Dr. Katja Rowell (1s):

I just had a paper published with a wonderful PhD candidate in England about this idea of the basic human needs. Self-determination to thrive. We need autonomy, competence and relatedness and baby led weaning like hits all three of those.

Katie Ferraro (16s):

Hey there, I'm Katie Ferraro, Registered Dietitian, college nutrition professor, and mama 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. Hey guys, welcome back to another episode of the baby led weaning made easy podcast. I've got a really interesting guest with me today. We're going to be talking about preventing picky eating. So my guest today is Dr.

Katie Ferraro (57s):

Katya Rowell. She is a family physician turned feeding specialist. So she does a whole bunch of materials. She writes books. She gives, talks all about helping parents establish a healthy feeding relationship. And what I really love about Dr Rowell's work is that she focuses on how children are fed. And that's so much about what baby led weaning is, right? Yeah. We talk about wholesome healthful foods to feed, but we don't wanna get over-focused on what they're eating. We need to help our babies learn how to eat. So Dr. Rowell is also known as the feeding doctor. She helps parents become especially moms to become a mom and feed as a mom, not a cop. And she's written a number of books, including helping your children or helping your child, rather with extreme picky eating.

Katie Ferraro (1m 41s):

It's a step-by-step guide to overcoming selective eating food aversion and feeding disorders. And she coauthored that with the speech language pathologist and feeding therapist. And she's going to talk in the episode today about how we can use baby led weaning to help prevent picky eating. Cause I know some of you are first time parents and you're interested in baby led weaning to prevent picky eating. But a lot of you are second or subsequent time. Parents who maybe have an older toddler or child who is picky, then you're aware of the research that shows that the greater, the number of foods and flavors and tastes and textures that babies are exposed to early and often, not only does that help you raise an independent eater, but it does help prevent picky eating. So Dr. Rowell is going to talk to us about, you know, what is picky eating?

Katie Ferraro (2m 22s):

What's the difference between typical eating, picky, eating and extreme picky eating, can babies even be picky eaters and why she recommends against using terms like food aversion and food neophobia. And she talks a little bit about the direction where kind of the discussions in feeding therapy and the world of feeding are going. So if you're a little bit of a nutrition research nerd, like I, myself am, I think you'll like her interview, but she also shares a lot of really practical stories about families that she's worked with who oftentimes are over-diagnosed or misdiagnosed, or sometimes over-complicating these feeding issues. So she's kind of like a back to basics. Again, family doctor turned childhood feeding specialist, and she acknowledges that, you know, one in three parents are going to ask a doctor for help with feeding, but many times that doctor won't know very much about feeding.

Katie Ferraro (3m 10s):

And so I just want to provide you guys with other resources. I'm going to link to everything that Dr. Rowell covers in this interview on the show notes for this episode, which is blwpodcast.com/ 36. So with no further ado, I want to introduce you guys to Dr. Katja Rowell in this episode, all about preventing picky, eating from our babies. First bites are I well, Dr. Rowell, thank you so much for joining us today to talk about preventing picky, eating from our baby's first bites.

Dr. Katja Rowell (3m 41s):

I'm so excited to be here. It's such a great age to really learn about this stuff.

Katie Ferraro (3m 46s):

Well, it's hard. I think for parents sometimes, cause they hear the term picky eating. They might have an older picky eater and sometimes they're starting solids with their babies and they say, I have a picky eater on my hands. So I'm just curious. Could you tell us if babies who are six to 12 months of age, can they really be picky or do they just need some more practice learning how to eat? Well,

Dr. Katja Rowell (4m 4s):

I think you absolutely at six to 12 months, they're, they're learning especially six, seven, eight, nine, you know, the, the earlier on that window. So I certainly wouldn't say within two weeks or two months that an infant is picky. And I, I do think that we have to be really careful about our mindset going in and, and try not to use those, those words prematurely. And, you know, I think we can say there that they're, they're still learning. They're young eaters, they're early eaters, they're learning eaters. And I do think that there's research that supports the idea. And it's certainly something that we can all observe that babies are different. Humans are different, how we approach things and how we approach the world.

Dr. Katja Rowell (4m 45s):

And that starts very young, you know, six to 12 months. We certainly see traits in infants where some are really quick to explore new things and to try new things, you know, they might reach for a new toy. They might be, you know, more interested in jumping into things right away. And then we might see some infants who are more observers and they want to learn more. And then they, they sort of watch and watch and watch and they explore, they're touching, they're licking their, you know, they're, they're really kind of engaged in the process of learning about things maybe before they chew them and swallow them or gum them and swallow them. But so I think we would want to be really cautious about saying, oh my eight month old, I've put, you know, broccoli on their tray three times and they haven't eaten it.

Dr. Katja Rowell (5m 33s):

So they don't like it. And they're picky. So we certainly can see different ways of approaching food and thinking of them maybe as learning eaters. And we do have research in toddlers and, and just over that infant stage where they showed that the toddlers who played with new toys right out out of the gate, also approach new foods in the same way. While some toddlers took them longer to warm up to the new toy experience and they approached food the same way. So there are differences in how children approach food with little more cautious versus that, you know, excited jumping in. But I think we need to be really careful to say, oh, they're picky or there's something wrong with that, or to get discouraged.

Katie Ferraro (6m 17s):

You pointed out the importance of all babies being different. I always try to remind our listeners that babies are going to be interested in food at different rates. And some parents, they see other babies on social media that baby's as old as my baby. And look at that baby chowing down on all these foods and my baby doesn't eat that well. I always say, you know, don't, if you compare, you will despair, your baby will do things at their own rate. I remember when we started baby led weaning with our quadruplets, one of them Henry, he put his head down on the table and didn't participate for the first six weeks of solid foods. And if he were my only child, I would have been really concerned, like what's wrong with him? All the other babies around, they started picking up eating at their own pace and eventually one day Henry woke up and participated as well.

Katie Ferraro (6m 57s):

So don't worry if your baby doesn't dive immediately into eating solid foods. And I agree to that. We don't want to define our kids by their eating habits and calling them picky right out of the gate is not going to do any good. What about the concept of food aversions and food neophobia parents here are these terms, food aversions, food neophobia and I think we all internalize and think, yeah, my baby has that or my baby. Does that, could you just explain a little bit about that terminology, what those things mean? And again, if they apply to baby six to 12 months of age,

Dr. Katja Rowell (7m 29s):

Of course. Yeah. I, I think that there is a tendency sometimes to want to label and, and almost over pathologize. So we're in kind of a weird world, I think, with feeding therapy and with, you know, with this feeding world where there are kids who are getting labeled and I think pathologized and ending up in feeding therapy that just don't need it where they may be that slow to warm up, or they might be just a couple of, of tips that can really make a huge difference. And then we also have kids who really are struggling. And I know we'll talk about that group later. So yeah, I would be really careful about using the words aversion or neophobia and neophobia is a big, scary word.

Dr. Katja Rowell (8m 11s):

Phobia sounds like, you know, gosh, I have to see a psychiatrist and you know, it's a big deal, but neophobia is just a word for meaning cautious about new things. And, and actually it's used differently kind of technically in the feeding world, but at six to 12 months, what I think of neophobia just means like kind of cautious of new things. And, and some of this goes back to that temperament piece again, to, again, if you have a cautious infant in general, they may approach food the same way. And there's this thinking also that, that this caution around new foods is actually kind of an evolutionary protective thing. And it makes sense if you think about it, you know, you're six, seven, eight months old.

Dr. Katja Rowell (8m 53s):

They may be willing to sort of explore the world through their mouths and stick everything in their mouths. It's, it's a, that's a huge sensory input and how they learn about the world. And then as they start getting mobile and crawling and cruising, suddenly you might have an infant that needs a little more time to get used to a food and watch you eat it and explore it before they eat it. And so we see that sort of neophobia emerging around 12 to 15 months, which is sort of the beginning of that typical picky eating phase, which is super common. And we can certainly get to that, but it's we think about it, like if we were out in, in the world and, you know, before we were all in our homes that were baby proofed, you wouldn't want your cruising toddler to, you know, grab every rock and mushroom that they find on the floor and stick it in their mouth.

Dr. Katja Rowell (9m 40s):

So, so I actually think that for many kids, that phase of, you know, that nine month old, that 10 month old who ate everything and then suddenly at 12, 13, 14 months, we do start to see them kind of chucking some of those things off the high chair tray and getting a little bit more choosy. But that is absolutely typical for research shows us at least half the population goes through sort of a typical picky eating phase, but it usually starts kind of after 12 for some. So, so I hope that helps to just kind of calm down some of the, the anxiety around that word. Neophobia that, that it's typical for about half to just start getting a little bit more choosy and suspicious at some point aversion.

Dr. Katja Rowell (10m 26s):

Oh, that's a, that's such a scary word. And I'm going to tell you a story if you don't mind real quick. And I think this is where baby led weaning is so wonderful. So aversion is really comes from that aversive. If so, if you've had a negative experience with something, you know, if your child picks up and eats a habanero and accidentally puts that in their mouth, that's a very aversive experience. So they might now look at a jalapeno or something that looks similar and be cautious, or they may be a little cautious for a while because you know, when we have bad experiences, we don't want to repeat them. But, you know, I remember getting a phone call and this has happened several times of a panicking mom of like a nine, 10 month old.

Dr. Katja Rowell (11m 11s):

And I remember this moment particularly said, oh my goodness, my baby won't take the spoon suddenly. You know, and this was before baby led, weaning was super popular. So he, oh, he's eaten everything. And now suddenly he won't take the spoon. I called my pediatrician. He diagnosed him with an oral aversion, and now we're going to the feeding clinic, but not for six weeks and I'm panicking and I'm putting him in a headlock to get the food in and we're, I'm freaking out, you know, and what they were coming up against was just that autonomy that I'm sure you talk so much about. And so we just talked about like, Hey, you get two spoons, load a spoon for them, let them pull it in their mouth. Here's how to do some foods that they can, you know, you don't even need a spoon.

Dr. Katja Rowell (11m 55s):

So we talked about these different approaches and literally the mom emailed the next day and said, I mean, I can't believe I was even fighting the, as soon as I stopped trying to put things in his mouth, he ate like a champ. And so they were able to cancel this feeding clinic appointment. And so this, this, this idea of like an oral aversion, I think we're using it too much. And boy, if after six weeks of her jamming, you know, headlock and really struggling with that relationship, he may have shown up at that feeding clinic and now been diagnosed with an actual oral aversion because he'd been kind of forced fed out of desperation for those six weeks. So to call that an aversion, that's a really specific, kind of more serious thing that we can talk about later.

Dr. Katja Rowell (12m 40s):

So I would be really careful about using those words. And I think that part of the reason why as they're really scary sounding, and for me, I have this worry cycle of feeding diagram. A lot of the times when we get stuck in feeding practices that are backfiring, it's fueled by that worry. So anytime we can reassure and just kind of educate around what typical is like, it's, it's really typical for a nine and 10 month old to want to feed themselves. And the fact that the pediatrician didn't know that and that they don't always know that is, is also kind of a big part of the problem. So I brought up lots of things, but I think, you know, a version is something specific that we can talk about later and certainly, you know, a child who eats or is learning to eat, I would be really careful about using that word.

Dr. Katja Rowell (13m 27s):

I know

Katie Ferraro (13m 28s):

In your book, which is about helping your child with extreme picky eating. So you guys I'll link up to Dr. Rowell all of the resources that she's mentioning here in the show notes for this episode. So that's at BLWpodcast.com/36. Your book is about helping your child with extreme picky eating. So I love that you pointed out that, you know, about half of the toddler population is going to have some degree of picky eating generally starts in the second year of life, but could you give us a little insight into what the difference between typical picky eating is and extreme, picky eating? Because there are certainly parents out there who are like, I don't think that this is typical, what I'm experiencing.

Dr. Katja Rowell (14m 11s):

Sure. You know, and, and also I want to mention that the book is, is helpful for a typical and extreme, picky eating. And actually most of what we do is going to be the same across the spectrum in terms of, you know, respecting the child's autonomy and focusing on relationships and all of these, you know, uncompetent and all of these wonderful things. So, so a typical picky eater generally starts around the second year of life with some can start a little bit sooner, but you might have a child who, who seemed to do quite well until that time. And then suddenly they are having preferences. And a lot of this goes along with what is developmentally appropriate.

Dr. Katja Rowell (14m 53s):

Toddlers, you know, toddlers are learning to say no, and they're learning to become separate individuals and, you know, toddler, their job is to kind of see what they can get away with and, and push your button exactly that and push your buttons and try something. And if they love the carb heavy, which is very common. And actually, we also think that there may be, you know, carbohydrates, our brains run on simple sugars and carbohydrates. And for these kids where they're growing, not to be afraid of carbohydrates, certainly want to offer lots of different foods, but they often will prefer the carbohydrates, the simple energy, and often, you know, wonderful textures and all kinds of different things.

Dr. Katja Rowell (15m 35s):

So you might see them preferring carbs. And so the 12 to 15 month old or 18 month old, you put a variety and they might, you know, scrape their non favorites off and pitch a fit and see if you'll make them or bring them their favorite food. And this happens so often. And then the problem then with typical picky eating is that we see that parents decide, oh, you know, he doesn't like bananas anymore, or he or she doesn't like broccoli anymore. And then it stops showing up. And so knowing that the typical picky eating phase that they go through, these sort of they'll drop foods that they loved for three months, they won't eat them, even if they keep showing up and then they'll come back to it, but it has to keep showing up.

Dr. Katja Rowell (16m 18s):

And that's the hard part. And probably one of the most common missed opportunities that I see is when kids head into this picky eating phase and then parents suddenly kind of stop in their minds and they start crossing off. Well, they don't eat bananas anymore. They don't eat broccoli anymore. They don't eat avocados anymore. They donate, you know, whatever it is. And then you start to cone down. And then when I work with kids with extreme picky eating, and they're three, four, five, and they're only eating 10 things. And then we actually see that they've only been offered those 10 things for the last 18, 24 months. So if there's any advice to help make it through or anticipate that typical picky eating stage it's don't stop offering those foods.

Dr. Katja Rowell (17m 4s):

And my daughter, one of her first words was Nana for banana. And she had bananas. Like they were going out of style for three or four months, and then didn't eat them for six months, but they kept showing up and then went back to eating them and other foods came and went. But the most critical piece is to keep the foods coming that you want them to enjoy, to eat into adulthood. So that's one of the kind of key things I want to get out about typical picky eating. And if there's worry, here's that word again, that worry. And that anxiety, if you're worried like, oh my child isn't big enough or I I'm worried about protein. And I know that he eats chicken nuggets. So I give him chicken nuggets every night because I'm worried about protein, you know, always kind of digging down and going, well, what am I worried about?

Dr. Katja Rowell (17m 50s):

Am I worried? They're too small. My word, they're not getting enough protein or enough vegetables. And usually it's those worries that cause us to kind of trip up in terms of offering the best opportunity for feeding. So anyway, so that's kind of a picture of typical picky eating. So they'll get upset if they don't have their favorite food, but they usually can come down and they can eat foods from other things that are offered usually. And not every meal. You know, they might have a meal where they pitch a little fit for five minutes and then they don't want to eat, but they come back the next eating opportunity and they're able to eat. They usually eat some foods from all the food groups.

Dr. Katja Rowell (18m 30s):

So they get a bit of a variety and extreme picky eating. On the other hand, often you might see a child 12, 15 months. Who's never once eaten a vegetable or never once eaten a fruit, even though they were offered. So they might avoid entire food groups, usually with extreme picky eating, especially if you see it in the infant years, there are other signs that there are problems. So maybe there were really severe challenges with breastfeeding or with, you know, finding bottle feeding that was working or they are losing. Weight is certainly a huge red flag.

Dr. Katja Rowell (19m 11s):

Sometimes kiddos will sort of fall where they stop gaining weight for a little while. Some of that is a normal growth pattern, but it really needs to be investigated and looked at. You know, let's look at the big picture if, if sort of the weight gain is slowing down, which again can be normal, but we want to look at the big picture. So any weight loss we need to take very seriously, any signs of pain or discomfort or anxiety. If you put your child in the high chair and they're riving to get out and they're crying and they're upset, or they look afraid, or you find yourself kind of pushing or anxious at meal times, then you need more support, you know, and whether or not there's a serious underlying problem or another challenge.

Dr. Katja Rowell (19m 55s):

If mealtimes are fraught with anxiety and you're worried, then you need to learn more and get support that you mentioned that

Katie Ferraro (20m 2s):

The weight gain issue, because so many parents think it's been two days and my baby hasn't really eaten any food. And one of, I think the beauty and benefits of baby led weaning is that in the six to 12 month period, as you're allowing your baby to explore all these new foods, you have an insurance policy in the background, which is breast milk and or formula. And that most of the baby's nutrition continues to come from that in the first few weeks and months of feeding. So even if they're not eating a lot, that's okay. And I think that helps really lower parents' anxiety when they realize it's okay, that my baby's not eating X number of tablespoons or X number of grams or half a cup of this or that because they, they see these portion guides and, and then they worry, my baby's not doing that, but I love that you point out, listen, you know, one or two meals, they might have a few days, they don't have great intake, but if it doesn't affect their growth and their weight, and they're staying on their growth pattern, we really need to look at the bigger picture here.

Katie Ferraro (20m 57s):

And I think those objective measurements like weight and growth charts without getting too obsessed on it helps parents realize, oh, okay. You know, this is just a snapshot in time. This is maybe not indicative of a trend.

Dr. Katja Rowell (21m 9s):

Yeah. And, and I, you know, I have this visual, I, you know, I just put my finger in the air and I just go up and down like kind of a, you know, a zigzag, but that is typical eating and an absolutely six, seven, eight, nine, 10, you know, at the early time, most of the intake is still from the breast milk or formula. And then, you know, by 12, 15 months, it should be that most of it is from solids. And if they get sick, you know, all bets are off for a week. If your child has a stomach bug or an upper respiratory infection, it's okay. If they go back to getting most of their calories, you know, for, to drinking that. And that's a time to when parents get sort of worried like, oh, they're, they haven't eaten for five days.

Dr. Katja Rowell (21m 50s):

And well, they, you know, they're completely congested. Maybe their sense of taste is off. So, so I think that the more we can just sort of take a breath and, and if we're worried too, to find out, do we really need to be worried? And, you know, growth is such a tricky thing as so much. Now there is sort of this also this panic about obesity and so babies with big appetites or bigger on the growth charts also, you know, often will elicit some worry from parents or physicians and like, oh, we have to get them to eat less, to prevent obesity, quote unquote. And, and you know, the more we try to feed either to get kids to eat more or get them to eat less, generally, the more we mess with that internal wisdom.

Dr. Katja Rowell (22m 38s):

And it's so okay for some babies to eat a lot at some meals and at some snack, you know, time eating times, and it's okay for some babies to eat less. There's actually a huge variety in terms of what, you know, what children will eat. And so the portion guides, I think, you know, I had a child who ate two to three times often what the recommended portion was, and, and that scared me too. So we recognize that sometimes they're going to eat really big meals maybe, and sometimes, you know, just like half a blueberry and that it's okay, you know, to have to see this wide variety and that the, you know, the portion guide is just mostly, I see that as like a tablespoon or a this, and then if they eat it and want more, they can have more.

Dr. Katja Rowell (23m 22s):

And if they leave food, that's okay, too. So, so, you know, we don't need to be afraid of these appetite variations that are very normal. I also wanted to mention the growth charts are really tough because, and I was really surprised to read this study that more than half of infants in the first six months of life will cross percentiles on their growth curves. And not just like two to fourth percentile, like, you know, 10th to 40th, there's this, you know, like, like significant ups and downs can happen. And so it's really important to not immediately panic. Like let's wait and get another, follow-up wait as long as everything's going.

Dr. Katja Rowell (24m 3s):

Okay. And then usually we'll see like, oh, well, there's a little bit of a height, growth spurt. And so while it looked like on weight for length, like it looked like, oh, they're getting chubby. It's like, well, we were just waiting for the height to catch. Or even

Katie Ferraro (24m 16s):

At that same appointment. Sometimes if you watch the way they obtain height in the typical pediatrician's office, a tiny little kick and your baby looks two inches taller, you plot that on the growth chart, parents freak out. So I always encourage parents be an advocate. I always am a little bit type a, but I always get my baby's height and weight at home before I go to the pediatrician and just compare it. And I have no qualms about asking two or three times for a reweigh or re height, especially if it looks like the baby's falling off the growth chart, same thing with iron checks, you know, they're, they're doing the heel stick and you can get a second and third request. You might leave the office feeling terrible. My baby fell off the growth curve and their iron's low when maybe a second or third opinion or chance there. And sometimes there truly is a problem.

Katie Ferraro (24m 56s):

And we need to acknowledge that.

Dr. Katja Rowell (24m 58s):

Yeah, I'm not saying that absolutely. That these things don't matter what I'm saying. And that's a great point. I actually have a slide in a lot of my workshops, feeding professionals is that we're super inaccurate. Like I had a parent of an almost three year old who was being considered for actually having a feeding tube. They were really, really struggling and low weight. And the mom called me and was hysterical. She said, last week they weighed my child in boots and like jeans and the undershirt and this time just an underwear. And they're like panicking that she's lost two pounds and I'm going, are you people, you know, you're kidding me. So unfortunately we do often have to advocate. And you know, you don't know if you have someone who's just fresh out of training or they don't know the protocols,

Katie Ferraro (25m 40s):

We're busy. And there's like a bunch of patients backed up and they, you know, they, they, they mark your baby's head and they mark your baby's foot and measuring between that. And when your baby can stand, they should always be using a stadiometer with your child is positioned upright, but before your baby can stand, we can't do that. So, and I love what you said also that even within your own family, like you had one child who ate twice as much, I have two sets of multiples. So a set of quadruplets and a set of twins. And with my twins, boy, girl twins, not to gender stereotype, but the boy routinely eats twice as much as the girl. And yet they're both fine on their growth curve, their iron levels. But if I only had that one kid and thought, gosh, two years ago, did my other kid eat twice as much as a registered dietician who teaches primary care practitioners at the university level medical school students, I politely remind parents that 90% of physicians in this country have never had a dedicated nutrition course.

Katie Ferraro (26m 33s):

And so parents go to their pediatrician and ask questions. And a lot of times they do get either outdated or incorrect information. And I'm in no way, dissing pediatricians. Many of them are very well-informed and up-to-date on current research. But in some cases, there is a situation where you're going to require additional help beyond what your pediatrician can provide. And so I wanted to ask you Dr. Rowell, if a parent does suspect that their baby has extreme, picky eating or something, that's not typical that you've been describing today, who should they contact for additional information?

Dr. Katja Rowell (27m 6s):

Yeah. This, you know, I think this I'm so glad you're training these upcoming physicians and primary care folks, because this is a huge to me, this is a crisis in terms of helping like that story. I told you earlier, you know, what that mom described was a totally typical feeding blip that this pediatrician wasn't able to give the, the most basic, you know, support. So one in three parents will ask their doctor for help. And, you know, I'm in my late forties and I went to a top 10 medical school. I had nothing on this. And when I went to a, you know, respected primary care program you're right. It was one lunchtime session on breastfeeding. And then we had a dietician come in and talk to us about low-fat fat-free cream cheese and what not.

Dr. Katja Rowell (27m 55s):

And I know you've changed your tune, but the problem is, is that a lot of the folks who've been in practice for a long time habit. So I'm so glad you brought it up because if you are going to your child's doctor and they're giving you advice that is making things worse and that you feel like, oh gosh, you know, this just isn't helping. It's okay to, you know, educate yourself and, and maybe even finding another pediatrician or another family doctor. So it's, you know, very tricky when the people that my clients are going to are same things like just make them eat it, or no child will start themselves. Very rarely. Children will end up really struggling. And so, you know, if you do have a child who's losing weight or they seem to be in pain or uncomfortable, and, you know, I think starting with your pediatrician is a good thing.

Dr. Katja Rowell (28m 46s):

And, and hopefully they'll listen to your concerns and be able to do a physical exam and any indicated lab work. You don't have to necessarily get lab work, but sometimes if it's indicated, so we might look at iron or depending on the circumstance may be led or some other lab work. And, and then, you know, from looking at the big picture, you know, it may be, if you're, let's say you boy, we had a terrible time with breastfeeding and we're, but then things went well with the bottle. And now we can't get off of purees. Like they can't seem to manage, or they're gagging frequently. Then a feeding therapist is an appropriate step.

Dr. Katja Rowell (29m 30s):

So a speech language pathologist who focuses on speech, or sorry on feeding is somebody that can be incredibly helpful and wanting somebody who can do a thorough exam of, you know, the tongue and the structures. If there's an indication, you know, gosh, we've never gotten off the bottle or pouches, you know, the feeding pouches, those little pouches of squeezy pouches, you know, there, there could be a tongue tie. I think we're over-diagnosing that too right now, but we have seen those being missed. And so having someone who can look at the structures of the mouth, so a speech language pathologist, sometimes a pediatric dentist. And I'll give you a resource to put on your list for that.

Dr. Katja Rowell (30m 12s):

And, and always just asking questions, you know, am I, I'm worried about weight? Do I need to be, I'm worried about protein. Do I need to be? So a lot of what we put in our book, helping your child with extreme picky eating is for people who are wondering is what I'm seeing typical, or is it more extreme? And we actually spent a lot of time reassuring and, and we've spent some time on how much protein do they actually need. And it's usually less than parents think.

Katie Ferraro (30m 37s):

And thank you for saying that because protein gets this huge, you know, parents over focus on protein and then they project their feeding behaviors onto their children. And one thing I love about your book is that you did write it in conjunction with an SLP who specializes in feeding and is a feeding therapist, because as a dietician, I'm qualified to talk about what you can eat, but the logistics of learning how to eat it, it should be in, in the realm of the person who's trained to do that. And not all SLPs are trained in feeding. So it's important to find those who've had the additional training to become a feeding therapist.

Dr. Katja Rowell (31m 9s):

It can be very difficult to find that help, especially if you're somewhere where maybe that help isn't available within a hundred miles of you. So, so it's really difficult. And I think that whatever the challenge or the struggle is learning how to maybe not make it worse is, is also a really important point. And so, you know, recognizing that the battles that the trying to force out of that worry, or, you know, pushing with the feeding often make these problems worse. And so we do see sometimes kiddos where let's say they had a GI bug. You know, I worked with a three-year-old where at 10 months they had hand foot and mouth illness.

Dr. Katja Rowell (31m 49s):

So they had these awful painful ulcers in their mouth and ended up in the hospital and with a, you know, a little tube in the nose to feed them while the ulcers healed, but the parents out of desperation and, and they're often told by doctors do whatever you have to, to get food in. Right? And so then we see parents clamping heads and pinching noses, and, you know, getting into really what parents know that just feels awful, but they're terrified. So this family got into this cycle of forcing this kiddo to eat because they had no support and got really bad advice. So even after the mouth ulcers healed, they were now stuck in that, that spiral, that vicious cycle of pushing the child and then the child resisting and having more and more negative experiences associated with eating.

Dr. Katja Rowell (32m 38s):

So if you're struggling is trying to find, you know, how do I not make this worse? Where can I get good support and good help. And ideally everyone would live near and have access to a speech therapist or a, you know, pediatric dentist who could help them figure this out.

Katie Ferraro (32m 54s):

And some of them increasingly are offering tele-health services at the time of this recording. We're in the middle of the coronavirus quarantine, and I'm not all, but many feeding therapists are having to get up to speed on doing this. And when we talk about some of these parents are scared of the idea of feeding therapy, and I always remind them that like the situation you were just describing, that's certainly scary and not typical, but for many, many situations, a few sessions of feeding therapy can be wonderfully. Like it can, it can solve all your problems. The feeding therapist can help you identify if there truly is a problem. If there is give you some oftentimes very simple, practical, straightforward interventions you can do, and then you don't have to be in therapy for the rest of your child's life.

Katie Ferraro (33m 34s):

I think for some were scared of that word therapy. So thank you for shedding light on this important area of, of involving a feeding therapist when we need to. And I was curious if you could just provide us with any final thoughts. Our audience is interested in baby led weaning as a method for helping to prevent picky eating down the road. So if you have any last insights on how allowing the babies to sell, feed, how we focus on, I love you always talk about as well as I do teaching our babies, how to eat, why this is important for preventing picky eating down the road.

Dr. Katja Rowell (34m 5s):

Yeah, I think, I think baby led weaning is just such a great philosophy and practice and, and way of feeding kids, because it really focuses on autonomy and relationships, right? So it, it absolutely by design it's autonomy, you know, everything that the child puts in their mouth, they do it themselves. And whether it's a spoon, you know, that they push it in there themselves or, or the toast fingers or whatever it is. So it really focuses auto on autonomy. And I think there's some promising research and we certainly see that when the kids have autonomy and they have that sense of competence, right. I just had a paper published with a wonderful PhD candidate in England about this idea of the basic human needs, basic needs theory, self-determination that to thrive, we need autonomy competence and relatedness and baby led weaning like hits all three of those.

Dr. Katja Rowell (34m 58s):

If we're not fighting over the spoon and we can come to the table in a calm, you know, open, joyful mindset, even if it's stressful getting food on the table, leaving space for that connection, that relationship and we're children feel safe at the table. They're enjoying the company of other people it's important in the infant stage, but this then carries on and sets the stage as toddlers to continue to eat based on cues coming from their bodies of, am I hungry? Am I full? So they're more likely to grow, to have a body that's right for them.

Dr. Katja Rowell (35m 38s):

So we see less of that kind of extreme where they're falling off the growth curve or rapid weight gain beyond, you know, maybe what they're genetically predisposed to. So we tend to see more stable weight growth patterns, where they have a good relationship with food and it's not sort of fraught. And, and when I look at, as a family doctor, part of why I did this work is I've seen teenagers with eating disorders. I've seen college students really, you know, eating disorders are, are, are lethal. In many situations. I've seen folks in the middle of years and beyond really struggling with their relationship with food.

Dr. Katja Rowell (36m 19s):

And it impacts all aspects of their lives, the joy, you know, if you're, if you're counting points or you're, you know, you're focused all day on that dessert you can't have, or, or, or I'm not eating enough for this or too much of that, as well as issues in terms of chronic health problems and inflammation. So, so to me, it's this wonderful preventive medicine sort of holistic way of raising individuals who feel good about food and, and can listen to and tune into their bodies in terms of hunger and fullness. And we know also that adults who are eating competent, it's this construct for melon, sadder, that adults who are eating competent also tend to be happier and, and healthier in measurable ways and less disordered eating and dieting.

Dr. Katja Rowell (37m 9s):

So I think it just sets them off for, for a great foundation. And, and I'm so thrilled that your resources here and that there are more and more resources for that.

Katie Ferraro (37m 17s):

I'm so happy that you mentioned the eating competence, as well as the autonomy. I knew I was going to love your book. We opened it up. The very first page has part of the, the forward or the, the advanced praise is from Jessica Setnick the eating disorder expert. Who's one of my dear dear friends. And she calls her book finally, an antidote to the infuriating trend of books about tricking children, into eating. Like there's an eating disorder specialist who sees at the other end of the spectrum, what the results of these behaviors can be certainly eating disorders, very multifaceted, lots of things potentially contributing, but we don't need to trick our babies. They actually can do this from the outset of being able to eat foods.

Dr. Katja Rowell (37m 56s):

Yeah, it's very trusting and it's very respectful and we can trust, even if they do it a little slower than their sibling, or then the, you know, the kid on the Instagram, you know, if they come to it and they're, you're seeing progress and they're happy at the table, even if it's a little slower than their peers,

Katie Ferraro (38m 15s):

Way less work, like to have a baby that feeds themselves. I mean, and I think parents really start to realize that it's, it's one of the few things that appeals to a second time parent. Like if you have an older picky eater and you struggle with spoon-feeding wait a minute. If I take it a little slower, wait until the baby's ready, this baby can learn to feed themselves and eat a wider variety of foods. So, well, thank you so much for sharing your time. You guys, I will be linking up all the resources that Dr. Rowell mentioned in the podcast episode today on the show notes for this episode, which is at blwpodcast.com slash three six, and you can find out more about where to find her. We'll be linking her Instagram to her Facebook as well as to her books in a number of different feeding resources. So thank you so much again, Dr.

Katie Ferraro (38m 55s):

Rowell.

Dr. Katja Rowell (38m 56s):

My pleasure. So I hope you guys enjoyed that interview with Dr. Rowell. Well, again, I'll be linking to everything that she covered in today's episode at the show notes page, which is BLWpodcast.com/ 36. I don't know about you. I could listen literally to her talk forever. I actually stayed on after the interview for an hour with her, like picking her brain and asking her opinion. I love being able to bring you guys these resources as well. And thank you to the parents who asked for this episode. I know a lot of you guys are concerned about picky eating, and I hope that after hearing what Dr. Rowell had to say, I hope in many regards, she helped you allay your fears about picky eating. If there's one takeaway message, you guys it's that about 50% of children will experience some degree of picky eating starting in the second year of life.

Katie Ferraro (39m 40s):

So one of the best things we can do is expose our babies to the greatest number of foods and flavors and tastes and textures, which is exactly why I developed the hundred first foods program for starting solids with baby led weaning, right? Cause if your baby is going to lose 10 or 15 foods to picky eating in their second year of life, and your baby only has 10 or 15 foods under their belt, by the time they turn one, that's going to be a very challenging child to feed. However, if your baby has tried a hundred different foods and you lose 10 or 15 of those to picky eating in the second year of life, it's really no big deal. So if you guys want to grab my hundred first foods list, I give it to everybody on my free online workshop, which is called baby led weaning for beginners.

Katie Ferraro (40m 22s):

I host that workshop a number of times each week. If you go to the show notes page for this episode, again, that's, BLW podcasts.com/ 36. You can click to sign up for the workshop there, and you can also find all of the other resources that Dr. Rowell mentioned in her interview today. And I'm hoping that even if picky eating is part of the future for you, I hope that it won't be that bad. I hope that baby led weaning will alleviate some of the pains associated with your baby, becoming a toddler and possibly becoming slightly more picky. And also if you are struggling with extreme picky eating, I hope that Dr. Rowell her work and a lot of her research and the resources that I'll share on the show notes page, I hope that they can help you get the problem under control so that you can move forward as a successful parent.

Katie Ferraro (41m 9s):

So, thanks again for listening to this episode, all about preventing picky, eating from baby's first bites with Dr. Katja. Bye now!