Overcoming Anxiety in the Feeding Relationship with Jo Cormack, PhD
- Some of the things parents do unintentionally to pressure their children to eat
- Activities that parents and caregivers can utilize to check themselves as they work with their children to become independent eaters
- What responsive feeding is and how you can use some of the responsive feeding methods or techniques to maintain that responsive approach as baby transitions to solid food.
LISTEN TO THIS EPISODE
PODCAST EPISODE SHOW NOTES
Feeling anxious about starting solids? Although it's pretty common for parents and caretakers to experience feelings of anxiety when facing the transition into solids with their babies, it does not have to be terrifying. In this episode I am joined by Jo Cormack, PhD who is a researcher, child feeding specialist, and award winning author. Jo is here to talk about the psychology of feeding and how parents can overcome their feelings of anxiety while building a feeding relationship with their babies.
SUMMARY OF EPISODE
In this episode I’m interviewing Jo Cormack, PhD who discusses:
Some of the things parents do unintentionally to pressure their children to eat
Activities that parents and caregivers can utilize to check themselves as they work with their children to become independent eaters
What responsive feeding is and how you can use some of the responsive feeding methods or techniques to maintain that responsive approach as baby transitions to solid food.
ABOUT THE GUEST
Jo Cormack, PhD is a researcher and child feeding specialist, an award winning author and creator of an amazing judgment-free feeding community
She is based in England but the impact of the work she is doing about the psychology of feeding and picky eating and pressure in the feeding relationship is resulting in a global impact
Jo has developed her own responsive model called Emotionally Aware Feeding (EAF) which she teaches and uses in her own clinical work which is highly adaptable and is therefore applicable to a wide range of feeding challenges, from developmentally normal 'picky eating' to Avoidant Restrictive Food Intake Disorder (ARFID)
Jo is currently working on a study called Development and Validation of the Feeding Anxiety Measure (FAM) which aims at learning more about the things that parents worry about in relation to feeding their children and they are looking for 1000 parents to join and be a part of this study
LINKS FROM EPISODE
To follow and learn more about Jo Cormack, PhD:
Follow on Instagram @jo.cormack
Join Facebook Group Parenting Picky Eaters
Website for Parents Jo Cormack
Website for Professionals Responsive Feeding Pro
Website for Picky Eating Your Feeding Team
Feeding Legacy Tool
Learn more about EAF (emotionally aware feeding)
Check out her book Helping Children Develop a Positive Relationship with Food: A Practical Guide for Early Years Professionals
Other Baby-Led Weaning Made Easy podcast episodes mentioned in this episode:
Episode 88 “Writing Your Family's Food Story with Chef Julia Nordgren, MD”
Episode 206 “Stay in Your Lane: Parent & Baby Roles in Infant Feeding with Marsha Dunn Klein OTR/L, MEd, FAOTA”
Episode 36 “Preventing Picky Eating from Baby's First Bites with Katja Rowell, MD”
Other references mentioned in the episode:
Byron Katie- The Work
“Self-Determination Theory as a Theoretical Framework for a Responsive Approach to Child Feeding”
Join and participate in Jo Cormack’s research study: Development and Validation of the Feeding Anxiety Measure (FAM) which aims at learning more about the things that parents worry about in relation to feeding their children. CLICK HERE to fill out the survey!
TRANSCRIPT OF EPISODE
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Jo Cormack (1s):
And another one that I see a lot in terms of client work is maybe where breastfeeding has been really difficult or hasn't worked towards how the mother has intended it to, you know, for whatever reason that might be. And then introducing solids becomes kind of fraud.
Katie Ferraro (14s):
Hey, there I'm Katie Ferraro Registered Dietitian college nutrition professor and mom of seven specializing in baby-led weaning here on the baby-led weaning made easy podcast. I help you strip out all of the noise and nonsense about feeding, leaving you with the competence and knowledge you need to give your baby a safe start to solid foods using baby-led weaning. Well, hello, sending a warm welcome to all levels of anxious, worried parents on today's podcast episode. It feels so weird to say that I'm excited about anxiety, but I am literally over the moon about our guest today.
Katie Ferraro (55s):
I don't think I've ever worked harder to get an interview. And I am so excited to announce that we finally have Jo Cormack on the podcast. So we've been trying for two years to get Joe on the podcast. She is a PhD researcher and child feeding specialist. She's an award winning author, creator of an amazing judgment free feeding community. And Jo is based in England, but the impact of the work that she is doing about the psychology of feeding and picky eating and pressure in the feeding relationship, it is certainly having a global impact. And I am so grateful that Jo is here today to talk about Overcoming Anxiety in the Feeding Relationship. Now, in this interview, she's going to get real about what parents and caregivers do.
Katie Ferraro (1m 37s):
It's almost always inadvertent, but we're doing a lot of things. We may not be even aware of. That's pressuring our child to eat. So Joe is going to share some activities that we as parents and caregivers can utilize right now to help check ourselves as we work with our own kids, as they learn to become independent eaters, Joe Cormack is very big in the whole responsive feeding space. So she'll be explaining a little bit about that and how you can use some of her responsive feeding techniques and methods that you've probably been employing during breastfeeding or bottle feeding, but a lot of parents lose sight of as they transition to solid foods and she is not going to let that happen. So tons of great resources shared in this episode, I know I was like scribbling down notes left and right as she was going through these different frameworks and tools and questionnaires.
Katie Ferraro (2m 20s):
So I'm going to link all of Joe's tools, her surveys, our research articles, everything about anxiety in the feeding relationship on the show notes for this episode, which you guys can find at blwpodcast.com slash 2 1 4. But one thing I want to ask you from the outset though, is there's this part of the interview. It's towards the beginning where Jo is explaining this current research study that she's working on with her team about pressure and feeding, and they're recruiting a thousand parents of children aged two to 12 to participate in an answer, a short survey. So I would love, love, love if a ton of you guys could complete Jo's survey and we can help return the love because she is showing us a ton of love by sharing her knowledge, her expertise, and a lot of really valuable information.
Katie Ferraro (3m 7s):
Like this is just a crash course in anxiety management and feeding and an overview of all the research that's been done. I think you guys are going to love it. She spent a ton of time working on the episode in her responses. So if you do have a child age two to 12, could you please, please, please go fill out Jo's survey. It will only take you a minute. And it's linked at blwpodcast.com/214. So with no further ado, I am so excited to introduce Jo Cormack, who was here talking about Overcoming Anxiety in the Feeding Relationship.
Jo Cormack (3m 40s):
Hi Katie. Thank you for having me.
Katie Ferraro (3m 42s):
I'm so excited about this conversation. I feel like I've been trying to put it together forever. So I have a lot of questions to ask you, but before we get into the questions, could you tell us a little bit about the work that you do and what type of population you work with and what inspires you to keep doing the work you're doing?
Jo Cormack (3m 58s):
My background is in therapy as in psychotherapy. So I work with pediatric feeding challenges very much from a relational perspective these days, actually I have more of a supervisory role. So rather than hands-on work with clients, I'm mostly focusing on my academic research and on training professionals. But I have a colleague Dr. Hazel Walston home leads the majority of my clinical cases, I'm there in the background. And we also work with an RD and sometimes when needed, we'll we'll work with OTs as well. So it's a kind of team approach, all tally health. Yeah. I've been doing it for, for a long time now. It's great. I love it.
Katie Ferraro (4m 36s):
And I know you recently completed your PhD, which congratulations on that. That's a huge accomplishment. And we tried to do this interview a number of times that you're like, I have to finish this to that. And that's why I kept harassing you because I am, I first became familiar with your work from Dr. Rowell. Who's been on the podcast talking about extreme, picky eating, and then a number of your other colleagues that you've published with. Like, you have to have Joe on, you have to have Jo on. And like, I know I'm trying, but she's working on her PhD. So congratulations. The research that you're doing right now. You mentioned the team that you work with. Is there anything you can share particularly about the research that you're doing?
Jo Cormack (5m 11s):
One of the studies that I'm working on now, and I'm quite excited about it's called the catchy farm is the name really catch title short for, for the feeding anxiety measure. And this is something that I'm, I'm definitely colleague Hazel and another colleague, Caroline Horton. And what we're looking at is whether we can validate an assessment tool to measure parental anxiety in relation to feeding, because we know that anxiety has such an impact on how parents approach, feeding, how parents feel about children's eating behaviors. And we think that if clinicians and researchers can measure that actually will be much better placed to serve families. So that's something we're working on now.
Jo Cormack (5m 52s):
And I don't know if any of your audience wants to help me. We're very much looking for participants. We're trying to get a really big sample who we're aiming for a thousand parents to complete our online questionnaire from
Katie Ferraro (6m 2s):
Around the world, or do they have to be from the UK around
Jo Cormack (6m 4s):
The world? Oh, and it doesn't matter whether the children are typically tutors or even feeding tube reliant. It doesn't matter what the child's eating behaviors are. Like. The only criteria really are that they're aged between 2 and 12 years old.
Katie Ferraro (6m 18s):
Okay. I'm going to put a link to the recruitment tool that you have on the show notes for this episode. So if you guys go to BLW podcast.com and search anxiety, it will be awesome. If you could help Joe out with her research. I think that's so important to, because I know the term anxiety, especially in parenting and in particular in motherhood gets used a lot and yet yeah. How do we measure anxiety? It seems to be such a subjective thing. I know I say we share a lot of videos of babies, gagging to teach parents that gagging is a natural and necessary part of learning how to eat and that while it's uncomfortable to watch, and it's certainly uncomfortable for your baby, as they're learning how to eat. It's so important to recognize that a baby can recover from a gag on their own.
Katie Ferraro (6m 58s):
And so when parents watch videos of other babies gagging and recover on their own, it gives them confidence in their baby's ability to do the same. So we have people give us feedback like, oh my gosh, this helped lower my anxiety so much, but it would be so interesting to be able to quantify objectively what that means and where you came from and where you are now.
Jo Cormack (7m 16s):
Absolutely. And it will also help us identify parents who might be at risk of struggling with feeding. If they're already likely to be feeling anxious about it.
Katie Ferraro (7m 25s):
It's not like there's a shortage of things to be anxious or nervous about as a new parent. But then when it becomes the time to start introducing solid foods to your baby around six months of age, I was curious if you had any tips for parents and caregivers about how they can manage their anxiety because their baby is building a relationship with food. And this is an important transition. But sometimes as parents, we kind of get in the way of our baby's progress. So what can we do if we are feeling anxious about this transition?
Jo Cormack (7m 51s):
Wow, I have so much to say on this. I think first of all, anticipates it and that can happen maybe before that six month point, when people are starting to think about introducing solids, it can happen almost a sort of preparation. I would advise parents to think about possible contributors to anxiety. So I don't know. You could ask yourself a question, like, how do you feel about food generally, what's your relationship with food? Like if it's perhaps a little bit difficult that there's a capacity there for that to spill out into feeding babies, do nutrition and health loom large for you, but also even looking back and thinking, how was your upbringing in relation to food? And then looking at the history, has there been a tricky start because for many parents, if, for example, the baby's born premature, maybe they've had a sort of early time where they've had to be very, very careful about how much the baby's consuming, maybe because that they're in the NICU, for example, or just come home.
Jo Cormack (8m 50s):
And that can all transplant over to the early phase of introducing solids. So I think if parents have had time to sort of stop to process, to look for those trigger points in a really self-compassionate way, but just asking the question, if there has been a tricky start, how could this then feed into that later feeding? And another one that I see a lot in terms of client work is maybe where breastfeeding has been really difficult or hasn't worked out as the mother has intended it to, you know, for whatever reason that might be. And then introducing solids becomes kind of fraud. So because there's already a lot of difficult emotions connected with feeding.
Jo Cormack (9m 30s):
So I would advise parents to just anticipate in terms of their own personal experience, whether there might be some possible contributors to anxiety about early feeding, other suggestions, and the actual face of that worry, I would want to suggest that parents get a sense of whether it's accurate or misperceive. We talk about misperceived worries a lot in the world of feeding. So imagine that a parent is worried, the baby is underweight or a parent is worried that the baby's just starting off with solids and a parent is starting to feel that they're not confident about the nutritional intake. First thing is we need to think about is that something that does need to be worried about?
Jo Cormack (10m 14s):
or not, and I don't know if you come across the work from Byron Katie. No, not familiar. So it's a really nice set of questions that can help anybody work through something they're worried about. And it's something that I think is really nice to share with parents if they are feeling anxiety. And they're recognizing that anxiety question one, you say to yourself, is it true? So let's say I'm giving my baby all these different foods and I'm saying most of them are all over the floor and I'm starting to worry that they're not going to be adequately nourished. So I asked the question, is it true? And I really, really think about that. And then let's say, I say, I think, yes, it is true. Yes. They can't be adequately nourished.
Jo Cormack (10m 54s):
That whole male is on the floor. And then I moved to question two, which is, is it absolutely true? So I'm really sort of pushing myself here. Do I know that this is true? And just to take a pause for a second, if it's nutrition that we're worried about, there might be ways and means of assessing it. If a parent is really genuinely worried that the baby's intake is, is not as it should be, perhaps they need to, to consult with an RD and have a objective professional assessment of what's going on. Because nine times out of 10, it's all probably going to be fine, but where parents are really worried, I think they do need to properly get to the bottom of, is there a need to be worried or not?
Jo Cormack (11m 35s):
And then jumping back into these four questions, the third question is, how do you react? What happens when you believe that thought? So this is helping parents then to sort of shift into an examination of what behaviors follow that worry, because it could be, if you're worried about your baby's nutrition, maybe that's the point at which you would start to not push, but encourage them to eat. And suddenly that attunement is going because you're feeling worried. They know you're feeling worried. And then the final question is who would you be without the thoughts? And it sounds like a really good question. It's incredibly helpful for supporting people to imagine themselves into a world without that worry.
Jo Cormack (12m 19s):
And these four questions, widely there's loads on the internet are in cages. Work's really popular, but these four questions can be a very powerful way of just helping somebody process the worry. So just to summarize, cause it's a, it's a huge area, isn't it? How, how do we deal with anxiety? First thing anticipated, do that work maybe even before you've even started thinking about solids, are there any contributors to anxiety in your personal history and your baby's personal history in your relationship with food? Second gets a sense of whether your worries are accurate or whether they might be misperceived. And then try just going down that pathway, using that model called the work where you test out, is this true?
Jo Cormack (13m 5s):
Is this absolutely true? And then experimented with what would it be like? Not to have this worry.
Katie Ferraro (13m 12s):
I love that question. What would it be like to not have this worry? Then you mentioned that so much of the worry is about nutrition. And of course, you know, registered dietitians and pediatric dietitians are there. If you need them. And you said nine times out of 10, I feel the same way. Anecdotally nine times out of 10, what parents are worried about. It's not time to worry about that yet. At six and seven months of age, of course the majority of babies, nutrition is still coming from breast milk or formula. We can't possibly expect the baby to be able to meet their nutrition needs with food when they don't even know how to eat food. And that's why getting education about starting solids and infant feeding from credentialed resources is so important because otherwise you're just watching social media, you think, oh, that baby's eating all of that food and my baby is not doing it.
Katie Ferraro (13m 53s):
So my baby's not getting enough. And you go sometimes down this hole of anxiety that's could be completely avoided if you'd had the appropriate education at the right time.
Jo Cormack (14m 1s):
Absolutely. Absolutely being informed is so key because then you don't feel unnerved when things don't go in the way that you might've imagined they word.
Katie Ferraro (14m 9s):
Okay. I loved your mention about addressing anticipation and we always encourage parents ahead of time. They are very familiar with Amy Brown's work also out of the UK regarding choking and that there's no higher risk of choking with a baby-led approach compared to traditional spoonfeeding. If parents are educated about reducing choking risk. And so we teach them, here's how you make the food safe. However, in the very rare event that your baby does have a choking incident, you should know basic CPR skills, CPR saves lives. So one thing you can do ahead of time is to take a CPR course so that you would know what to do in the event that your baby chokes that's one piece of the puzzle. So I'm totally on board with you for the ahead of time information. But when let's say, you know, now you're in the thick of it and your is getting most of their nutrition from breast milk or formula, but you're trying solids once or twice a day at the six and seven month mark for parents that feel like, oh my gosh, I can't do this.
Katie Ferraro (15m 1s):
Or this is too much. And maybe the anxieties about choking, or maybe it's about nutrition, or maybe it's about, you know, an underlying, unresolved eating disorder in mom, whatever the case may be, any tips for managing once you're actually in the thick of it.
Jo Cormack (15m 13s):
Well, I think understanding it is key and I'm in fact, I have a tool that might be useful for, for you to share with some your audience. So if you, if you'd like to,
Katie Ferraro (15m 22s):
So I link everything you mentioned, this is fabulous. You're giving us like a rundown and anxiety management on a baby-led weaning podcast.
Jo Cormack (15m 28s):
This is about the feeding legacy and the feeding legacy is the sort of, some of influences over how we come to feeding. We will arrive at feeding with this baggage, you know, whatever that might be. And I think it's just useful to structure a conversation about what you might be bringing, where these trigger points might be. And to talk through that with a friend, for some parents, if they have highlighted that there could be a particular difficulty, it could be worth speaking to a therapist. If you feel that you're very, very anxious and you don't have a concrete grounds for that, you know, you're not pointing to something that needs them addressing. I think it's important to stop and take time and be really, really kind to yourself really self-compassionate and try and dig deep and see if you can trace back the origins of that worry, whether that's something to do with your baby's history or your own personal history or pressures from just society.
Jo Cormack (16m 21s):
I think there's a lot of pressure, you know, like you were saying with the sort of social media image of this, baby's eating that and why isn't my baby eating that that can generate anxiety in itself. It really can.
Katie Ferraro (16m 31s):
I like the, you mentioned the feeding legacy and analyzing what emotions we might be bringing to the feeding experience with our babies. And also the Babies can sense pressure and stress, and they know intuitively when you're worried as well. So we talk about it's like, I struggle with infertility. People tell you, oh, just relax. And then you'll get pregnant. It's like, you know, I tried relaxing and I'm not pregnant. Thank you very much. He said, oh, just relax. It you'll be fine at the meal place. It's like, come on. I know, you know, sometimes parents need a little bit more. So I'll definitely link to that tool that you mentioned in the show notes at blwpodcast.com. We had this, a good friend of mine. She's in the San Francisco bay area and she's a pediatrician. Her name is Julia grin, but she's also a trained chef and she has this analogy. She calls it, writing your family's food story.
Katie Ferraro (17m 13s):
She was on our podcast, it's episode 88, if anyone's interested in listening to it. But she talks about, you're basically starting with a blank slate, a blank book, and that you are yes, responsible for helping to build the foundation of food, whatever that may be for your child, but you don't have to replicate the concerns or the worry or the emotion or the baggage that you have with food in your own child. And she gives parents permission to start the story from the beginning. And that you're the one who's writing the story for your baby. And I love that because parents admit all the time as I don't have a great relationship with food myself, and I don't want my child to feel the way about food or weight or body image that I do. And there's a lot of pressure there.
Katie Ferraro (17m 53s):
Like this is my chance and tell parents, listen, you're also responsible for helping to provide them with nutrition and to make sure we're doing it safely, but there's a lot of the emotional side of it. So I love that your team has really exploring that as well, because I think, especially in nutrition, all we talk about is calories and milligrams of iron and grams of fiber. And it's just so impersonal and food is so much more than that. I think it's so important. Parents understand that as well.
Jo Cormack (18m 17s):
It's fundamentally social, isn't it? I mean, I think the only thing that adds to that, the concept of the blank book is to say that maybe it isn't entirely blank in that also children bring their own genetic inheritance to eating. So what really come out of my research is just how responsible parents feel about their child's relationship with food. And yes, there's loads of good stuff that we can do to support a positive relationship with food. Of course there is, but children will have their own temperament. They'll have their own sort of taste buds. So for some children, they will simply experience better, tastes more intensely than the child next to them. And I think it's important that parents see that children will eat in a way that's also guided by these genetic factors and how a child eats is a mixture of environmental and genetic factors.
Jo Cormack (19m 9s):
And this is born out when parents look at comparing how siblings eat and you can think, well, gosh, the environment has been broadly the same, and yet these children eat really differently. So I think it is. I love the idea that you can write your own story and that you can start fresh and you don't have to replicate some of those aspects that might not have been positive from your own childhood. I also think it's important to acknowledge that what that story you write is not the whole of it because your child will also be bringing whatever that temperament is that, that tastebuds and all these other genetic aspects of how we eat as humans
Katie Ferraro (19m 48s):
And back to the education component. It's important to understand that all children will experience some degree of food neophobia generally starting in the second year of life and you are not a bad mom. If your child is a picky eater and parents, but I did baby led weaning. And now my child's a picky eater. And so I teach this a hundred FIRST FOODS approach where we teach parents how to feed a hundred different foods before the baby turns one with the notion, being that with traditional spoon-feeding babies have only had 10 or 15 foods by the time they turn one. And when you lose those 10 or 15 foods to picky eating in the second year, that becomes a very challenging child to feed. However, if the baby has a hundred foods, they eat and then you lose 10 or 15 to picky eating. It's not the end of the world because you're still left with 85 or 90 things.
Katie Ferraro (20m 29s):
There's many, many foods out there to choose from, but it's much easier to choose if they've been exposed to them in the period when they're more likely to actually want to eat them, which we all know is not toddlerhood. So I don't want parents to walk away feeling, oh, I'm a failure of my child's picky. You must understand there's some degree of picky eating that will set in in almost every case.
Jo Cormack (20m 47s):
Absolutely. And I think, again, it's we keep coming back to patient. Don't worry. I think if parents understand that neophobia is normal and sometimes it can be as early as 12 months even it's to be expected. And I'm sure you've had people talk before on your podcast about the there's some theories around the origins of neophobia, which is that as children become mobile, so maybe 13, 14 months, this is the point at which in a cave dwelling days, they might've wandered off, picked up poisonous berries and been at risk. So there's this adaptive mechanism or so the theory goes that children suddenly just at the sort of point where they're starting to walk and have that independence decide that all they want to eat is very, a narrow range of very familiar foods, often not brightly colored, because again, those poisonous berries might be brightly colored and often not better and better as a sign of toxicity in nature.
Jo Cormack (21m 42s):
So you can see that some of these mechanisms might've had a protective role when we had a different kind of way of life. So I think if parents appreciate that neophobia fear of unfamiliar foods is something to be expected and that we usually see it out that sort of 12 months to 24 months window, if you're expecting it, it's a lot easier to handle.
Katie Ferraro (22m 6s):
Jo, can we talk a little bit about exposures? Yes. B get feeding is relational, but I'm just curious about your thoughts as a PhD researcher on the stats. You always hear floating around, you know, baby needs to see a new food X number of times before they like or accept it. I'm just curious. Is that something you think personally is important for parents to know X number of times, or do we just want to reinforce the idea that, Hey, you can't just show a food to a baby once and expect that they're magically gonna know how to eat it and love it. Any thoughts on the numerical side of those stats?
Jo Cormack (22m 37s):
Okay. So this was actually the most important finding in my doctoral study was about exposures is widely, widely known as interpret the importance of multiple exposures. But in my study, the women I was speaking to, they were using exposure theory as the basis for non-responsive feeding practices. And this is because, yeah, because these were people who were trying to do the absolute best by their child. Because as I said, they were a sampling of the sub clinical samples that they were people who've gone to the health care providers seeking help for feeding challenges, picky, eating, avoidance, eating, how would we label it? So they were making the child eat or try foods because they thought it was the right thing.
Jo Cormack (23m 21s):
They thought it was a means to the end and they thought they were helping their child. So I was finding that if women are using this knowledge that we need to be exposing to children to feed multiple times as they Browns for what we would all agree. When you look at the research into the impact of pressure on child's eating behavior, you can see that there was a huge, huge problem here. So I looked at a few examples of guidance for fussy in inverted commas or picky toddlers and all of that guidance. And this is from things like the national health service in the UK or the MCT, which is the national trial bus trust. So this is not just random blogs. This is fairly official advice and there would be information sheets.
Jo Cormack (24m 3s):
And so on. Every single one said that if your child is not, is rejecting foods maximize exposures
Katie Ferraro (24m 11s):
By all means possible, right?
Jo Cormack (24m 13s):
Yeah. So they were quoting different numbers ranging from the eight to 20. And yes, we have many studies with different numbers, some interesting data implying that age is a factor and how many exposures are needed. But the point is that this guidance was saying, if your child is a picky eater, Hey, remember, did you know, you need to give them X number of exposures, but they didn't define what the exposure entailed and neither did they talk about the socio-emotional climate or the exposure, how that felt for the child. So parents in my study had come across information like this. It's almost become part of the sort of popular parenting Canon really well known.
Jo Cormack (24m 54s):
And they were using that theory. They were clinging to it, seeing it as the right thing, the right way to get their child the best start in life possible. And that when you actually go back to the original studies, this is not an error that they're making the original academic sources do almost all make the point that the socio-emotional climate of exposure matters, but that has been lost in translation. So we see parents am, I can only really speak to people using exposure theory in the context of perceiving a problem, because that was my sample. But we're seeing parents drawing on these rules that children need to be exposed to things X number of times, and it using it as a grounds to push those exposures, which actually has the opposite effect.
Jo Cormack (25m 42s):
So I talk about autonomy, supportive exposure, just as a way of helping parents think, is this an exposure to a food that has compromised the child's autonomy or not, who is in control? How does the child want to interact with food or have I somehow pushed it? So for me, I think what you said earlier, the idea that we just keep on offering in a relaxed way, ideally because we're eating it in the food is just there. That's not autonomy supportive exposure. Whereas if there's an expectation that the child's going to interact with the food, then this can tip over into what would academically be called pressure to eat. And we know unequivocally that pressure to eat contributes to problems with eating.
Jo Cormack (26m 25s):
It makes sense.
Katie Ferraro (26m 27s):
If I could ask a very leading question as a dietitian specializing in baby-led weaning, I would say that the greatest autonomous supportive exposure and infant feeding would be allowing your baby to feed themselves, which is big. Okay. So Jo, when you mentioned your PhD work, you were studying a sample of parents who were potentially using exposure theory as a basis for non-responsive feeding practices. What is an example of a non-responsive feeding practice past breastfeeding? So once we're involving solid foods,
Jo Cormack (26m 57s):
That's a great question. It can be really such a range and different people will give you a different answer to this question. For me, I think that responsive feeding is really about genuine autonomy. So you are letting your child make their own discoveries about food and not persuading them, not encouraging them to eat. And I know that's quite counter-cultural, I don't even recommend that parents praise children for eating. So it really is just a social experience that children can engage with nonresponsive feeding. Then it might look like spoon-feeding when the child is not welcoming that. And I know you've had Marcia done Klein on your podcast and she has this great concept of a positive tilt where we're looking for that, the child moving towards the food, the food moving towards the child, and it's sort of synchrony, as opposed to the child is moving backwards and the food is moving towards them.
Jo Cormack (27m 53s):
So that sort of overriding of the child being the one in the driving seats, if you like,
Katie Ferraro (27m 59s):
When you mentioned some kind of extreme reactions beyond, I mean, I call force-feeding, but I'm sure there's a much more politically correct way to say that. What other examples of non-responsive feeding might one be engaged in if they're not aware of it?
Jo Cormack (28m 12s):
Well, in, in my sample, the children being older, it wasn't really physical intervention. It was much more that parents were insisting that children ate. Sometimes they were withdrawing attention or certain positive things that the child wanted or, or on the other hand, they might've been trying to persuade a, chanting it by saying, if you try this, then you can have this. And actually in some cases, it was to the point where children were, were vomiting because they were under such pressure. And it was shocking to me. I have seen this in my clinical work, but to delve so deeply into these experiences with a sort of academic hat on was really eye opening. So nonresponsive feeding is fundamentally compromising a child's autonomy.
Jo Cormack (28m 56s):
There's other aspects to it, autonomy all of it. But when we're talking about who has the power, this is what we come back to is that principle of autonomy. So ideally children would be able to make their own decisions about whether they would go to eat food, whether they finish the food, whether they were going to engage with it, rather than the parents saying, oh, try this. Or you might like this, or how about a lick of this, et cetera.
Katie Ferraro (29m 19s):
And Jo, I know we're on a baby-led weaning podcast. So most of the audience here has children or works with babies somewhere between six and 12 months of age. But what I think is so unique about baby-led weaning is that it's one of the few things that appeals to a second time parent. A lot of parents are like, I figured it all out, except I'm dealing with this picky eater or this picky toddler or this food averse, whatever you call it, older child. And I'd like try something different with my next child. So I know that a lot of your work has focused on older children as well. You've developed your own responsive model called the emotionally aware, feeding. Curious if you could just explain to us what that is and how it's become an effective way to help with anxiety during the feeding journey. Even past infancy,
Jo Cormack (29m 59s):
Show us the response model really based up, I ended up parents of children from two outputs up to adolescents. It's drawing on my specialism, which is the psychological relational elements of feeding. But the idea is it can be used alongside any other specialism. So a dietitian could use as an occupational therapist could use it. A speech and language pathologist could use it. It's about well, loads of bits to it. But to give you a bit of a nutshell, giving parents the basics of responsive, feeding that education piece alongside helping them gain insight into the own specific potential pitfalls. If you like. So we do a lot of work before we even talk about new foods.
Jo Cormack (30m 41s):
We do lots of work, helping parents understand their own responses. And this thing you said earlier, Katie, you said something about you. Can't just tell a parent, well, I'd like you to stop feeling anxious. Now, every time that you're taught gags and that they say, oh brilliant. Yes, I will great advice. It doesn't work like that. That comes into play here where with EIF, it's about equipping parents with the tools and the space to process their own responses, understand where they might've, they might've come from be compassionate to themselves so they can move away from guilt. And self-blame because when parents are struggling with feeding the amount of guilt and self blame that creeps in, it's just overwhelming.
Jo Cormack (31m 23s):
And we have to get beyond that in order to, to move forward. Really. So we spend a lot of time talking all this through also another strength to it is spending a lot of time working on creating an environment where children can feel intrinsically motivated to explore new foods. It's just not about making them do it or getting them to do it or encouraging instead. It's about the opportunities being there when they're ready for it. So there's, there's quite a few sort of different stages to it. I think what makes it different from some other approaches is the amount of time spent getting that groundwork, right? So we usually work over a six month period with clients and it might not be too sort of months five or something where we even have a conversation about new foods.
Katie Ferraro (32m 5s):
Interesting. And I think setting the groundwork, you've talked so much about anticipation today that with your baby, when you're starting solid foods, if you can come to terms with the fact that the goal here is not to get or make the baby eat, I think we've had every international feeding expert on here. We're all saying the same things, using different words, but hearkening back to Alan sadder and the division of responsibility and feeding theory, whenever you're feeling that anxiety rise up, we tell parents, what's your job. We just did an episode with Marsha called stay in your lane. Like, what are our rules? It's not your job to make your baby eat this arbitrary amount of pureed processed food. That's been stuffed into a pouch. That's not your job. You're responsible for other things, for sure.
Katie Ferraro (32m 47s):
But I think that helps lift this burden of, as you said, you know, the guilt and the shame and the self-blame, if you realize, Hey, that wasn't even my job to begin with my job here, even from your baby's first bites, it's hard with breastfeeding. A lot of parents are coming into solid foods, having struggled immensely with breastfeeding, and they already feel that they're behind the eight ball. Like the authority gone all wrong for me. And I've ruined this child, you know, for the indelible, horrible things for the rest of their life. We always say, that's not the case. Your child needs to learn how to eat and it's not your job to make them eat. And for a lot of parents, they're like, oh, that makes sense. Now, of course, that does not alleviate all anxiety, but it can just, I think we start to have these conversations of let's anticipate what our ultimate goal is here.
Katie Ferraro (33m 27s):
And it is not to force the child to eat X, Y, or Z amounts of foods.
Jo Cormack (33m 31s):
And then let's translate that to what that actually looks like in reality. And this is a meal where attunement is prioritized. So it's about connection. And it's about what laying and it's about just all being, and I'm not talking about a family meal that has to have no two parents grammar it's it can just be one parent and the child connecting, eating together rather than the whole sort of focus of the male being, trying to direct how the child engages with food.
Katie Ferraro (34m 2s):
Exactly. And you talked about power and control because I mean, that's a whole separate episode, but there's so much of that at play, especially so many of us grew up in an era where you eat everything on your plate because there, you know, starving children in Africa, not to be politically incorrect. That's what my parents actually said to me. And I know many parents grew up with variations of that. My dad grew up in a family where there was not enough food to feed the seven kids. So you ate really, really fast or you didn't eat at all. Like it's not pleasurable to sit down and eat a meal with him. And he's not patient when they're feeding themselves. Cause he's like, this takes so long. It's like, well, dad, the ultimate goal here is not to get like the food into them as fast as possible. He said, well, that's what it was for me when I grew up. I mean, there's, there's so many layers coming in to,
Jo Cormack (34m 41s):
It really is. And it's so socially normal to encourage a child with eating say, well done, you've tried that or amazing, or to say, Hey, you're like this. Or to say, well, you won't know if you like it because you haven't tried it, all of these phrases for here. And they're just not helpful. It's much better to just be there. The food is there, you're there. And you can chat about your day.
Katie Ferraro (34m 60s):
And I appreciate researchers, like you saying, what languages not helpful. I think that's very important. A lot of people are scared to say that, oh, I don't want to be perceived as shaming. The parents are judging the parents. It's like, we can talk about positive language all day long. For me, it's very hard. It's a foreign language. I have seven small kids for awhile. We had seven kids, three and under we're doing baby led weaning with twins. We had quadruplet toddlers. It was awful. If someone just said, don't say that I would have really appreciated it. Don't tell them to eat everything. Don't say good job. When you eat, like you should have a whole training on what not to say based on your research because positive language is one thing, but we need to know what negative language to avoid as well.
Jo Cormack (35m 37s):
Exactly. I think if we always start from this place of assuming that parents are just doing the best that they can with the information they have. So it's lots of judgment and also it's absolutely socially normal. So to say to a parent, look, don't try and persuade your child to take this one bite or a no thank you. Bye. To after I say it might be, if there's food, it's not judging them for doing that. Because to do that with just to fit in with everything that's around them and probably what they experienced themselves.
Katie Ferraro (36m 3s):
I love it. You call it a no thank you. Bite. We have people in United States called a polite bites. There's nothing polite about making them take a bite of something that they weren't going to. I hate it. I know. I know. But again, it's hard. You can't get on social media and say, don't do this because then people will blow you up. But it's like, it's so important to your
Jo Cormack (36m 18s):
Friends
Katie Ferraro (36m 18s):
To, anyway, I know you do. You guys definitely follow Joe. I'll link to your page on ours. I really appreciate your insight because you are doing the research as a PhD credential professional, studying these behaviors because it isn't black and white, you know, people make fun of nutrition science, oh, it's such a soft science. It's like, well, at least there's measurable quantities of things in iron and carbohydrates and fiber. The area that you're in, that's kind of no man's land. And yet we do it three times a day. Like there's clearly a science to what's happening here.
Jo Cormack (36m 48s):
Yeah. I mean, it's interesting because the pressure that teachers really overwhelming and I'm, I'm just in the middle of it.
Katie Ferraro (36m 52s):
You're overwhelmed by the pressure literature. I love that.
Jo Cormack (36m 55s):
I know I am. I am well, I was very overwhelmed by it. A few months back, I'm currently trying to publish a study that I've just putting it together. Really weren't reviewed all of the studies that look at picky eating and pressure to eat. And it was 53 of them. So that took awhile and finding them take awhile. So, but what I have found, you know, the evidence is overwhelming. There's just, there's no debate in academia about whether pressure, which I think is maybe better framed as encouragement or persuasion because pressure sounds horrible, but precious
Katie Ferraro (37m 29s):
Sounds but encouragement sounds good. There we go. With the semantics. I would think encouragement,
Jo Cormack (37m 32s):
Right? Yeah. This is exactly. What's what, what my paper concludes really is that we need more clarity on what this constitutes, how we need to appreciate that for different children. They will experience pressure differently because they will come to eating with their own sort of unique personalities and preferences and so on. And so for one child might say, I mean, I can't, I should be saying this because I'm constantly telling parents not to encourage children to eat, but I might say to my nine-year-old, oh, have you tried this? But that's because I know her relationship with food. She's a typical eater. She's very relaxed about foods. And for her she'll probably think, oh no, I haven't. Oh, I might do well. She might not. And that's fine. Whereas another child, if we were to say, have you tried this, that could then
Katie Ferraro (38m 17s):
Come
Jo Cormack (38m 17s):
To a real genuine, yeah. It could be like a really stressful experience for them to hear that.
Katie Ferraro (38m 22s):
And I would say, as the mom, did you try this? Cause I freaking spent 20 minutes making it for you guys for dinner. Like, you know, there's, there's so many reasons why certain words come out of our mouth. And I feel like we're just living in an era where, you know, anything you say is, can be perceived incorrect. So again,
Jo Cormack (38m 37s):
That's true too.
Katie Ferraro (38m 38s):
Thank you for the insight though, because words do matter and words around food matters and we all make mistakes. When it comes to those words,
Jo Cormack (38m 45s):
You can express it quite simply as well. I think it's a, it's a difficult thing to actually do to stop encouraging eating, but it's a simple concept and that's why I'm sort of, I'm feeling okay about saying to parents, look just don't do this because it conveys the simple concept that we just need to leave children to manage their own eating really, you know, within the context that you set up. I love that.
Katie Ferraro (39m 6s):
And I think about like toddlers, they getting them to dress. For example, the goal here is that you eventually get dressed, but I'm not going to comment on every single button as you're like, literally parents are narrating. They are play by play of every single bite. The baby's eating and sometimes just say, Hey, can you do me a favor? Especially the parents I work with we're filming here. Can you just not talk for 15 minutes? And the mom's like, really? And she's like, oh, this is actually kind of nice. Like you that's a break, let the baby do their thing. Don't wipe them. Don't touch him. Don't move him. Don't talk to them. Chill out. Let them
Jo Cormack (39m 34s):
Statistics of experience that as an adult, wouldn't sit and have somebody kind of sweep in and wipe your face off.
Katie Ferraro (39m 39s):
I feel if you're trying to learn how to ladies attacking you with a wet wipe, right?
Jo Cormack (39m 43s):
Exactly!
Katie Ferraro (39m 44s):
Jo, I could literally talk to you all day long. I know we probably need to wrap it up. I've written down like five other episode ideas. So I'm sorry I have to ask you back. I'm going to link to all of the tools and the resources that you shared on the show notes page for this episode@blwpodcast.com, but Joe tell our audience, where can they go to learn more about you and your team and the work that you guys are doing?
Jo Cormack (40m 2s):
Sure. Okay. So for parents, you can find more about my work at jocormack.com. And I have my blog there, loads and loads of articles for parents. I know quite a few professionals listen to your podcast. If you're a professional listening, you can find me at response to feeding pro, which I run with Dr. Katja Rowell and we have, it's kind of a hub for responsive feeding therapy training for professionals from all sorts of disciplines, anyone working in feeding. Yeah. So I think that's probably the best places to point you to I'm on Instagram. I'm a bit rubbish on it, to be honest,
Katie Ferraro (40m 37s):
I love your Instagram. And that's how I eventually got in touch with you because you were a very busy lady and very hard to get in touch with. So thank you for doing the interview. I really appreciate it. Thank you for all of the work that you're contributing to this base, all of your colleagues. I think it's so important and it's helpful to us as parents because nobody was born knowing how to do all this. And it's important that we hear all the different sides of how we might consider doing it as we help our babies transition to solid foods.
Jo Cormack (40m 58s):
Absolutely. Thanks Katie.
Katie Ferraro (41m 1s):
Wow. I feel like we just got a crash course in anxiety management around mealtimes. I mean, lots of really practical tips for starting solid foods, but I think a lot of things that for those of you with older kids, I know I was like taking notes frantically like, oh, I definitely say that. Or I could do more of this or, wow. I didn't realize I was doing that. Jo really is the expert as far as psychology in pediatric feeding goes. So I know she mentioned a lot of different tools. This is a very, very layered episode you might say. So I'm going to put everything on the show notes for this episode at BLW podcast com slash 2, 1 4, I'll put up links to Jo's materials, her emotionally aware feeding model, also her feeding legacy tool.
Katie Ferraro (41m 41s):
I was also thinking maybe if you guys all complete the survey that she asked about, remember she's recruiting a thousand responses from parents of children aged two to 12. Like it would be so cool if a lot of them came from this episode, maybe she'll come back and talk about the feeding legacy. Cause I really, really want to learn more about that. So, you know, basically what are we bringing to the table from our experiences and how does that affect our children's abilities to learn how to eat in infancy and then also to continue to foster the relationship with food as they get older. So go to BLW podcast.com/ 2, 1 4, please explore some more of Joe's materials. And if you are a parent of a child age two to 12, please fill out her survey, which will be linked there as well.
Katie Ferraro (42m 22s):
Thanks so much for listening guys. See you next time.
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