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These simple cookies come together very quickly and only require a few pantry staples – and use up those spotty bananas! This is a very kid-friendly recipe, so it is okay if the measurements aren’t exact. These cookies also count as both a fruit and a starch. Also, since there are no raw eggs, it is safe for kids to taste as you bake! Make sure you try out the Food Scientist Tips at the bottom!
Makes approximately 20 cookies
Food Scientist Tip #1: Try using different mix-ins or a combination of mix-ins. Other fun ideas might include M&M’s, white chocolate chips, or peanut butter chips. You could also try stirring in a spoonful or two of peanut butter, chocolate peanut butter, or other nut butter for some extra protein! Choose something familiar and preferred to help these new cookies work better for you!
Food Scientist Tip #2: Add 1-2 scoops of Collagen Protein Powder (we love Great Lakes and Vital Proteins) for some extra protein without changing the taste at all! Then these cookies have a protein (protein powder), a starch (oats) and fruit (bananas and applesauce) in them – a complete meal! Just make sure to pair it with something else since it is boring to only eat one food at a meal or snack! 🙂
Food Scientist Tip #3: Do these cookies work better for your body when they are cooked or do you like the dough better? Experiment with making different shapes of cookies to change the texture (big, thick cookies or thin, flat cookies).
Food Scientist Tip #4: Experiment with different flavors of applesauce – maybe try cinnamon applesauce, berry applesauce, or maybe even canned pumpkin! Which works the best for your body?
Recipe adapted from Blue Zones
Many families are being faced with their children having to stay home from school for the next few weeks because of the Coronavirus. Forced time at home can raise everyone’s stress, but even more so if your family is living with a Picky Eater or a Problem Feeder.
In our house, we made green pancakes (put our regular pancake ingredients into a blender, then added a handful of spinach – fresh or frozen, and blended) and a green smoothie.
Here are some other fun ideas you might try (today, or any day!):
We encourage you to find ways for your child to be involved in food preparation as much as possible and to find ways to make it fun. We will keep sharing ideas here, so check back often! You can also join us at a membership level for even more ideas and support.
Written by Dr. Kay Toomey
ARFID is a diagnosis that the American Psychiatric Association created in 2013 to replace the old DSM IV-TR diagnosis referred to as Feeding Disorder of Infancy and Early Childhood. A number of studies indicated that the prevalence of the DSM IV-TR’s Feeding Disorder diagnosis was only about 3-12% of the population of children with feeding challenges (Burklow et.al., 1998; Rommel et.al., 2003; Field et.al., 2003; Williams et.al., 2009). This low prevalence was due in part to a number of exclusions in the Feeding Disorder of Infancy and Early Childhood diagnosis. To receive this diagnosis, a child needed to be under 6 years of age, they had to have weight loss or failure to gain weight for at least one month, and they could not have a medical or mental health disorder that would account for the child’s feeding problem. It is also very important to note that the DSM IV-TR diagnosis was classified under the developmental disorders section of the DSM (Diagnostics and Statistics Manual). We will come back to this point in just a minute.
Due to low usage, the ARFID diagnosis was created to capture a larger group of children. The age criteria was eliminated, as was the requirement for weight loss or failure to gain weight. Now, any child who is not meeting their nutrition or energy needs can qualify for ARFID as long as one of 4 issues is present: significant nutritional deficiency; dependence on enteral feeding or oral supplements; marked psychosocial issues; or weight loss/growth faltering. In addition, if there is a medical or mental health issue present, the child’s feeding difficulty had to be worse than the average feeding problem seen in children with that same medical or mental health issue. The other major change that was made was that this diagnosis was moved out of the Developmental Disorders of Childhood section of the DSM and moved into the Psychiatric Disorders Diagnoses section of the DSM; specifically into the Eating Disorders section.
#1 – The shift out of developmental disorders into psychiatric disorders has now psychopathologized feeding difficulties from being a medical/developmental/skill acquisition set of problem to being a mental health disorder (Kirkey, S., 2012. Picky eaters could join ranks of mentally ill. Canada National Post. 1-6.). The world’s leading feeding experts disagree with the American Psychiatric Association’s classification of feeding problems as mental health disturbances. This disagreement was part of the impetus for these experts, with Feeding Matters’s help, to create the new Pediatric Feeding Disorder diagnosis. Dr. Toomey says that it is important for professionals to understand “Feeding problems are not all in children’s heads. It’s all in their bodies”. When children don’t eat, it is because something about their body is not working correctly (Dr. Kay Toomey).
#2 – Because ARFID now is considered an Eating Disorder, any professional who is not an expert in Eating Disorders should NOT be assigning an ARFID diagnosis. For a professional to assign an ARFID diagnosis, they should be a physician, psychiatrist, psychiatric nurse, psychologist or another mental health professional who is allowed to give psychiatric diagnoses. In addition, these professionals should be trained enough to also be comfortable assigning an Anorexia Nervosa diagnosis or Bulimia Nervosa diagnosis in order to be qualified to give an ARFID diagnosis. Many professionals do not realize that they now need a different set of qualifications in order to ethically be able to give an ARFID diagnosis and to not step outside of their scope of practice. Additionally, this move of feeding problems into Eating Disorders excludes most Rehabilitation Professionals (such as Speech Pathologists) from giving this diagnosis to their patients.
#3 – The ARFID diagnosis is now so inclusive that almost any child who is power struggling with their parents about food could qualify for this mental health disorder. This overly broad diagnosis occurs, in part, because there is no clear definition of what is “marked interference with psychosocial functioning”. Does this mean the parent doesn’t like how their child eats or what their child eats? Does this mean the child’s eating is bothersome enough that the parent is asking for help from a professional? Does this mean that the child doesn’t like eating in the school cafeteria, but can do it? Or, does this mean that the child is eating by themselves in their bedroom and that they eat none of the same foods as their family members? Having a diagnosis that is this broad is not helpful to us as professionals or parents, in understanding what is happening with our child/clients/patients.
#4 – The last issue I have with the ARFID diagnosis is with the exclusionary criteria because a) most professionals assigning ARFID are not considering the exclusions; b) there is disagreement in the field whether feeding skills deficits should be part of the exclusionary criteria (Dr. Toomey believes they should be); and c) because to be diagnosed with ARFID in the presence of another medical or mental health issue, your feeding problem has to be worse than the average child with that same exact medical or mental health problem. This latter piece of the exclusionary criteria is the biggest problem with ARFID because we do not have in the field enough data to say what the AVERAGE feeding problem is for children with medical and mental health diagnoses. For example, we cannot say what an average feeding problem is for a child with Cystic Fibrosis or Down Syndrome or Gastroesophageal Reflux is. We don’t know what the average feeding problem is with a child with oral-motor problems or Sensory Processing Disorder or an anxiety disorder. While we have some good ideas about what types of feeding problems children with these issues have, we do not have the data to say what the AVERAGE feeding issue is clearly enough to then say that X child’s feeding issues are bad enough to qualify them for ARFID.
Minimize and limit changes. Limit the number of Valentine’s Day parties and events that they will attend, based on your child’s age.
Prepare your child in advance
Feed your child BEFORE the event
Limit the Sweets
A common concern parents of Picky Eaters or Problem Feeders share is that it can be hard to expose your child to new foods, especially if they aren’t able to eat meals at the same time with the family or if they are reluctant to even being in the same room with you if you are eating something different. While we have many strategies and tips for helping kids learn to enjoy learning about new foods, a common first place to start is just getting the child into the kitchen with you while you are preparing foods. Here are a few simple ideas that you can start incorporating tonight!
SOS Professor, Bethany Kortsha, OTR was interviewed by RX Nutrition about feeding problems in children on the Autism Spectrum and how to help (published January 24, 2020). You can read the article here.Â
Bethany also had a presentation in the International Pediatric Feeding Disorder Conference, hosted by Feeding Matters. Her presentation was titled Pediatric Feeding Disorder and Autism: It’s About More than Compliance. The course is available until February 24, 2020.
Have you ever wondered what feeding therapy using the SOS Approach to Feeding looks like? Take a peek at some of our sessions this week. There seemed to be a ‘snowman’ theme, but each session was individualized and totally different depending on the child’s interests, comfort with different foods, and their goals.
This child was working at the lower steps on the Steps to Eating, especially with fruits and vegetables. As we built the snowman, we learned about each of the circles (Cutie orange, prune, and cucumber) and had to do some cutting. We explored how it smelled and felt, and sometimes used a mini cocktail fork to move the extra squishy pieces, since those are the most difficult for this child. This allowed a child who typically can’t stay at the table during meals with his family to not only create this snowman, but have fun while doing it!
To round out the foods we learned about, we explored crunchy chickpeas (a great, crunchy protein that is easier to chew than meat) and used them to make the snowman’s face and crushed them into powder to make it ‘snow’ on him. Cinnamon sugar pumpkin seeds added another new protein (which worked great for him – he ended up holding them in his mouth to ‘blow’ into the clean up bowl!). We broke apart his favorite pancakes to make arms and a hat, and then used our carrot stick like a snowplow to clear everything before moving on to our drink and clean up!
This friend was a little older and was eager to build on the “same but different” theme we have been using to help her anticipate what we will be working on in Food School. Earlier we had made a face to ‘decorate’ her rice cake, using several foods that she already eats, but doesn’t eat combined. During the session, we were talking about other foods she prefers ‘plain’, and decided to ‘decorate’ a pizza in a similar way.
She helped her mom pick out the groceries she needed for her special pizza, including pizza dough, three different sauces (tomato, alfredo, and pesto), olives, pepperoni, mini bell peppers, and mushrooms. Best of all, a few of these foods were totally new to her, and the familiar foods are usually eaten separately (and not touching!).
She decided to make her snowman look like her, and rolled her dough into a circle to make the face. She then used the ‘white food glue’ (alfredo sauce) to hold all of the toppings on. Olives required some cutting, but made great ‘rocks’ for the eyes and mouth, and half of a mini bell pepper made a great carrot nose. She used kitchen scissors to cut the pepperoni into ‘hair’ so that it looked like her, then added cheese ‘snow’. It was just about perfect, but she realized the snowman was missing freckles! Her mom remembered that they had picked out mushrooms at the store, but mushrooms were a hard food to think about adding to pizza! In the end, we used a mini food chopper to finely chop one mushroom, then it was gently sprinkled on top, and then the snowman was ready for the oven!
As perfect as it looked going into the oven, the pizza dough rose more than we expected, so when it came out, it looked pretty different. Not knowing what to expect can be tricky, so it took some learning about the cooked pizza. Excitedly, the snowman pizza (complete with mushroom freckles) worked for this “plain cheese pizza girl!”
Another food school friend was working on feeling comfortable tasting new foods by blowing “rockets”, and this snowman (made from an empty coffee canister) made the perfect target. He also needed to work on his oral motor skills, so practicing getting food out of his mouth was important for both his confidence and safety. Children who are able to blow or spit food out of their mouths are less likely to gag or choke on food, and it is also important for other life skills, like tooth brushing.
This boy was excited to have a new target, and blow “snowballs” at the snowman. Since we were working on blowing, most of our foods were small, ball-shaped foods like frozen peas and blueberries (perfect for this snowy theme!), Love Grown Power O’s (cereal made from beans), American cheese rolled into small balls, and a protein bar cut into small pieces.
We started out with the target close to us, and practiced dropping the pieces of food out of our mouth, letting gravity do most of the work, then progressed to taking a big breath and making a ‘pooh’ sound as we exhaled to make our rocket shoot farther and farther. This guy was disappointed when it was time to clean up, and his parents were thrilled at the variety of foods that he was so excitedly putting into his mouth!
My last friend was also working on making pizza using a “same but different” theme. He also only really eats pepperoni pizza from a few takeout restaurants, so his family was excited about the idea of making homemade pizzas.
Figuring out how to roll out the pizza dough was tricky, but with some teamwork, we made it work! While we learned about the variety of sauces, toppings, and types of cheese to put on the pizza, he happily added them to his snowman creation. He eagerly added both pesto and pizza sauce to his dough, then topped it with a little bit of cheese and used pepperoni for the eyes and mouth.
While he loves ham sandwiches, he doesn’t typically eat ham another way, but today we had some ham and chopped it up with food scissors to make hair for his pizza snowman. He also chose to use a mini bell pepper to make a ‘carrot’ nose, then his pizza was off to the oven.
After a quick break to re-regulate from touching and interacting with all of those wet foods, his pizza was out of the oven and cool enough to learn about.
He proudly carried his pizza to the table (in his bare hands, without the pan) to set on the table, then proceeded to immediately ask for help cutting his pizza so he could eat it! His mother and I asked if we could have a piece to learn about as well, and he said “Okay, but only a little… This is going to be my dinner!”.
A message from his mom, later on, revealed that he did, in fact, eat several more pieces of his pizza for dinner that night.
There is a new multidisciplinary feeding group at the Wichita State University Speech-Language-Hearing (SLH) Clinic using the SOS Approach to Feeding therapy. You can read the article about this program below.
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Make sure you have a regular-sized kitchen table and supportive chairs versus sitting at a breakfast bar, a tall top table, or on a bench. WHY? In the body’s list of priorities, not falling on your head (Postural Stability) is priority #2. In case you were curious, priority #1 is breathing. Eating is the body’s priority #3. Bar stools and benches do not provide children with good enough side and foot support. A supportive chair is one that puts your child’s hips, knees and ankles each at a 90 degree angle. To do this correctly, the chair should have:
Postural stability is what allows our trunk to be stable while other parts of our body move to do a motor task. Related to mealtimes, we need to be able to have enough endurance and strength to maintain a stable seated position for the entire duration of the meal.
Make one big meal for the family that includes everyone’s foods, and serve everything family style. Family style serving means that everyone takes at least one piece of every food served at the meal, puts it on their plate, and passes the serving dish to the next person at the table.
For example, you may be having spaghetti and meatballs, salad, and garlic bread as the main meal. However, your child will only eat the garlic bread. In order to give them good nutrition, you may also need to make chicken nuggets and offer thin carrot sticks (the rest of the carrots can be chopped up into the salad). All of the foods will be passed family-style, so there is no differentiation between the ‘kid’ food and the ‘adult’ food.
Your child may not eat some of the family’s foods at first, and that is okay. The goal is for your child to start learning about the other foods. Learning to eat new foods begins with being able to tolerate looking at and smelling the food in front of you. Then, the child needs to learn about how the food feels by touching it with a utensil or their fingers. It is only after being okay with looking at, smelling, and touching the food, that they will be able to learn about tasting the new food.
A food jag is when your child wants to eat the same exact food, prepared the same exact way, over and over again. The problem with food jags is that your child will eventually get sick and tired of that food. Once children start “burning out” on foods, their food range gets smaller and smaller. This is how children eventually end up with only 10 foods that they will eat.
To avoid food jags, a child is allowed to have their perfect version of a food only every other day. If you give them a food today, they can’t have it again today and not tomorrow either. They can only have it again the day after tomorrow. Milk and milk alternatives are the only exceptions to this rule. However, some children do burn out on milk, so we advise offering either water or juice at one meal a day.
Apples and pears are plentiful and in season right now, and there are so many fun ways to play and learn about them!
In my role as a Pediatric Psychologist, Pediatric Feeding Specialist and Developer of the SOS Approach to Feeding, I have heard this “myth” being reported frequently by well-meaning professionals trying to convince parents that they do not need to be worried about their child’s eating habits. However, it is not true that all children are picky. Nor is it true that they will all outgrow it. The research in the field of Feeding Disorders actually shows that on average, only 20-30% of children will struggle with some type of feeding challenge or picky eating at some point within their first 5-6 years of life. In addition, the data indicates only about one-third to one-half of these children will actually just “outgrow” their feeding difficulties without some type of intervention (see the summary of the major research studies summaries). When you look at the statistics over time, about 50% of children with picky eating challenges continue to struggle with not eating a wide enough range of foods well into their grade school years and beyond.
It is also interesting to note that these statistics are the same regardless of the child’s country of origin, culture and/or parenting practices. I have been privileged to teach the SOS Approach to Feeding program both nationally and internationally and can attest to seeing the same types of feeding issues occurring in children across the entire world. I believe that we find similar feeding/eating challenges around the world, regardless of what culture a child lives in because feeding difficulties are about how the human body does or does not work correctly. My 30 years of clinical experience in assessing and treating Feeding Disorders has taught me that feeding problems are not all in children’s heads. It’s all in their bodies. When a child doesn’t eat, we need to look for the skill deficits, developmental challenges and physical problems underlying this child’s difficulty with eating or feeding well. We should not be blaming parents or saying that a child has a behavioral feeding problem.
In the SOS Approach to Feeding program, we assess and address the 7 areas of human functioning that are involved in the process of learning to eat well: organ systems; motor & oral motor abilities; sensory processing; learning history/style/capacity, development, nutrition, and environmental factors. We identify what about this child’s body is not working correctly for them to gain the skills they need to eat a wide variety of nutritious foods in the right volumes to grow well. Then, we teach children and their families, the skills the child needs through “play with a purpose” of moving them up a series of 32 Steps to Eating.
Because of the research which shows that at least half of the children with feeding problems will continue to struggle with being able to eat well, I encourage all families not to wait to seek out help for their child – even if you think it is “just picky eating”. The earlier families can get their child into feeding treatment, the more likely their child’s issues can be fully resolved. Ideally, children will enter into therapy before 3 years of age if they are struggling to eat well.
Additionally, you can search and find an SOS trained feeding therapist in your area to assess your child’s skills and help get back on the road to happy mealtimes.
Join us at a membership level for more support and strategies.
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