's hungry' doesn't always apply to these children.

One of the biggest lessons to food chaining is to keep what works and BUILD from those foods, to expand from those core foods, to explore what is similar and interesting about those core food and to NOT take away these successful core foods. Why take away what the child is successful at? Why not keep what the child can successfully eat and grow that food repertoire to include foods that are similar in taste, texture, and aftertaste to the core diet? Food chaining is about building upon success. Food chaining is about growing a whole child, about building a love for food, a tolerance for trying new things, about educating the child about food and eating, and most importantly, about understanding what your child can handle and making that child feel safe and successful with eating.

As you have seen in this blog, my son Ewan has come a long way. He started with an extremely restrictive diet and has slowly worked his way towards eating many fresh and raw fruits and vegetables, meats, and a variety of other single ingredient types of foods (spaghetti and no sauce). We didn't get there overnight and guess what--all those foods he came into the clinic with such as waffles and Pop-Tarts, still have a place in his diet. Those foods helped us find the flavors and textures that he is comfortable with and as much as I wanted to empty my cupboards of all waffles, crackers, and chips we stopped ourselves from doing just that. Instead, we pushed Ewan to try different flavors, different varities, build upon texture acceptance, and to use dips and flavor masking in order to build a complete diet for him.

Happy Chaining Everyone!
Alicia

Dole 5 A Day Program

Hi. We have been having a great time in therapy using this website in treatment. Food education is a vital part of any food chaining program. You can use the website to help teach a child about fruits and healthy eating. We have a lot of fun in therapy and we focus our treatment on making food enjoyable. So many kids never enjoy eating. Be creative in therapy and use a low pressure approach, just remember the cardinal rule, once the food is in front of the child it is HIS CHOICE whether or not to eat it. Just having food in front of him is a learning experience about the appearance, texture (by touch) and aroma. We model eating the food. Our comments are about the food, its appearance, how it taste/what it tastes like. We do not say things like, "eat it" or "take a bite." Many times that is the difference. We set up a social situation to give the kids a pleasant experience, we model tasting food and so many kids then go on to follow our lead and do the same when the pressure is off.

Letting go...

Hi all! Stephanie here. When Cheri and friends started this blog spot I emailed Jase's Clinton County EI therapists to let them know about it. I received an email today from our favorite speech therapist in Clinton Co., Angie, that she had given the blog information to a parent of a child with some feeding issues. I instantly thought about what our life would be like had we had this kind of information available to us when Jase first started struggling.
I think a lot of parents going through this, no matter how ridiculous of a thought it may be, looks to themselves to find out what they did to contribute to their child's problem. I know that I did.
On our first visit with Jase to see Cheri, Sibyl and Cheryl in Springfield, Cheri said something that will always stay with me...don't get me wrong, they said a lot of important stuff...but Cheri looked me in the eye and said, "you did not cause this." My eyes have welled up with tears just writing that and I did the same that day, too...but how did she know? I hadn't asked her what I had done. She knew though that I needed to hear it and I think that all parents need to hear it.
So, if you are here looking for information about how to help your child with feeding difficulties...no matter what the cause or diagnosis...let go of your guilt. Letting go will lift the weight of the world off of your shoulders and when you do you will use that guilty energy and transform it into "let's do something about it" energy. :)

Lead

I just had a two year old patient in my clinic and it turned out she had lead poisoning. Thank God that WIC tested her. Her levels were 16 micrograms per deciliter. She had complaints of stomach pain and a major change in her sleep habits. She was very pale. Dr. Fishbein always taught us to look at a child and ask yourself if the child looks healthy or unhealthy. She did not look good. Sibyl found information that poorly nourished children are more suspectible to the affects of lead poisoning. There is so much concern out there regarding toys so I thought I would post some information from WebMD to help get the word out. This is way under-diagnosed. Scary!

"Lead is a very strong poison. When a person swallows a lead object or inhales lead dust, some of the poison can stay in the body and cause serious health problems. A single high, toxic dose of lead can cause severe emergency symptoms. However, it is more common for lead poisoning to build up slowly over time. This occurs from repeated exposure to small amounts of lead. In this case, there may not be any obvious symptoms, but the lead can still cause serious health problems over time, such as difficulty sleeping or lowered IQ in children.

Lead is much more harmful to children than adults because it can affect children's developing nerves and brains. The younger the child, the more harmful lead can be. Unborn children are the most vulnerable.

Children get lead in their bodies when they put lead objects in their mouths, especially if they swallow the lead object. They can even get lead poison on their fingers from touching a dusty or peeling lead object, and then putting their fingers in their mouths or eating food afterward. Tiny amounts of lead can also be inhaled.

Testing shows that many children have too much lead in their blood. Overall, about 1 in 20 preschoolers have high levels of lead in their blood. Any child can be affected. Children living in cities or older houses are more likely to have high levels.


Lead used to be very common in gasoline and house paint in the U.S. Although these items are no longer made with lead in them, lead is still a health problem. Lead is everywhere, including dirt, dust, new toys, and old house paint. Unfortunately, you can't see, taste, or smell lead.

Lead is found in:
• House paint before 1978. Even if the paint is not peeling, it can be a problem. Lead paint is very dangerous when it is being stripped or sanded. These actions release fine lead dust into the air. Infants and children living in pre-1960's housing (when paint often contained lead) have the highest risk of lead poisoning. Small children often swallow paint chips or dust from lead-based paint.
• Toys and furniture painted before 1976.
• Painted toys and decorations made outside the U.S.
• Lead bullets, fishing sinkers, curtain weights.
• Plumbing, pipes, faucets. Lead can be found in drinking water in homes whose pipes were connected with lead solder. While new building codes require lead-free solder, lead is still found in some modern faucets.
• Soil contaminated by decades of car exhaust or years of house paint scrapings. Thus, lead is more common in soil near highways and houses.
• Hobbies involving soldering, stained glass, jewelry making, pottery glazing, miniature lead figures (always look at labels).
• Children's paint sets and art supplies (always look at labels).
• Pewter pitchers and dinnerware.
• Storage batteries.


There are many possible symptoms of lead poisoning. Lead can affect many different parts of the body. Over time, even low levels of lead exposure can harm a child's mental development. The possible health problems get worse as the level of lead in the blood gets higher. Possible complications include:
• Reduced IQ
• Slowed body growth
• Hearing problems
• Behavior or attention problems
• Failure at school
• Kidney damage

The symptoms of lead poisoning may include:
• Irritability
• Aggressive behavior
• Low appetite and energy
• Difficulty sleeping
• Headaches
• Reduced sensations
• Loss of previous developmental skills (in young children)
• Anemia
• Constipation
• Abdominal pain and cramping (usually the first sign of a high, toxic dose of lead poison)
• Very high levels may cause vomiting, staggering gait, muscle weakness, seizures, or coma

You can reduce your exposure to lead. Consider the following steps:
• If you suspect you may have leaded paint in your house, get advice on safe removal from the Housing and Urban Development (HUD) at 800-RID-LEAD or the National Information Center at 800-LEAD-FYI.
• Keep your home as dust free as possible.
• Everyone should wash their hands before eating.
• Throw out old painted toys if you do not know whether the paint contains lead.
• Let tap water run for a minute before drinking or cooking with it.
• If your water has been tested high in lead, consider installing an effective filtering device or switch to bottled water for drinking and cooking.
Avoid canned goods from foreign countries until the ban on lead soldered cans goes into effect.
• If imported wine containers have a lead foil wrapper, wipe the rim and neck of the bottle with a towel moistened with lemon juice, vinegar, or wine before using.
• Don't store wine, spirits, or vinegar-based salad dressings in lead crystal decanters for long periods of time, as lead can leach out into the liquid.

Except in severe cases where someone has received a high toxic dose, a trip to the emergency room is not necessary. Contact your health care provider or department of public health if you suspect possible low-level lead exposure. A blood lead test can help identify whether a problem exists. Over 10 micrograms per deciliter is a concern. In many states, blood screening is recommended for young children at risk.

Other lab tests may include:
• Iron level
• Complete blood count and coagulation studies
• Erythrocyte protoporphyrin
• Bone marrow biopsy (stippled erythroblasts)
• X-ray of the long bones and abdomen

For children whose blood levels are at a moderately concerning level, the steps are to identify all major sources of lead exposure and keep the child away from it. Follow-up blood testing may be needed.

Chelation therapy is a procedure that can remove higher levels of lead that have built up in a person's body over time.

In cases where someone has potentially eaten a high toxic dose of lead in a short period of time, the following treatments might be done:
• Gastric lavage
• Bowel irrigation with polyethylene glycol solution

Prognosis

Adults who have had mildly elevated lead levels often recover without problems. In children, even mild lead poisoning can have a permanent impact on attention and IQ.

People with higher lead levels have a greater risk of long-lasting health problems, and must be followed carefully. Their nerves and muscles can be greatly affected and may no longer function as well as they should. Other body systems may be harmed to various degrees, such as the kidneys and blood vessels. People who survive toxic lead levels may suffer some permanent brain damage. Children are more vulnerable to serious long-term problems.

A complete recovery from chronic lead poisoning may take months to years. Symptoms resembling chronic intoxication may be develop over a period weeks or months."
http://www.nlm.nih.gov/medlineplus/ency/article/002473.htm

PreChaining: Alex's Story

From Jessica:
Alex was on TPN for the first three weeks of his life, after his malrotation surgery the doctors let him have 5cc's in his tummy, I believe it took him 30 minutes to take these 5cc. I figured he wasn't able to eat right after he was born so he would need some practice. Everyday after that first meal they went up about 10cc's per day, finally we were way over our heads in what he could take by mouth. He then had an NG tube placed. When we left the NICU he was taking 20 to 30 cc's by mouth, and about 50 was then put down the NG tube. I kept working with Alex at home, and got him to average around 40 cc's. One time he took 80, and sometimes could do 60. He was referred to Cheri and had a swallow study that day. One month to the day we were hospitalized with pneumonia, Alex did a swallow study and it showed that he was silently aspirating on thin and thickened milk. I had been drowning him all that time.
The Tuesday after we came home from the hospital we went to see Cheri, and Alex has belonged to her ever since. He still does not take any liquid by mouth, he has learned to suck and take tastes by a dipped pacifier and we have been tasting foods, and he is doing very well with the stage one baby food.

I hope to post more accomplishments as they happen, but this is where we are at now.

Cheri: Alex has a PreChaining program in place. The second swallow study will be done soon. He is at a level of therapeutic tastes and on a pacifier program to improve oral stage skills. He is beautiful as you can see from his photo and he has my heart.

Luke

Luke is sick. He has another raging sinus infection. He is coughing like mad. He sounds awful. Well we have the standard course of antibiotics and Allergra D and now we are going to try something new. A sinus wash. Doesn't that sound lovely. I am dreading putting him through this but it sounds like something that may be beneficial. Either that are we need to move to Arizona.

Tinkerbell with an Eye On The Mountaintop...

Being a therapist is hard but it is also a blessing. Sometimes I feel like I can't breathe with all the pressure on me and the needs of so many children. Since May of 2006 I have been in the driver's seat when Dr. Fishbein left us to go on to Chicago. I knew and he knew that God put us together for many reasons (including saving my little boy from the horrors of cyclic vomiting syndrome). Dr F and I had to teach each other our respective trades. Who knew then that the dream team, the Stooges, whatever you want to call us, would one day part? The first day I had clinic without him, that empty chair...well I sat down in his chair, heart pounding and wondering how in the world we would ever move on. Thank God for Cheryl, Chris and Sibyl. Dr. F always called me "Tinkerbell" because he thought I could fix just about any feeding problem. No pressure huh? Well, Tinkerbell sat down and closed her eyes and prayed to the One who is behind all we do and asked for help 911 style. I "let go and let God" and He led me to Koke Mill in February 2007 and I have never been so blessed to work anywhere in 20 years as a therapist. I am blessed to have the people who support and believe in us at Memorial. But there are still days that I feel overwhelmed and unsure. We are working on telemed so Dr. F may be at my side again electronically and it will have come full circle.
But hard work pays off. I had sessions this week that made my heart smile. This week was a true blessing and it was because of three little babies who have each taken my heart away. I am literally teaching two to swallow. Our first steps together left both moms unsure and with the feeling we were doing nothing in treatment. I could see where it was going but they could not yet. The first steps are baby steps but pay off. The third baby could breastfeed but not bottle at all. And I mean nothing. I think people come in to treatment expecting Tinkerbell and instead see me with open hands to God asking Him to help me have eyes that see. They hung in there with me though because they had no other options at the moment..Laura was busy...ha and this week, God worked through me and I sat with these little darlings as they ate. All three, baby food tastes to a full meal, faces covered with biter biscuits, bringing DuoSpoons to mouth independently and my little one took about 2 ounces of liquid safely by bottle and it was beautiful. I wanted to do cartwheels down the hall. I am an old cheerleader. A realllly old cheerleader with a broken elbow and too much weight to put up on these little wrists, but in my heart I was flying and sprinkling pixie dust and doing cartwheels. I am just the instrument and I get moments like these once in a while to convince me to keep going. Laura and I talk about opening a flower shop sometimes...these days are why we keep doing what we do.

Dippety Doooo

Cheri started a blog earlier and mentioned dips and using dips as a method of flavor masking. I have to say that dipping is one of my favorite things about food chaining. I love to dip my food, and like Remi in Ratatouille (not much adult tv in this house!) I like to experiment with the flavor combinations I can make. My boys sometimes need a little push in this department and I'll often have to initiate some dipping. Some of our favorite dips right now include: different flavors of instant pudding (made with Soy milk due to allergies), peanut butter, applesauce, powdered sugar, cinnamon, salt, garlic salt, nutmeg, vinegar, salad dressings, chocolate or strawberry syrup, and even sometimes our drinks like Sprite, Soy milk, or water.

For those of you that don't have to contend with allergies, I would encourage cool whip, ranch dressing, and yogurt (smooth or with chunks--whatever your child can handle). This can really be a great and healthy snack if you get to the point where you are incorporating fruits and vegetables. We now have a lazy susan that we put on the table and have bought these cheap plastic condiment cups from Wal-Mart to put a variety of dips on and do some taste testing.

Often, we try and stick with similar flavors or textures so as not to overwhelm the boys with too much stimulation. Puddings are a favorite with Ewan right now and we have experimented with Pistachio pudding; partly for the green color and partly because he is trialing nuts because of the Eosinophilic disorder! We cut up apples, bananas, oranges, grapes, green peppers, spinach leaves, make the pudding together, and begin the fun!

Alicia

Under Pressure

Hello everyone, this is Alicia, a guest blogger here at Cheri and Laura's Food Chaining blog. My son, Ewan, is often discussed on this blog as is his food chaining experience. Tonight, I'm sitting here listening to my new mp3 player (wow, that only took me a few years longer than everyone else to get!) and I'm listening to some classic David Bowie and Queen...Under Pressure. The song motivated me to get off the couch and come type up some thoughts about food chaining, eating, and of course, all the anxiety and pressure that can come with all the fighting over food and eating. Under Pressure is a little how I feel right now with a new job, graduate school, 3 kids (4 if you count my husband!), and regular, everyday life. Trying to figure out how to keep up our food chaining goals and education with all these new changes in our life has brought me to think about all this tonight.

It still comes down to finding those 'teachable moments' and in these situations quality is far better than quantity. Teaching about food and eating, without pressure, in reality only needs to be a few minutes here and there--not a five hour discussion between you and the kiddo. Often, these moments of clarity come in quick spurts and what may not seem like anything to you, can leave a lasting impression on a young and developing child.

So after a super long day and week, each day has had quick little experiments, tastings, and playing with food. Tonight was smoothies. We were doing a little carry-over from what my two boys did at the feeding clinic this morning with Stacey. At clinic, we made smoothies and the boys got to pick what they wanted in their smoothies: Ewan chose oranges, bananas, orange juice, berry juice, sherbet, and ice while Vaughn chose oranges, orange sherbet, orange juice (see a theme?), 3 pineapple chunks, one strawberry and ice. The boys then got to take their concoctions (Ewan so aptly named Banana Crush and Orange Crush) to some adult patients in another part of the hospital. It was great fun and believe it or not, the boys even got some cash tips and were thrilled with their quarters!

My last few thoughts about being Under Pressure, is to sit back, take a deep breath, and prioritize. Parents and caregivers need to take care of themselves in order take care of their children's needs. Find your teachable moments when they pop up or you create the opportunity and be ready to expand on your child's interests--it will pay off in the long run. Food chaining is a cross country race, not a sprint. It is most assuredly a way of life and not a passing phase. Food chaining is about learning to experience new things in life, food related or not, in a safe and appropriate manner. Embrace it and most importantly, have fun with it!

Alicia