Picky Eating in Toddlers with Melanie Potock

00:00Happy Thursday. Welcome to Instagram Live. As we mentioned yesterday, Melanie Potock and I

00:07are going live today talking about picky eating in toddlers. Melanie is a pediatric feeding

00:14therapist, an author, and a speaker. We're going to be diving deep into... Hello!

00:37Hello, my friend. How are you doing? Good to see you again.

00:40Thank you. Thank you. Thanks for doing this today. You know it's my favorite topic.

00:44So the favorite topic, it's a big topic. So as we did a brief introduction to what our live is going to be today, we're going to be talking about toddlers and picky eating, which is as a pediatric dietitian, that is probably the number one thing I get consulted about.

01:00but something that's important for families to realize is if the child continues to be quote

01:06unquote picky eating there are probably other things going on and today we're going to be

01:10talking about what that looks like and how anxiety plays into feeding behaviors so thank you for

01:16being here do you want to tell our audience a little bit about you you bet that you do happy

01:21to hi to everybody i'm looking forward to everybody popping on i know i'm going to be

01:25recognizing a few of my followers, who I know wanted to be a part of this today as well.

01:31My name is Melanie Potock, and I'm a speech-language pathologist, but I specialize in pediatric

01:37feeding, and most specifically around kids who have trouble eating and have a lot of anxiety

01:44around eating. I have a special interest in the preschool population because I have a preschool

01:49food curriculum that's now in Head Start and in four different countries around the world.

01:55at I particularly love that age because that's when we can really really make a difference as

02:01well as helping kids early on of course who have some motor difficulties sensory difficulties etc

02:08but I know today we're going to be talking about the preschooler yeah and talk to us about common

02:13causes of picky eating so there's statistics anywhere from 30 to 50 percent of parents I

02:19would argue that it's actually much higher than that in the toddler population being picky but

02:24talk to us about what are the common causes in that particular age group sure well one of the

02:32things no matter what the age that we want to consider is the whole child and the way i typically

02:38explain this to the parents that i work with is that i want you to think about three blocks stacked

02:43on top of each other the first block is physiology that's how your body functions that's body and

02:50brain functioning. GI health, sensory processing, anxiety. Gosh, we could list 50 different things.

02:58And then the second stack are motor skills, gross and fine motor skills. And the third stack would

03:04be behavior, learned behaviors. Why kids learn to protect their bodies and stick to just what

03:12they think of as safe foods. So it can be a variety of reasons, but often they're not detected until

03:19the preschool years because that old adage of all kids are picky gets in the way of getting

03:27early intervention yeah and how many of these kids that you've worked with will the adults

03:32their parents caregivers report that they too had similar behaviors when they were that age

03:37you know i think that's pretty common and and that then leads to oh all kids are picky and

03:43a lot of it but also for me as a therapist it makes me wonder about that those parents in their

03:51own food culture and how they were raised around food and how sometimes the child's temperament or

03:57maybe um some of the challenges that they're facing are influenced by the family's relationship

04:03with food so it's it's a very intimate connection yeah and when we talk about temperament with

04:10children as we know every child is so different and temperament often plays a huge role in

04:16everything that they do in life right like I know even when I had my son I'm like this all makes

04:21sense you know the pushback the challenging behaviors that it's just who he is and so he

04:27wasn't going to be one who faded into the background for example so talk to us about

04:31temperament the role of temperament and how that plays into feeding compared to say environmental

04:38Yeah. Well, we're all born with a specific temperament that's unique to us. But then the environment and how our caregivers or parents respond to our temperament begins to influence our personality and the temperament from there.

04:58so it's a it's a it's a very dynamic relationship and I think one of the things to really keep in

05:07mind is that when you have a more hesitant eater although their temperament is a big piece of it

05:15the way we parent that child is also a big piece of it it's nobody's fault it's not the kiddo's

05:21fault it's not the parent's fault it's just that there are a lot of different ways to raise children

05:26And understanding how that unique child adapts and adjusts to the world is so important.

05:37It's why if you go into the local bookstore, there's not just one parenting book, right?

05:43There's probably hundreds of parenting books.

05:46So especially for our more anxious eaters, understanding the role of anxiety and that more extreme picky eating is a big part of this.

05:54Yeah, and something I've noticed working with kids, having my own kids, is often the word sensitive comes up all the time in different areas.

06:04They are sensitive to certain fabrics of clothing, sensitive to sound, very sensitive to texture and aroma, right?

06:11They might feel more overwhelmed than, say, their body.

06:15So it's this big umbrella term of sensitive.

06:18And then, of course, definitely when it comes to feeding and being, air quote, picky.

06:22and picky is such a big umbrella term it really runs the spectrum from that garden variety picky

06:29eating that a lot of kids go through to more extreme picky eating like avoid restrictive

06:34food intake disorder i see that some of our friends in australia have joined us who special

06:39who are particularly interested in our food so it's nice to have them here absolutely and again

06:45there is the comment box so if you have any questions for us please feel free to put them

06:50in there we do welcome all questions comments related to our conversation tell us about

06:58long-term consequences because I often get asked well when will my child outgrow picky eating and

07:05I've seen kids as a dietitian those are the consults I get kids that are older eight or

07:09nine or ten years old who are still very limited in their intake and then of course by that time

07:16you're seeing a lot of behavioral issues and you're seeing a lot of nutrient deficiencies

07:21And that's often when I get consulted.

07:23What have you seen in terms of long-term consequences?

07:26I think the biggest thing for me, because I do have a special interest in ARFID and

07:32avoidant restrictive food intake disorder, is that what goes along with that is this

07:38high, intense level of anxiety for these kids.

07:42And so the longer we wait to help a moderate to highly selective picky eater in the preschool

07:49years to achieve more adventurous eating and find the joy in food, the more likely they

07:56are to develop an anxiety disorder or possibly even ARFID.

08:00And we have very good research by Dr. Nancy Zucker at Duke University, the Center for

08:09Eating Disorders, and she did an excellent study fairly recently where she looked at

08:17moderate to highly selective eaters in preschool. And she reported that those children have a higher

08:24incidence, a higher risk of ADHD, anxiety, and depression. So when we think about identifying

08:34these moderate to highly selective eaters, we're actually thinking about identifying kids who may

08:40have some challenges around mental health. It's really important that we educate our preschool

08:44teachers around that issue yes and they're often intricately linked so if they are having these

08:50nutrient deficiencies because of their poor intake and of course they're going to have a lot of

08:56behavioral challenges to sleep issues bowel movements you know we i see a lot of that

09:00constipation and so the digestive health the gut health there's a lot of talk around that so

09:06it is all related but you're right to getting to the heart of the problem often is where it gets

09:11missed easily because again all kids are picky is kind of the attitude but the truth is one out of

09:19four typically developing children will develop a pediatric feeding disorder which is different

09:24than ARFID but still within that same realm in terms of challenges around just finding the joy

09:31in food yes and Melanie can you tell for the audience who don't know what ARFID is or they've

09:37heard of the term, but they can't distinguish between that and typical anxiety disorder.

09:42Can you talk to us about what that is? That's a great question. So there are a variety of

09:49anxiety disorders that I think we often hear about in the media, generalized anxiety disorder,

09:54specific phobia, that sort of thing. And although ARFID is not an anxiety disorder,

10:01of up to 50% of children who have avoidant restrictive food intake disorder have an

10:10anxiety disorder. So the point is anxiety is a big part of this. It's not to say that a child

10:20with ARFID may not have some minor challenges around chewing or some minor GI health issues

10:28because many kids do, is that anxiety is the biggest issue, and it's really the biggest

10:34obstacle. And that is what drives that diagnosis for ARFID as compared to pediatric feeding

10:41difficulties or pediatric feeding disorder. So without having, you know, we need more time to

10:46really get into the differences, but that's kind of it. Yeah, that's helpful. And, you know, I hear

10:51from families all the time, well, I try to do the things that everyone tells me to do. Be calm around

10:57food be patient around food offer variety but it's still not working and so I think this is

11:03where this conversation is really helpful because if it's not a typical picky eater you're right

11:08like you could do all the things you can be well-meaning you can follow all the advice that

11:13you see on social media or an expert but unless that person knows your child well and the dynamics

11:19the personality like you said and if there are any underlying issues then you can give all the

11:25advice, it's just not going to be helpful. Yeah. When those practical suggestions that we all

11:31hear from books and social media and blogs don't seem to be working, then probably seeking out a

11:40pediatric feeding evaluation would be really helpful because then we can take a look at the

11:45unique aspects of that child's temperament and also their relationship with the family around

11:52food and then we can determine is this perhaps a pediatric feeding disorder or ARFID or is it just

12:00that we need to tweak a few things and we'll be on our way to more adventurous eating. Nothing

12:05wrong with getting an evaluation because at the very least you'll get a bunch of really great tips

12:09specific for your child. Now at what point would you encourage families to seek out support? Not

12:16only when those practical tips that we all learn on social media, on your page and my page, that

12:23if those aren't working, but the bigger issue is that it's really stressing you out. It's stressing

12:30you out as a parent, stressing out your kid and your family. So I always tell the families that

12:35I work with, if you feel like you need additional support, the one thing you can tell your

12:40pediatrician who cares about your kid is you're stressed that you're stressed right like stress

12:47it to them i can't say the word stress enough and that's something they'll really really listen to

12:53and they'll help you find the right support and if you're having trouble with that you can dm one of

12:58us and you know we'll try to guide you in the right direction to make sure that you do get the

13:03support you need and that's why i'm all about that just interdisciplinary approach because often

13:08people approach me and say well can you just work with this child and yes as a dietitian

13:13I like to work in conjunction with say oftentimes the child does need a feeding therapist

13:18and so we would work together rather than me trying to address something that

13:22may be underlying and it makes sense for two people to work together so that's something I

13:27always encourage families if it's a feeding issue that's something that needs to be addressed and

13:33then of course I'm happy to work with them too and come up with ways we can introduce food either

13:37back into the diet or new foods as they go along so I love collaborating I love learning from you

13:44and really the value of feeding therapy is so huge because of course the younger we can address these

13:51issues our goal is happy healthy adults and so there are a lot of adults that'll say you know

13:56I wish I had that same support when I was younger but it's also really never too late and so we want

14:02families to know that we're here, we're happy to support, we can always, you know, direct you to

14:07other resources that are helpful. What are some of those resources, Melanie, that parents can go to

14:13for help? Well, gosh, I hope they'll follow me on Instagram. So click that follow button, but also

14:19on my website, and you'll find that link to my website on the Instagram. I have tons of free

14:24downloads. I have some on-demand courses. I have my books. I have six different books. I

14:30have so many free resources, especially on my YouTube channel. So follow me on Instagram and

14:39that'll get you started. Just click the links from there. Thanks for asking. I appreciate that.

14:43And that's how I found you. So a little bit about me for our new audience. I'm Argavon. I'm a

14:49pediatric dietitian and I work with families on all sorts of issues related to nutrition. And then

14:56on top of that i have a podcast baby steps nutrition podcast found on all popular listening

15:01platforms and i had the honor of having melanie on just two episodes ago episode 139 and we did

15:09focus on teens and anxiety but this is just such a big topic you know because feeding as we know

15:14there's a huge psychological component so we can't talk about feeding without talking about feelings

15:19and emotions and environment and temperament absolutely and the relationship between the

15:25child and the caregiver because feeding your child is a big deal yes it's about love and nurturing

15:32and responsibility and it feels good to see a kid around food so we want to make sure that every

15:39family gets to experience that feeling absolutely so feel free to reach out to either of us both of

15:44us and we're happy to help guide direct whatever it is that your family needs melanie i love asking

15:51this question, any sort of last words of advice, wisdom, life's philosophy, what does that free

15:57you? You know, I think whether you're a feeding therapist or a dietician or a parent,

16:05for whatever reason you're tuning in today, just keep in mind that the ultimate goal is to find

16:12the joy in food. And it's not about taking three more bites. It's not about eating all your

16:18vegetables. And I wrote a book all about eating vegetables. I love vegetables, but it really is

16:25about enjoying our time together around the table. And, uh, at family meal times, the least

16:34important thing is the meal. The most important thing is the family. So focus on family and focus

16:39on the fun. And I would say thanks for following both of us for more tips. Yep. And I couldn't

16:46love that more so as a dietitian I'm all about food is pleasure because often we get a bad rep

16:51where food is medicine yes but I really want to bring back joy and pleasure around eating and

16:57food and enjoyment and and slowing down I know we all need that in this crazy daily grind

17:03hustle of a culture that we live in but food is everything and so hopefully we can start bringing

17:09that back just like our ancestors did so slowing down enjoying life and enjoying each other's

17:15company I love that thank you so much Melanie for being here thank you to all of you again do reach

17:22out follow us we're here to help and hopefully more Instagram lives in the future a lot of great

17:27topics I know we can top cover for our audience let's do it that sounds great thank you so much

17:34Melanie and happy Thursday the week has flown by and we'll be in touch and thank you to all of you

17:40have a good rest of your week bye everybody bye