1. When is picky eating MORE than picky eating. I explain when picky eating should be seen by a feeding therapist and the benefits of seeing one.

2. Preparation tips for a 2.5 year old to attend preschool

00;05;21;20 – 00;05;32;03

Dr. Mona

Welcome to Monday Mornings with Doctor Mona, where each week I answer your questions. Let’s get to our first caller.

 

00;05;32;06 – 00;06;01;06

Mom

Hi, doctor. Mona, I was wondering if you could ever talk about, food therapy and trying to figure out if your kid is just a picky eater or has a texture problem, or if it’s something more serious, like a tongue tie, or, if it has something to do with gag reflexes. Because right now we’re trying to figure out with our kid what’s going on, and they don’t think he has a tongue tie, but, he doesn’t want to eat, and he gags a lot with textures, so I don’t know if it’s just a texture problem or a tongue issue.

 

00;06;01;08 – 00;06;02;11

Mom

Thank you.

 

00;06;02;14 – 00;06;28;04

Dr. Mona

This is a great question, and I think it’s a really important one to differentiate. To me, picky eating involves so many components, but can be under two major categories. Is it more of a behavioral boundary situation or is it more of a mechanical texture sensory situation. So one is developmental and one is behavioral. This is a huge difference in behavioral.

 

00;06;28;04 – 00;06;48;00

Dr. Mona

This has to do with preferences. You know we all have preferences. And to combat this we introduce safe foods. With every meal we reduce pressure. At meal times we have a routine a schedule. We stop rewarding eating so we don’t label foods as good or bad. You know, you eat your broccoli, you get dessert, you just present the food all together and the child decides if they eat.

 

00;06;48;02 – 00;07;12;02

Dr. Mona

You know, the mantra is you decide when and what, and they decide if and how much. So that has to do with more of the behavioral component. But I’ll do more about picky eating in the future. The other is development. And this is huge and very important. So we have behavior and development. They’re both interchangeable. But in development I oftentimes have parents who come in who have been doing all the behavioral adjustments right.

 

00;07;12;02 – 00;07;39;13

Dr. Mona

They are doing all the routine and, offering safe foods and nothing is really changing. So it’s important that we also evaluate the developmental aspect. Sensory aspect. Can they swallow? Can they eat? How is the function in their mouth or is it that they’re just choosing not to eat? Let’s do an example. I had a situation where a child would not eat what mom gave at meals, but would eat Cheetos, cookies, etc. snack foods.

 

00;07;39;15 – 00;08;04;00

Dr. Mona

So in this situation, I knew that the child can chew and swallow. They can do various textures, right? I mean, you have cookies, you have Cheetos, they could do yogurts, they could do many different things. But we needed to work on boundaries at meal times and snack times in the routine, the behavioral aspect of eating. On the other hand, I had an 18 month old new patient, so I had never seen them before who was only eating purees.

 

00;08;04;03 – 00;08;29;01

Dr. Mona

You know, mom tried advancing and just said that the child gags uncontrollably. And this was concerning to me because the child’s 18 months, one year, I want a child to be having more than just puree. Gagging is normal and we’re starting off solid. So just so you do baby led weaning at six six and a half months, or if you do puree and then transition to more textured foods around eight and nine months, you can see some gagging happening when they’re doing textures.

 

00;08;29;04 – 00;08;46;02

Dr. Mona

But at 18 months, if they’re still gagging, there’s one of two things happening here for me. Is it that we waited too long to start more textured foods and the child is just not tolerating it, you know, so kind of what we’re seeing, what we’re we should be seeing early on when we start more texture foods. But we’re seeing it for an 18 month old.

 

00;08;46;04 – 00;09;02;04

Dr. Mona

So if you can imagine that the child has had almost a year right from the time we would have started more textured foods, let’s just say six and a half, seven months. If you do baby weaning to 18 months, one year of eating food and only eating puree, it’s going to be hard to teach them new tricks, right?

 

00;09;02;06 – 00;09;23;04

Dr. Mona

To teach them how to eat more textured foods. So is it that we waited too long, or is it that the child has a mechanical developmental issue making it hard to tolerate textures? Do they need a swallowing evaluation? Can they swallow? Can they chew? Eating is so much more than just putting food in your mouth. It’s how do you get that food from your tongue to the back of your throat?

 

00;09;23;04 – 00;09;59;10

Dr. Mona

So it’s important to differentiate. Is it development or is it behavioral? Now tongue ties can go into that mechanical developmental category. But before releasing a tongue tie I think it’s important to get a specialist evaluation. And in this case for feeding it’s getting a feeding therapist evaluation. Why is that? I do think that many people are quick to release tongue ties, lip ties without doing the full evaluation from a specialist example would be if you have an issue with breast feeding, you would talk to a lactation consultant, see if you can maximize techniques, and halt if you have an issue with speech and a tongue tie, you would talk to a speech therapist.

 

00;09;59;15 – 00;10;22;15

Dr. Mona

Maximize all the therapies with speech before saying that it’s the tongue tie. Same thing goes with feeding therapy. If we are concerned of that texture issue, that mechanical developmental issue, a lot of gagging issues with that. I think it’s great to see a feeding therapist if you know your child can swallow everything, chew everything right, you know that they can eat certain foods and different textures and all that.

 

00;10;22;18 – 00;10;42;14

Dr. Mona

You don’t necessarily need a feeding therapist, but hey, can I be honest? It’s not going to hurt either way, because if anything, the feeding therapist is going to guide you with picky eating. The feeding therapist can guide you with mechanical issues and evaluate for that. My personal recommendation is if a child is not tolerating textures besides purees by one year, I would want a evaluation.

 

00;10;42;14 – 00;11;07;10

Dr. Mona

I am very, very conservative about this, right? The reason is, is I look at feeding as a milestone. Then like we talk about rolling, like we talk about speaking, and we can miss a big opportunity for introducing food and also creating food aversions. I talk about the 18 month old that child had a food aversion, meaning they never got introduced it, you know, they were only eating puree and it ended up being a food aversion.

 

00;11;07;10 – 00;11;25;11

Dr. Mona

And that’s something a feeding therapist can help with. So I think it’s important to remember this. I also think that feeding is a source of a lot of stress for families, and a feeding therapist can help this process. If a child is not advancing textures after one year. I think, you know, a lot of times parents are like concerned.

 

00;11;25;11 – 00;11;48;05

Dr. Mona

Well, should I see one? Do I need to see one? If you’re even asking yourself a question and you’re concerned it is not going to hurt, it will never hurt to get a second opinion. It will never hurt to get educated. It will never hurt for a specialist to look at your child more is my opinion. Now. If they see something that’s outlandish and you’re like, I don’t agree with that, always speak to your child’s clinician because they do know you from, you know, the time that your child was born.

 

00;11;48;12 – 00;11;58;01

Dr. Mona

But this is my advice because I don’t want us to miss an opportunity. If a parent is concerned, let’s get to our next caller.

 

00;11;58;03 – 00;12;21;15

Mom

Hi, doctor. Mona, I really appreciate everything you post. I learned so much. Thank you so much. I have a daughter. She’s two and a half years old. And, actually, I just have a two month sort of school next week. No, actually, she’s been taking care of, either me or my husband or a grandma.

 

00;12;21;15 – 00;12;43;26

Mom

So, this is the first time, someone else is going to take care of me, so. Yeah, on the first service, I need your tips. How to, like, keep her calm, how to get you ready to ready for school, without throwing, like, you know, like, just to give her more, like, confidence how to pull recess changes.

 

00;12;43;28 – 00;12;49;21

Mom

Please give me all the tips you have, like, thank you so much. Bye.

 

00;12;49;24 – 00;13;06;19

Dr. Mona

Congratulations on your child’s starting school. I think school is such a great thing. Especially after two years. You know, I like it after 18 months, but two years and up, it’s a great time for children to be around other children and learn from teachers and learn from their peers. So congratulations. This is going to be a great step.

 

00;13;06;21 – 00;13;23;14

Dr. Mona

Now remember that everything new is scary. Anything that we do, any time of our life, it’s going to be scary and different and new. And it’s not always going to be fun to start out with, but it’s not harmful. What we’re doing here right? You are sending your child to school. This is something very good for her.

 

00;13;23;16 – 00;13;41;03

Dr. Mona

I think we often get worried that our kids are upset with a new situation when if we look at the actual situation we’re putting them through, it’s not harmful. It’s not going to hurt them. It’s actually going to benefit them. So we want to stay patient with it when it’s something obviously for their own benefit, but also understand that they may take some time to adjust.

 

00;13;41;05 – 00;14;01;02

Dr. Mona

So a few things when we’re preparing our children for new experiences, it involves a few main principles. One is prep if they are older than two. I think this is important from a developmental standpoint. You can do it younger too, but definitely after to the child brain changes and we want to prepare them as much as we can with some reasonable expectations.

 

00;14;01;04 – 00;14;20;20

Dr. Mona

Number two is patience and understanding that every child is different and how they warm up to new situations. Number three is consistency. And number four is persistence with some flexibility. Of course. And I’ll get into all these in terms of prep, here are some tips I want you to try to build a similar routine in your day at home.

 

00;14;20;20 – 00;14;39;08

Dr. Mona

You can wake up at the similar time that you would for drop off. You can practice getting ready. You can set up a player in your home if you’re able to. You can even go visit the school. I don’t know if they’ll allow that, but you can just go drive to the school, visit. It just do even like a ten minute session just to walk around the school and see it when you’re home.

 

00;14;39;08 – 00;14;56;15

Dr. Mona

Lunchtime around the same time, nap time around the same time. Try as much as possible, but don’t worry if it’s not feasible with your schedule. This is just a suggestion. If your child is a little more slow to warm with this type of, new situations, if you go visit the school, obviously you have to clear this because we still are in the pandemic at the time of this recording.

 

00;14;56;17 – 00;15;17;23

Dr. Mona

But another option is starting with half day. So just say your eventual plan is to do five full days. Maybe start with doing three half days. See how that goes. After that, you can go up to four or half days, five half days and then finally go to full days. You can do this slow transition. I sometimes find that this can really help some toddlers, so it’s really up to what works for your your child.

 

00;15;17;26 – 00;15;39;06

Dr. Mona

Remember, every child is different. Some kids will have no issue adjusting, some will take a little more time and all of it is normal. So just be patient with yourself. The other big thing is be consistent with the drop off and pick up right? You can discuss the routine with her, but stick to it. So if you say, you know, mommy’s going to drop you off and then I’m going to go, you don’t want to promise something you’re not going to do.

 

00;15;39;06 – 00;15;56;08

Dr. Mona

So if you say, I’m going to leave and then you linger around for 20 or 30 minutes, it’s not, you know, falling through. You want to be very consistent. And you also don’t want to linger. You don’t want to make the goodbyes drawn out. People think that that’s going to help them, but it actually doesn’t because you want to make it that this is our routine, this is what we’re doing.

 

00;15;56;12 – 00;16;12;27

Dr. Mona

I’m going to leave, but I’m going to come back. Remember, separation anxiety is healthy. It’s normal. But we want to be very firm. We don’t want to sneak out. We want them to see us leave and also understand that we’re going to come back. The other really big thing is be very aware of your body language and how you are feeling.

 

00;16;12;27 – 00;16;34;17

Dr. Mona

I will always say this like a broken record, but children are extremely empathetic. They feel our energy without us speaking, especially if you’re a mom. There is some uncanny ability for a child to feel super connected to their mother in terms of understanding how she’s feeling and even just by looking at you. So if you’re tense, they can sense it.

 

00;16;34;19 – 00;16;54;25

Dr. Mona

And I kind of explain it like a snowball effect, right? They’re already nervous. They feel your nerves, and it just adds to that snowball. And that snowball builds and builds and builds so they’re nervous. It’s okay for them to be nervous. It’s okay for you to be nervous, but it’s really trying hard to tell yourself, hey, this is normal for her, for me, for all of us, and we are going to get through it.

 

00;16;55;00 – 00;17;17;01

Dr. Mona

And I’m going to try my hardest to control how I’m laying off my energy in front of my daughter. It doesn’t mean that you have to be fake or, you know, always strong, but it’s really about those drop off and pick up moments. I love you, I see this is really hard. An example that I do is that my son Ryan was not a fan of some class, and I have to drop him into the pool with the instructor and walk away.

 

00;17;17;08 – 00;17;37;10

Dr. Mona

He cried and cried and cried. I didn’t linger, I didn’t say anything different. I said, I love you, Ryaan. You’re doing amazing. And I walked away. Of course, it didn’t make me feel good that he’s crying, but he adapts. They adapt and they’ll adapt more quicker if we are patient with them. And also don’t linger. Remember, patience is key.

 

00;17;37;10 – 00;17;55;13

Dr. Mona

Every child is different in how they warm up. Talk to the school about what they’re seeing, if there are any concerns. Consistency is also very important. So a similar routine if we can do it right, you’re dropping off picking up around the same time. Try. It may not always happen with our work schedule and that’s perfectly fine. We try our best.

 

00;17;55;15 – 00;18;11;02

Dr. Mona

Persistence has to do with I don’t want you to stop sending them to school because you don’t like how they’re feeling and you think that that’s a bad thing, right? We want them to be understanding that this is our new routine and we’re going to get through it. So don’t stop sending them. It’s important to be aware of their feelings and verbalize.

 

00;18;11;02 – 00;18;27;22

Dr. Mona

I see that you’re upset and we’re going to try again tomorrow. I see that you’re happy to see me. I’m so happy to see you. What do you want for dinner? Give them two choices. I see that you’re sad. I see that you’re angry. It’s okay to be sad. And mommy or daddy or grandma, whoever’s picking them up, we’ll see you after naptime.

 

00;18;27;24 – 00;18;47;08

Dr. Mona

Remember to explain to them time is after an activity and not a time frame. Right? So don’t say I’ll be back at 4:00. Say I’ll be back after naptime. I’ll be back after story time or whatever. You can label because kids don’t understand time. My biggest tip is check your emotions. As a toddler. Mom, I know this firsthand.

 

00;18;47;08 – 00;19;06;22

Dr. Mona

I know how much my emotions and my well-being and how what I’m bringing off is affecting Ryaan. If he gets upset, he’s entitled to be upset because we all have emotions. But if I’m upset too, it adds fuel to the fire or adds snow to that snowball. Any other follow up questions? Let me know. I would love to hear how she’s doing.

 

00;19;06;22 – 00;19;23;02

Dr. Mona

So if you want, you can call me again. Thank you for tuning in today. If you find this series helpful or any of my content helpful, please make sure to share it on your social media channel because that is how other people can find this resource. So thank you so much for joining us and I will talk to you next week.