“What happens during the first months and years of life matters a lot…it sets either a sturdy or fragile stage for what follows.” Shonkoff and Phillips. From Neurons to Neighborhoods: the science of early child development
The first session explores the formative years, when children learn to relate to food and their bodies. With a base of “typical” development around eating, knowing how, when and why an individual diverged from typical informs treatment. Negative experiences with food or mealtimes (including anything that made chewing, eating, swallowing, or digesting negative, difficult, or painful) increase the odds of avoidant eating. With a relational lens, understanding challenges such as aversive experiences, sensory differences, temperament, anxiety, and the piece that is often missing- feeding dynamics- informs treatment beyond merely addressing presenting symptoms.
We will also consider the spectrum of “picky” eating to ARFID, and examine the current eating disorder ARFID research.
- Describe three common worries parents have related to a child’s eating
- Describe “responsive” feeding and how it differs from authoritarian or permissive feeding styles
- List possible reasons (in addition to fear of choking or vomiting) why we might observe an individual avoiding eating
- List three common tactics parents use to try to “get” children to eat more or different foods
- Consider how research focused on intensive ED treatment may impact protocols and refeeding as it relates to weight trajectory and subtypes of ARFID
Session two builds on the foundation from Session 1 to consider the range of common pediatric feeding therapies that your clients may have experienced, and the philosophies behind them. We then transition to clinical application: an overview of the STEPs+ approach of Responsive Feeding Therapy (RFT), assessment, addressing parental or teen/adults’ worry and frustration, supporting interoception, appetite and curiosity, and navigating the potential negative complications of non-responsive feeding and therapies. We touch on trauma and neurodiversity, and set the stage for session three’s panel of presenters as we dive more into treatment.
- List two common pediatric feeding therapy approaches and briefly discuss how autonomy and internal motivation are supported or not
- Describe how feeding and eating disorder therapy can pressure, and may recreate non-responsive feeding and resistance cycle
- Describe why reducing anxiety and conflict helps appetite
- Describe how goal-setting, anticipatory guidance and pointing out progress helps parents avoid counterproductive feeding
- List some “tools” RDs may use from their treatment toolbox that fit in with a responsive approach
Katja Rowell MD is a responsive feeding specialist, described as “academic, but warm and down to earth.” She was a clinical faculty member of the Ellyn Satter Institute and has joined a group of multidisciplinary experts to develop, research and promote “responsive feeding therapy” as an approach to selective/avoidant eating.
Rowell has a special interest in sharing this work with eating disorder providers: viewing ARFID from a lifespan understanding, bringing together child development, nutrition, and relational feeding dynamics, with a trauma-informed lens and with cultural humility.
Rowell has co-authored articles including, Self-Determination Theory as a Theoretical Framework for Responsive Approach to Child Feeding(JNEB 2020), and a recently released White Paper on Responsive Feeding Therapy: Values and Practice. With Grace Wong, RD, CEDRD-S, she co-wrote articles on Responsive treatment approaches to ARFID for NEDIC (National Eating Disorder Information Centre) and provided clinical supervision to RDs. Her books include: Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorders, Conquer Picky Eating for Teens and Adults