Building Sensory Enjoyment at Mealtimes with Karen Dilfer, MS, OTR/L

Katie Ferraro (0s):

When it comes to the allergenic foods, there's one that parents always complain about making safe for their babies. Can you guess it, it's shellfish. Shellfish is hard, especially if you don't cook a lot of shrimp or crab or crustaceans or mollusks regularly. But this week I'm making shrimp, which is the type of shellfish for baby Ezra. So he's my friend's baby that I'm making all of his 100 First Foods and each week, I prep the five new foods for the following week. So we're going into week eight of my hundred First Foods daily meal plan and the five new foods that Ezra is gonna be trying this week are plum, parsnip, quinoa, bison, and then shrimp for his allergenic food. And so for shrimp, I'm doing this really simple Thai shrimp cakes recipe because I do not do whole intact cooked shrimp for early eaters.

Katie Ferraro (47s):

It's not safe, but you can make shrimp safe for babies with a few simple modifications. If you're interested in learning more about, oh, how do you actually make these foods safe for baby-led weaning and you wanna see it, the best place to get started is my free online video workshop called Baby-Led Weaning For Beginners I just redid this whole training. It's so good. There's so many visuals of how to prep the food safely and ideas on what to feed your baby for the first 10 days of baby-led weaning, plus a whole section on making allergenic foods like shrimp safe for your baby to eat. Everybody on this workshop gets a copy of my original 100 First Foods list, so you'll never run out of ideas for your baby to eat. You can sign up at workshop.babyledweaning.co.

Katie Ferraro (1m 29s):

You can register, you can take it now. You can take it later today when your baby's napping or sleeping, or tomorrow if you've got some time, can clear your schedule to really dedicate yourself to learning about how to do baby-led weaning safely. Again, that signup is at workshop.babyledweaning.co and I'd love to see you there. Has your baby tried the potentially allergenic food tree nut yet? So Tree Nut is separate from peanut. It's one of the big nine allergenic foods. Those are the foods that you wanna introduce early and often to help prevent food allergy. But we can't do thick globs of nut butter or intact nuts for babies because these are choking hazards. So my favorite way to introduce tree nut is by using the Puff Works baby Almond Puffs. So Puff Works baby Almond Puffs.

Katie Ferraro (2m 10s):

They're not those little tiny star puffs that you see at the store. You buy these online, they're longer shaped, they're kind of like the length of a Cheeto, I would say, and they have no added sugar and just a smidge of sodium for preservative, which I love. The Puff Works baby Almond Puffs are also super soft, so they dissolve really easily in your baby's mouth. And these are safe to offer even before your baby has teeth. You can get 15% off the Puff Works baby Almond Puffs with my affiliate discount code, "babyled", you go to Puffworks.com and just a heads up that the Puff Works, baby Almond Puffs also contain peanut. So make sure you've done peanut a number of times on its own without reaction before you try out the Almond Puffs. If you're over on their site at puffworks.com, pick up a case of the baby peanut puffs and then a case of the baby almond puffs.

Katie Ferraro (2m 56s):

And that way you've got two of the big nine allergenic food categories knocked off in a no-stress low-mess way. Again, the code for Puff Works is "babyled" for 15% off at puffworks.com and happy feeding.

Karen Dilfer (3m 13s):

We are thinking about giving kids experiences that are helping them learn about themselves and also tap into their own internal motivation to want to eat. And when we think about enjoyment and we think about sensory. We can give kids so many experiences that first of all, they feel really good. And second of all, we can think about giving kids experiences that just fire up their curiosity.

Katie Ferraro (3m 38s):

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 a confidence and knowledge you need to give your baby a safe start to solid foods using baby-led weaning, sensory enjoyment, sensory processing, sensory challenges. What emotions or feelings do these terms around the words sensory conjure up for you as you're introducing new foods to your baby?

Katie Ferraro (4m 18s):

Well, my guest today knows a lot about sensory stuff. That's my term, not her term. Her name is Karen Dilfer. Karen is an occupational therapist, she's a feeding specialist and she helps children who have motor sensory and mealtime challenges. Karen's based in the Chicago area. She's a founding member of the Chicago Feeding Group. She's neurodevelopment treatment trained NDT trained, and she has some postgraduate education in sensory integration. So Karen, you might recognize her name 'cause we've talked about her a number of times in the episodes with Marsha Dunn Klein. So Karen works with Marsha Dunn Klein as well as Stephanie Cohen, another guest who's been on the podcast before a number of times they collaborate, they teach together and they teach about using the sensory aspects of food.

Katie Ferraro (5m 4s):

And so in therapy they work with children and babies who have sensory difficulties. But today we're gonna be talking about building sensory enjoyment at mealtimes. So with no further ado, here is Karen Dilfer talking about how to build a sensory enjoyment at mealtimes with your baby.

Karen Dilfer (5m 25s):

Hi there, how are you?

Katie Ferraro (5m 27s):

I am wonderful. I'm so glad you, it's taken us a while to get this interview together. I feel like I've been hounding you for a year, but I am so excited to chat with you today about building sensory enjoyment and talking about mealtimes and babies. But before we get started, could you tell us a little bit about your professional background? What drew you to helping children who have feeding challenges?

Karen Dilfer (5m 47s):

Yeah, absolutely. Thanks so much for having me on. I just wanna say that I am a person who has always loved eating. So sometimes I'll joke with my friends that eating is both a personal and a professional interest. So I, remember when I was in graduate school and I was studying to be an occupational therapist, I was always just drawn to the content that had to do with food, in part because I love eating food has always been a big part of my life. And I kind of got fascinated by the concept of what happens if a person is struggling to eat? What's the experience like for that person? What's the experience like for the parents of that child? In part because eating is such a central part to being a person. There's this great James Beard quote I always think about and it says that food is a universal human experience and If you can't eat or you struggle to eat or you enjoy eating.

Karen Dilfer (6m 36s):

How does that really influence your participation in connecting with other people, having relationships and maybe even maybe even being a person? Right. So I was always just really interested in food and eating and I had been practicing as an occupational therapist for about five years and the clinic where I was working would have these wonderful continuing education seminars and it just so happened that Marsha Dunn Klein came to our practice and was giving her talk about tube feeding with love. And after just listening to Marsha and being a part of that conference for two days, I was like, this is it. Like this is everything I want to do as a professional.

Karen Dilfer (7m 17s):

I was just so drawn to her work and really drawn to the message and how she got at the, the idea that eating was not just about food, eating was about love and connection and relationships. And that resonated with me at a deep, deep, deep, deep level. So the funny thing was that when Marsha was visiting Chicago, she was telling me about how her son, who was a little bit younger than I am, who is also a physical therapist, had just completed a fellowship with the Denver Broncos and she started telling me that, you know, Karen, occupational therapists need to have fellowships too. So we can have these advanced clinical experiences so more therapists can learn these, you know, specialty areas of practice.

Karen Dilfer (7m 58s):

And I said, Marsha like this is amazing. Like I'm your person. I would like love to learn more about the way that you think about feeding kids and supporting families. And then Marsha was really sweet and very nice and she said, you know, Karen, it's so nice that you're interested in this but really you live in the wrong part of the country. And you know, they were kinda looking for someone to do this fellowship who was like kind of the new graduate. And I had been practicing for a number of years. So anyway, time passed and I was pretty persistent in making phone calls and writing emails. And roughly a year later I found myself in Tucson, Arizona and I worked with Marsha at her clinic for about a year.

Karen Dilfer (8m 39s):

And it was an amazing experience and that I really learned what it looked like to support parents and kids and to support their relationship as kids learned to love eating.

Katie Ferraro (8m 51s):

That's wonderful. My next question was gonna be like, tell me more about how you do Marsha, but I never heard that backstory. I also, every time I go to Tucson I just call her, I'm like, can I come over and hang out and just talk to you? You're one of my favorite persons in the entire world. I think she's lovely. She's been so generous with her time. She's been on our podcast a ton and I, I really love how gracious she's been towards other people in the feeding world. Not she is an OT, she is known as an OT but also SLPs and other dietitians and really acknowledging that as you said, it's not just about food, meals are about love and connection and relationships and that's such a unique perspective from a therapist standpoint because especially as dietitians, like no food is all about calories and milligrams. Like no it's not.

Katie Ferraro (9m 31s):

It's about love, connection and relationships. And I love that Marsha's kind of set that tone and trained at this point, you know so many different practitioners but I always know that you and Stephanie Cohen has been on our podcast as well and Marsha, you guys work together with the Get Permission Institute sharing, you know, If, you don't mind share. Could you tell us more about the work you do with Marsha and Stephanie in Get Permission Institute? Like what, what is about their approach that was appealing enough to you where you're like, I'm gonna go to Tucson for a year and and learn to work with Marsha?

Karen Dilfer (9m 58s):

I know I, it was funny, I always tell people, you know, I packed up all my possessions and I put them in my small city car and I recruited a friend and we drove across the country and I essentially moved to Arizona. And when I moved there I wasn't sure if I was gonna live there forever or if I was just gonna live there for a short amount of time. But you know, it ended up being a great experience and something I will never, never, never regret. You know, part of the reason that I was so compelled to move was because I felt like there was, you know, the emotional aspects of eating are so important and I think that that is something that I've grown up with and something I've always sort of known in my gut for my whole life. You know, like I can tell you stories about like when I was a little girl and I'd go over to my grandma's house and like we'd make cookies together and it was like this really fun thing and it was like so fun to be with her and to make these delicious cookies.

Karen Dilfer (10m 43s):

And I mean she's passed away a number of years ago, but to this day, like my mom will make the cookies at Christmas and like we eat them and they're so special. You know, so I think that there's a big emotional part of eating for a lot of people. And I think if we neglect that in our work with our clients, we're, we're fooling ourselves.

Katie Ferraro (11m 1s):

And I also think you keep mentioning like the emotional aspects of eating as a dietitian, when you hear those terms you immediately think eating disorder, eating disorder, those are the dietitians who go and work in eating disorders and yet only a small percentage of people who eat have an eating disorder or disordered eating. And yet all people eat and all people have emotions. So there's this whole swath of people I feel, especially from the nutrition standpoint is all I can speak from the clinicians are ignoring that emotional side. Oh I don't work in eating disorders. Oh, so you don't work with emotions. Like when we work with babies, it's all about the interpersonal and sharing love and connection and relationships so that then the toddler wants to cook with the mom and the grandma is making cookies with the school age.

Katie Ferraro (11m 43s):

Like we lay these foundations in infancy and I feel like at least in my profession too often we just, well I'm not an eating disorder dietitian, So, I don't speak about emotion. So I love that you, Marsha, Stephanie, you guys are always kind of drawing back the emotional aspects of eating and that's so important and I love that story of making cookies with your grandmother. 'cause I think everyone has some aspect of food that's emotional, good emotions, bad emotions, neutral emotions, whatever the case may be. We do need to address the emotion is involved in mealtime.

Karen Dilfer (12m 9s):

Yeah and I mean I'm just gonna say I'm a clinician. I mean occupational therapist people come to see me because their child is not eating or is not eating well or like something is going wrong and you know, parents are really upset when they come in and for good reason because we all kind of know that, you know, a parent feels responsible for feeding their child. And also, I mean I don't think it's a stretch to say that you know, parents love their child by nourishing them with food, right? We wanna see our kids eat, we wanna see our kids grow. And so when that process isn't playing out in a way that seems typical, of course people are really, really upset. And so again, I think that that identifying that, having skills as a clinician to address that and then talk about how our work together in therapy can begin to, I mean help a child eat but also help a parent's emotional experience in connecting with their child.

Karen Dilfer (13m 2s):

Like it's so important.

Katie Ferraro (13m 4s):

I know you have completed postgraduate education in sensory integration. Could you tell us a little bit about this idea of sensory enjoyment and then what types of children do you see in your clinical practice who are having sensory challenges?

Karen Dilfer (13m 29s):

Yeah, so, I'm so glad that you asked me about sensory stuff because I wanna say I feel like there's a lot of information out there and I also feel like it's a topic that's just a little, I don't know, like it's not always like really clear.

Katie Ferraro (13m 41s):

Exactly. Which is why it makes for very interesting Instagram content parents, like they love the word sensory because not, it's not fully understood. And, we were having a conversation before the interview that like there's so many different interpretations depending, you know, what side you're coming from, what area of expertise you're coming from, just the choice of the use of words. I think it kind of opens up this Pandora's box. So I guess I'm asking, you know, what does it mean to you in your own occupational therapy feeding practice?

Karen Dilfer (14m 7s):

Yeah, so if we start from like the perspective from 40,000 feet, what I would tell you is that people everywhere process sensation, and this should not be a novel idea, right? Like maybe today you got up and it was a little cold where you lived 'cause it's a little cold in Chicago today, it feels like fall. And I thought, oh wow, it feels cold here I'm going to put on a sweater. And I found my favorite fuzzy sweater and part of the reason I picked it is because I know when I put it on, I like the way that it feels on my skin, right? It's soft, it's kind of cuddly. It will keep me warm on the cold day. So there was a sensory choice in me choosing that shirt, right?

Karen Dilfer (14m 48s):

And so the idea of sensory processing is that sensations are coming into our bodies through different channels, right? With my sweater example, it's the sensation of the sweater is coming to me through my skin. My nervous system is transmitting that information to my brain. My brain is saying, oh you know you're wearing the fuzzy sweater, you like that? And there there's a response, right? And in my case the response is enjoyment. This feels good, I'm glad I put this on. We can think about sensory processing in relation to things like motor skills, right? If, you are rock climbing for example. You know, because that's an activity that's kind of a challenging motor activity that you know kids or grownups might do.

Karen Dilfer (15m 30s):

You might feel the little rock climbing hold on the wall and your body might respond in a certain way, maybe by you know, extending your knee to stand up on that hold to climb up the wall, right? So sensory processing is something that we all do. We feel sensations that go to our brains, our brains helps us make sense of the sensation and then we respond. And I'm just gonna say that there's like a bell curve of what we might consider like typical responses, right? The response meeting like oh I like the sweater, it feels good. You know, that's kind of like a typical response but If, you think about a sensation that's maybe, I don't know, less preferred or different, you might have like a response that's too big or maybe a response that doesn't seem big enough.

Karen Dilfer (16m 19s):

For example, maybe you put on a fuzzy sweater and you don't really like, like wool 'cause it's like itchy and scratchy. And so you put the sweater on and then all of a sudden you cannot tolerate, you can't think, you can't function, you're like scratching yourself. You're like how do I, how do I take it off? Do I have a different sweater? Right? That might be a indicative of a response of someone who has difficulty processing what I'm gonna call tactile information or that specific tactile information. Right? And I think the thing that like trips us up is, is providers and as people is that everyone's sensory systems and everyone's sensory preferences are different. Yeah. Like

Katie Ferraro (16m 58s):

Who gets to say I, you know the the big emotion stuff like I don't know, I have seven kids, So, I see lots of different ranges of emotion and you kind of get an idea of what a baseline is and like, oh that's not typical 'cause I've seen this before, but when it's your first kid you have no clue like who's determining what a big response is. And then you know, how do we quantify this for a clinical setting? Like I I see where a lot of the challenges come in because a lot of this is subjective observation.

Karen Dilfer (17m 25s):

Totally. And I mean I think the thing that's tricky is like sometimes you're seeing someone have a big response and you're like, is that normal? Is that okay? Should I be worried? You know it, it's funny when I think about like my sweater example, I love wool sweaters but my mom will not tolerate them. So like one year for Christmas I bought her a wool sweater and I don't think I realized like how much she hated it and until she puts it on and she's like, I can't do it, I can't do it. You know, and so I think that we see like a similar response in kids with eating, right? Like I mean you've seen that you give your little one applesauce on the tray and all of a sudden like the fingers are up, maybe there are tears or throwing the spoon. Like something about that sensation, either the way that it feels or the way that it looks or smells like is not working for that child in that moment.

Karen Dilfer (18m 8s):

Everybody is different, right? And everybody's preferences are different, everyone's taste preferences are different. Everyone's, you know, preferences for being messy is different, right? Like you know like some people love to be messy and some people are like there is no way I am touching anything that's smooshy or gross, right? So, I think that you know, we are right to say that there is a wide range of what we might consider normal or typical. I think the thing that begins to be a problem for folks is when these sensory preferences of kids just like totally and completely prevent them from having eating experiences, right?

Katie Ferraro (18m 42s):

Exactly. The parent who's constantly wiping the baby's mouth with a wet wipe every time that there's a dribble of food or constantly wiping them down when they touch the food. At which point you know that I would not want to learn how to eat if I was constantly being attacked by a person with a washcloth or a wet wipe.

Karen Dilfer (18m 55s):

Yeah. 'cause that doesn't feel good. I mean and most kids don't like that. Some might be okay with it but, but a lot of 'em don't. To go back to your question, do we need to be worried if kids don't like certain things? No, but what I am gonna say is I think that in a responsive, attuned parent that parent realizes, oh my child does not like this, doesn't like this flavor, doesn't like this group of textures. Write whatever it is. And that parent is able to first of all identify it and then second of all think about what does my child enjoy and how can I start from there? And I think that's the magic that we don't often talk about in our, our Instagram feeding world.

Katie Ferraro (19m 33s):

And I love that before the episode you did acknowledge that you spend this little time on Instagram as possible, which I appreciate that. 'cause I think sometimes parents come like Katie, I think my child has a sensory processing disorder. It's like why do you think that? Oh 'cause they don't always like touching the meat in the bowl. Oh so they're just being a baby. Again, I'm not making light of the situation. I wanna talk about what real sensory challenges are, but I think we live in this era where we're very quick to over pathologize what's happening at mealtime when your baby doesn't know how to eat yet we need to give them, it's like, as you said, the 40,000 foot view back up and look at the weaning period is an opportunity for your child to learn how to use food to eventually nourish themselves. But at the same time lots of other things are going on, participating in family mealtimes, enjoying the way they taste, trying new things.

Katie Ferraro (20m 19s):

It's not just about how many, you know, calories or milligrams of iron gets into the baby. And I know in from the nutrition world, that's sometimes it that's hard to break. I'm a college nutrition professor, we teach nutrition throughout the lifecycle and sometimes parents are like, well I'm just so worried about how much the baby's eating like that. That's not the point here. Your baby does not yet know how to use food to provide their body with nutrition. Let's give them the opportunity to practice and experience that. So could you maybe share what sensory difficulties look like in an infant who's transitioning to solid foods? Like the typical versus non-typical if you're comfortable saying that without freaking parents out. Like what is typical and then what's not?

Karen Dilfer (20m 57s):

Yeah, so what I wanna say is there is a wide range of responses and I think someone who's fed a lot, a lot of babies over the years, sometimes you offer a child an experience and they just seem to get it like it seems to make sense. It's easy. You know, like you, you put the puree on the little, the dipper taster spoon and the child picks up the spoon, they look at it and they put it in their mouth and they go, oh can I have some more? Right? And that's, that would be like an easy experience. Or maybe, you know, you're someone who's really into baby-led weaning your baby is is beginning to eat. You know, taste solids. You give your baby like a big chunk of a hard carrot and your baby can pick it up and they kind of put it in their mouth and they like teeth on it a little bit, right?

Karen Dilfer (21m 38s):

It's not like scary from a motor perspective they can't get a bite off but they're just interested. They're exploring, there's flavor, there's wetness, maybe there's coldness and the baby gets to say, oh yeah that's good So I think those would be examples of things that just kind of like feel easy and make sense. Where a child sees something, they initiate it on their own, they're exploring, they have a response that maybe it's positive, maybe it's neutral. In some situations it's even negative, right? I mean you will all have seen those videos on the internet of like babies like picking up like lemons or I just saw one of a baby eating a kiwi

Katie Ferraro (22m 14s):

Oh yeah that was huge. Kiwi, his reactions. It's great. I mean they're all over the board. That child is so invested in the kiwi.

Karen Dilfer (22m 19s):

But the thing is that kid has a big response but he keeps going back to it. Like he's, he's exploring and so I think when we give kids opportunities to explore sensory input, specifically taste smells and textures, they begin to learn the way that their bodies work. They begin the way that their mouth works. And like those are the foundational experiences that help them learn to eat. I think the thing that sometimes like trips us up is if a baby isn't doing a lot of initiating or if a baby doesn't seem to really enjoy it, I think that sometimes parents get worried and then maybe parents get a little pushy and saying like, but but I see that you're supposed to be doing this so I'm gonna try to make you do it even though maybe you're not quite ready or this experience isn't quite right.

Karen Dilfer (23m 2s):

And I think that's where we get into some tricky places.

Katie Ferraro (23m 17s):

So how do sensory challenges impair the ability for babies to learn to eat or self feed? Because yes it is about mealtime enjoyment and the emotional connections, but at the end of the day your child needs to stop getting as much nutrition from milk. It needs to get more from food. Like we're working along this continuum where around one year of age most of babies nutrition can be coming from food but if they never wanna touch the food and we're still a hundred percent infant milk at one year of age, that becomes a health, a nutrition, a development problem. So how can sensory challenges, how do you see them impairing abilities for babies learning how to eat?

Karen Dilfer (23m 53s):

Yeah, I think there are a couple big things that we see over and over again. I think one thing that we see is some kids are just really sensitive on their hands and they don't wanna touch wet things or they don't wanna touch messy things. And so these experiences of like exploring with your hands and bringing them to your mouth, like maybe those experiences don't happen or they don't happen a lot, right? So that that's one thing. Another thing is there are some kids who just have really, really strong reactions to certain types of food or sensations that are brought to their mouth. I can tell you stories about babies I've met who do not like purees, right? And that can be a really hard thing 'cause I think there are a lot of parents out there who go, oh I don't wanna give my baby large pieces.

Katie Ferraro (24m 37s):

Yeah they think it's a stepping stone. Like I can't get to soft finger foods if we haven't "passed purees."

Karen Dilfer (24m 43s):

Yeah. And if a baby is not into purees or you know they're turning away, they're refusing, they're crying whenever purees are offered, I think that can be really hard for parents. On the flip side, there are babies that love purees and then as soon as you give them a piece or you give 'em something with lumps, they're just like, oh my gosh I can't do this. And again, you're seeing that really big response and the big response doesn't seem commensurate with the experience that was offered.

Katie Ferraro (25m 10s):

We have parents whose babies, they're just starting solid foods and like a lot of neurotypical infants, they'll just not be super interested in food from the get-go. And we say it's 'cause they don't know what to do with it yet. So if they don't dig right in with their hands, the parents will worry. Or I see them like literally just diagnosing their own babies. Katie my, I have a super sensory baby or my baby has a sensory processing disorder, doesn't like touching food. What risk is there in ascribing these terms to a baby in the absence of a diagnosis from a credential feeding professional.

Karen Dilfer (25m 36s):

I think the big thing is I think that sometimes parents are like, oh my baby doesn't like this and they stop offering experiences and that's kind of a hard place to be because we know that kids learn through opportunities, right? And so when parents change the opportunities or limit the opportunities, you know, kids might be missing out on things that that could be okay. Right? I really kind of think that the place to start is can we figure out what a child likes? Can we figure out what a child enjoys? Can we figure out what a child's sensory preferences might be? And let's start from there rather than saying, oh you know you don't like purees, we're gonna figure out how to get you to eat purees.

Karen Dilfer (26m 18s):

You know? No, no, no. Oh you really like crunchy crackers. We can start from there. You know there's, there's lots of ways that we can help you enjoy the crunchy sensory food group and then you know, maybe with lots of time and practice and variation you're, we help you to learn that you could dip your crackers in a puree or in a spread maybe something that's not quite so wet, right? So we're, we're figuring out those things that a child likes. And I'm just gonna say that, I mean you know as someone, I'm a pretty like typical eater maybe, maybe I'm a little bit of an enthusiastic eater. But I think this idea of us as people gravitating towards foods because we enjoy the sensation, like I think that makes sense to us on so many levels.

Karen Dilfer (26m 58s):

And I think that you know, part of the reason that maybe we don't go there as professionals is because we kind of forget that infants are people too. You know, they have preferences and it's totally, completely okay and normal.

Katie Ferraro (27m 10s):

I love that 'cause you're kind of walking a fine line sometimes, right? You don't wanna pressure the child. It is not our job to make the child eat, right? The child we're talking about Ellyn Satter's division of responsibility and feeding theory, that's ultimately up to the child if they are going to eat how much they're going to eat, that's their job. However, as the parents, because our job is to be in charge of what and when and where they eat. The what if you give up after one exposure because you think oh they don't like it, you are limiting those opportunities. And I love that you said that children learn from the opportunities and when we as parents change the opportunities or limit the opportunities, we can be affecting the child's ability to recognize their own full potential with that food.

Katie Ferraro (27m 53s):

Like broccoli. Kid hates broccoli, we're never gonna do broccoli again unless it's slathered in nacho cheese. Well that's not necessarily true. Maybe they, they don't know what to do with broccoli yet or it was too cold that day and we don't want you to have to go and make broccoli 5,000 different ways. But it's not a one and done situation. So could you talk a little bit more about exposures and how we navigate that fine line to like not making you eat broccoli but also making sure you see broccoli enough so you have the opportunity to maybe someday like and accept it.

Karen Dilfer (28m 20s):

Yeah, so, I mean again I, I think the idea of figuring out what a child likes in starting there is always, always a safe idea. I just wanna say this for a minute, this is backing up for a minute. As you know you shared, you know Ellyn Satter division of responsibility And I think that sometimes as grownups, professionals or parents, we think it's our job is like the grownup in the room to get kids to eat. And I wanna say that the longer I do this job, the more I am convinced that eating is a personal experience and it is an internally motivated experience. So people call me up when something's not going right with their little one. But almost always what I tell them is, I will not be the person to get your child to eat.

Karen Dilfer (29m 1s):

I will not force your child to do things they're not ready to do. What we will do is we will partner together to help your child tap into their own internal motivation, right? And when we think about internal motivation and eating, and again you might think about yourself, you probably eat because you, you're responding to hunger cues you probably eat because it looks good and it tastes good or you might be eating 'cause like you're with other people and there are social aspects that make it interesting, right? So I think that, you know, we are thinking about giving kids experiences that are helping them learn about themselves and also tap into their own internal motivation to want to eat.

Katie Ferraro (29m 40s):

And when we think about enjoyment, and, we think about sensory, we can give kids so many experiences that first of all they feel really good and second of all we can think about giving kids experiences that just fire up their curiosity, right? One of the most powerful things that parents can do with their young children is to eat with them. And you know, parents can be eating something totally and completely different. You know they're eating like fried chicken and broccoli or burritos and Caesar salad, right? Like you wouldn't give those foods to like a, a small infant. But almost always what happens is when parents get into the habit of bringing their young children to the table, kids watch parents eat and kids learn the sensory aspects of what eating looks like, right?

Karen Dilfer (30m 25s):

They learn that the visual aspect, oh broccoli are green, they experience the smells, right? They might even be so excited that they reach out and they're trying to like grab the broccoli off of mom's plate, right? And so there's a tactile experience. Experience. So I think that you know, again you used the word exposure, right? We're exposing kids to food. I just wanna say that word always feels like a little like clinical to me. It's kind of like can we include kids in our normal eating routines and can we help kids engage in the process of sensory learning so that they can again participate in the relationship, right? Because if you're eating at the table with mom and mom is your most favorite person in the world, of course you're gonna wanna be there, right?

Karen Dilfer (31m 6s):

There's a relational aspect and there's a sensory aspect. And I'm just gonna say there's also a safety aspect because again, when kids are there with their parents and they feel safe and they feel connected, it gives them the freedom to explore. It gives them the freedom to want to have those opportunities with sensation. And ultimately those are the experiences that help kids learn and grow and maybe become a little bit adventurous with, with eating.

Katie Ferraro (31m 34s):

I can so tell that you've trained with Marsha Dunn Klein because you have the nicest way of redirecting language. Like I don't love the word exposure, let's talk about experiences. One time I was talking about a mom who was excessively micromanaging at the mealtime and Marsha's like don't say that, say that she's excessively cheerleading. And I was like oh my gosh, that's such a nicer word. So I appreciate your attention to detail in language and I love that you tied it back to the safety aspect because the baby wants to do what you're doing and they might not be there yet with the burritos or the Caesar salad, but they feel safe knowing that they're doing something that you are doing. And I'm gonna start using the word experience more than exposure. So thank you for that Karen.

Karen Dilfer (32m 14s):

Also opportunity. Opportunity is my other favorite word these days. You know,

Katie Ferraro (32m 18s):

I love opportunity.

Karen Dilfer (32m 19s):

Yeah.

Katie Ferraro (32m 19s):

Okay, so for parents, let's go back to like the ones who are listening 'cause they're like, I think my baby has a sensory challenge. What they are experiencing and their reaction is, is not typical. It is big. I don't think this is quote unquote normal even though that's a terrible word. What do you suggest for that parent? What should they do? Where should they go if they think their child would benefit from an opportunity with an occupational therapist who specializes in infant feeding?

Karen Dilfer (32m 42s):

Yes. So what I wanna tell you is that there are lots of professionals in the world who can help you. I just happen to be an occupational therapist who's had a lot, a lot, a lot of really good training. But there are speech language pathologists in the world who have a lot of good training. There are even some dietitians in the world who have a lot of good training in this area. So I think the most important thing is to find someone in your area who has expertise and who loves supporting families and kids who struggle with this. And again, it doesn't have to be an OT, it doesn't have to be an SLP, but when you start asking around, you will find that person in your area who everyone's like, oh yeah, that's the person you need to see.

Katie Ferraro (33m 19s):

And I'm just gonna say that you know, If, you as a parent are feeling worried If, you have this gut instinct that something is not right, make the call because I get those phone calls and almost always what happens is we have a conversation about what doesn't seem to be right. We meet together, we help the infant have an eating experience together and I'll just say, okay, oh it looks like they like, like they really are enjoying this. Can we give them some more or let's change the way that we're offering this. Let's put it on a spoon or in the, in the silicone feeder, right? And so almost always what happens is with you know, maybe one visit or two visits, therapists can identify what's happening and can give parents little modifications to make it feel better.

Katie Ferraro (34m 3s):

And you know, almost always what happens is parents go oh this makes so much sense or I feel so much more confident and it's so important to me that parents feel confident as they're feeding their kids because feeding children can be really hard.

Karen Dilfer (34m 17s):

And again, when kids have big responses, like it can be confusing. So absolutely if you're a parent and you're listening to this and you are uncertain, call up that person in your area who can help you and just know that you know, oftentimes you know that person can help you make changes in a relatively short amount of time.

Katie Ferraro (34m 45s):

And I love that reminder that If, you quote unquote go to a feeding therapist. It's not a lifelong diagnosis, it is not something you're going to have to do forever. More often than not a well-trained therapist is going, they're working their way out of a job. If I do my job, you don't come back to see me because I'm going to give you the toolkit to deal with whatever it is you're going through right now. And that in as few as even just a couple of sessions, a lot of, we're not fixing the problems but we're helping parents gain coping strategies to help their child progress towards becoming an independent heater.

Karen Dilfer (35m 18s):

I'm also just gonna say, if I can shamelessly plug myself for a moment at the Get Permission Institute we are having a class for parents to help parents introduce solids to their infant. This is a new offering and so if you go to Get Permission Institute you will be able to find this class and we're hoping that it can be something that you can can just access online and watch it and it'll give you lots of good information, lots of videos about helping your baby transition to solids if maybe it seems tricky or hard.

Katie Ferraro (35m 49s):

I love that. Where do they go to learn more about Get Permission Institute?

Karen Dilfer (35m 52s):

Yeah, so the URL for Get Permission Institute is getpermissioninstitute.com

Katie Ferraro (35m 57s):

And then how about for social media?

Karen Dilfer (36m 0s):

Our handle is Get Permission Institute and if you're a parent and you're looking for Get Permission Institute and you click on our Instagram, what you'll notice is that it's a little grasshopper. That's our logo.

Katie Ferraro (36m 8s):

So I will link to that episode where she gave the history of the Get Permission Institute and her approach and involving children in mealtime. I love- I I feel like you're this lovely extension of Marsha, just, just your language. I could listen to you talk all day long. I know you said you like to do like eight hour long webinars, so I'm definitely interested in learning more from you. I appreciate that you guys also do continuing education opportunities for other professionals. Like what you've learned from your experience, what Marsha has learned from her experiences. It's so helpful to other younger people coming up in the fields of, and you mentioned it, SLPs, occupational therapists, registered dietitians. There's not one credential professional who's fit to deal with the entirety of feeding because it is so multifaceted.

Katie Ferraro (36m 53s):

It does involve so many different parts of the body and the brain, So, I think it's important that we're all working together and I appreciate that you guys do continuing education. I know you're offering continuing education credits for registered dietitians as well, which is a wonderful opportunity. 'cause I would argue that we don't have as many advanced training opportunities as occupational therapists and SLPs do. So the work that Get Permission Institute is doing is really important for my profession as well. So thank you for that.

Karen Dilfer (37m 17s):

Yeah, I mean we just love feeding kids. I think one of the things that happens too sometimes is, is maybe like kids have strong preferences or they're struggling is I think that sometimes parents forget to know that is they're offering foods to their baby. They're getting to know their baby as a person. You know, oh my baby really likes savory tastes. I can think of one little girl I worked with years ago and like there were a lot of things she didn't like because she had a variety of medical complications and things weren't easy for her, but we offered her the sauce to butter chicken, like we were eating Indian food and she just like went crazy. Like it was so good, you know? and it was, it tasted so good to her and it was so fun to us to watch her experience that enjoyment and then we could share it together, you know?

Karen Dilfer (38m 1s):

'cause we're eating Indian food for lunch too. And you know, to all the parents listening, I just wanna tell you that you know, look for the things your baby loves and celebrate those things because it can be so easy to forget that when maybe things feel hard or you as a parent are just feeling kind of worried.

Katie Ferraro (38m 18s):

Well, thank you so much for your time and all of your tips and your advice, Karen. I really appreciate it and it's been great chatting with you.

Karen Dilfer (38m 24s):

Thanks so much for having me on. I just love your podcast. It's so fun to talk with you today.

Katie Ferraro (38m 30s):

Well, I hope you enjoyed that interview with Karen Dilfer from Get Permission Institute. I just love the way she talks. I was telling her after like I can tell you've you've trained with Marsha Dunn Klein, you were like an extension. She's like, oh my gosh. I used to like voice record her because just the way she describes and connects with families is so powerful. And Karen is herself a very accomplished feeding therapist. I'm going to link to her resources, but including the classes she was talking about through Get Permission Institute. I also have to say I really appreciate her constructive feedback. My husband tells me I'm bad at receiving constructive feedback. I was like, no, I just don't get a lot of it. And maybe yours is not that constructive. But Karen's, I like how she pointed out the use of the word exposure feels pretty clinical.

Katie Ferraro (39m 11s):

Whereas experience or opportunity might be more inviting to parents. I'm gonna start using the words experience and opportunity more and try to use the word exposure less. So I really appreciated just having the conversation with her and I hope that you appreciated it. If you're worried about some of the quote unquote sensory stuff pertaining to your baby and if there truly is a problem or you believe that there is a problem that you also learned a little bit more about how you can possibly get in touch with a feeding therapist who is qualified to help you with your baby. So all of the Shownotes and resources will be linked for this episode at BLWpodcast.com/378. We're online at BLWpodcast.com and thank you to our sponsors at AirWave Media. If you like podcasts that feature food and science and using your brain, check out some of the podcasts from AirWave Media.

Katie Ferraro (39m 51s):

Thank you so much for listening and I'll see you next time. If you're interested in doing baby-led weaning, but you're not exactly sure, like what does that mean? What does it look like? Where do I start? My online program called Baby-Led Weaning with Katie Ferraro has everything you need to give your baby a safe start to solid foods and get them to eat over a hundred foods before they turn one, whether you're terrified of choking or maybe you've started but you feel like you're feeding your baby the same foods over and over 'cause you don't know what to feed next, or you're looking for guidance on how to prepare foods safely for your baby's age and stage. My program has exactly what you need.

Katie Ferraro (40m 33s):

There's five hours of concise self-paced video training. You can knock this thing out during nap time this week. You also get access to my 100 First Foods content library so you can see and learn exactly how to prep all of the a hundred foods as well as my original a hundred days meal plan. I've been refining this program for the last seven years. Just today, a mom wrote to me and told me that the a hundred days meal plan has been a quote game changer for her busy lifestyle. When you join the program, you also get access to over a hundred phase two combination food recipes. So you're gonna try out the trickier textures, push your baby's palette. And what's cool about these recipes is your whole family will enjoy them. So everything you need to give your baby a safe start to solid foods is inside of the program. It's created by me, a registered dietitian who specializes in infant feeding.

Katie Ferraro (41m 14s):

If you're tired of hunting and pecking around the internet trying to piece this stuff together on your own, I put it all in one convenient place for you. I invite you to check out the Baby-Led Weaning with Katie Ferraro program that's at babyledweaning.co. Again, that website is babyledweaning.co and click on program to learn more.