Preventing Severe Picky Eating from Your Baby's First Bites with Dr. Katja Rowell, MD

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Katja Rowell (2m 7s):

For many kids, that phase of 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. Research shows us at least half the population goes through sort of a typical peaky eating phase, but usually starts kind of after 12 months.

Katie Ferraro (2m 31s):

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 with Katie Ferraro podcast. I help you strip out all of the noise and nonsense about feeding, giving you the confidence and knowledge you need to give you baby a safe start to solid foods using Baby-Led Weaning. What's the difference between picky eating and severe picky eating? And if you are interested in Baby-Led Weaning because you've learned that it helps lower the risk of severe picky eating, you're not wrong. But I wanna make a clarification before we dive into today's episode, And that is that picky eating is not a problem to be fixed.

Katie Ferraro (3m 17s):

Okay? Picky eating is developmentally appropriate for toddlers. If you have an older child, you know, when they cross over that one year mark, there's some degree of picky eating that we can't expect to set in, and yet so many parents feel like a failure. I did Baby-Led Weaning and my baby is still picky. Now as 1-year-old, guess what, that's developmentally appropriate. Again, picky eating is not a problem to be fixed. And so when you, you know, hear people developing like I have a picky eating, you know, prevention course or reversal course, it's hogwash because again, this is not a problem. This is what we expect for children. Where we run into a problem is that when children have such severely limited numbers of foods that they can eat, if you take babies that are conventionally adult-led spoonfed, they have at most 10 or 15 foods that they know how to eat by the time they turn one.

Katie Ferraro (4m 5s):

And if your 1-year-old loses those 10 or 15 foods to picky eating, then that becomes a very challenging child to feed. But if your baby can eat, I don't know, say a hundred foods before they turn Baby-Led Weaning is going to prevent picky eating. But if you can do Baby-Led Weaning in a way that helps your baby achieve diet diversity, when you lose 10 or 15 of those foods to picky eating because it's developmentally appropriate and gonna happen, it's not such a big deal.

Katie Ferraro (4m 48s):

My guest today is Dr. Katja Rowell. She's a family physician turned feeding specialist and she's gonna share some practical, compassionate advice on how to help your baby build a positive relationship with food from their very first bites. We're gonna be talking about what typical versus extreme picky eating is and what learning eaters actually need and why autonomy at the table matters so much. So much of what Dr. Rowell is gonna talk about today aligns so beautifully with the baby-led waning approach and I invited her onto the podcast to do this interview. 'cause I wanna hear from her perspective as a physician. 'cause I think you'll notice it's a lot different than the way a lot of our doctors are talking about starting solid foods.

Katie Ferraro (5m 32s):

Dr. Rowell's approach is all about responsive feeding, avoiding pressure, and trusting your baby's cues. She's gonna talk a little bit about diet diversity. So if you're looking for kind of a roadmap to help your baby achieve all these foods, be sure to grab a copy of my original 100 First Foods list. I give that to everybody on my free online workshop called Baby-Led Weaning for Beginners, which you can find the registration link for that online at babyledweaning.co/workshop. So with no further ado, I wanna invite Dr. Rowell onto the podcast. She's gonna be talking about preventing severe picky eating from your baby's first bites. And I also should mention before we bring her on, she's the author of the book, which she'll mention in this interview it's called Helping Your Child with Extreme Picky Eating, A Step-by-Step Guide for Overcoming Selective Eating, food Aversion and Feeding Disorders.

Katie Ferraro (6m 23s):

Dr. Rowell co-wrote that book with Jennifer McGrath, a speech language pathologist. And since the time we recorded this interview, she's gone on to release a newer book. Okay, this one's kind of more for older children, but it's called Helping Your Child when Mealtimes are Hard, loving Support for Anxious Eating Weight and Nutrition Worries and everything in between. So I'll put the links for Dr. Rowell's book as well as her resources in the show notes page for this episode, which you can find at blwpodcast.com/36. And here is Dr. Rowell.

Katja Rowell (6m 58s):

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

Katie Ferraro (7m 2s):

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?

Katja Rowell (7m 21s):

Well, I think you absolutely, at six to 12 months they're, they're learning especially 6, 7, 8, 9, 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 they're, that 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.

Katja Rowell (8m 1s):

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 more interested in, in jumping into things right away. And then we might see some infants who are more observers and, 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, they're, 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 wanna 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 so they don't like it and they're picky.

Katja Rowell (8m 51s):

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 approached 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 (9m 29s):

And I like that you point out the importance of all babies being different. I always try to remind our listeners that babies are gonna be interested in food at different rates. And some parents, they, they see other babies on social media And 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, 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've 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. So don't worry if your baby doesn't dive immediately into eating solid foods.

Katie Ferraro (10m 14s):

And I agree too 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 hear 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.

Katja Rowell (10m 41s):

Of course. Yeah, I, I think that there is a tendency sometimes to wanna label and, and almost over pathologized. So we're in kind of a weird world I think with feeding therapy and with 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.

Katja Rowell (11m 21s):

Phobia sounds like, you know, oh gosh, I have to see a psychiatrist and this, you know, it's a big deal. But neophobia is just a word for meaning cautious about new things. 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 too. 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 6, 7, 8 month old, they may be willing to sort of explore the world through their mouths and stick everything in their mouths.

Katja Rowell (12m 7s):

It's a, 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.

Katja Rowell (12m 50s):

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 usually starts kind of after 12 months for some. So I hope that helps to just kind of calm down some of the, the anxiety around that word neophobia. That that it, it's typical for about half to just start getting a little bit more juicy and suspicious at some point aversion.

Katja Rowell (13m 34s):

Oh, that's a, that's such a, a scary word. And I'm gonna tell you a story if you don't mind real quick. And I think this is where baby led weeding 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 a habanero right? 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 wanna 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.

Katja Rowell (14m 18s):

And I remember this mom in particularly said, oh my goodness, my baby won't take the spoon suddenly, you know, and this was beforeBaby-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, 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.

Katja Rowell (15m 2s):

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 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 force 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.

Katja Rowell (15m 46s):

So I would be really careful about using those words. And I think that part of the reason why is 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 wanna 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, aversion is something specific that we can talk about later and, and certainly, you know, a child who eats or is learning to eat, I, I would be really careful about using that word.

Katie Ferraro (16m 33s):

Hey, we're gonna take a quick break, but I'll be right back.

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Katie Ferraro (18m 17s):

So I know in your book, which is about helping your child with extreme picky eating. So You guys, I'll link up to Dr. Rowell's 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, it's 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? 'Cause there's certainly parents out there who are like, I don't think that this is typical what I'm experiencing.

Katja Rowell (18m 59s):

You know, and, and also I wanna mention that the book is, is helpful for 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, on competence and all of these wonderful things. So, so a typical picky eater generally starts around the second year of life as 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 for toddlers.

Katja Rowell (19m 41s):

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 you know, and

Katie Ferraro (19m 53s):

Push your buttons

Katja Rowell (19m 54s):

That sounds exactly, and push your buttons and try something. And if they love the carb heavy, which is very common and, 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 wanna 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. So you might see them preferring carbs and so the 12 to 15 month old or 18 month old, you put a a variety and they might, you know, scrape the, their non favorites off and pitch a fit and see if you'll make them or bring them their favorite food.

Katja Rowell (20m 37s):

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 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 'em even if they keep showing up and then they'll come back to it. But it has to keep showing up 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 don't eat, you know, whatever it is.

Katja Rowell (21m 26s):

And then you start to cone down. And then when I work with kids with extreme picky eating and they're 3, 4, 5 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 pick eating stage, it's don't stop offering those foods. And my daughter, one of her first words was nana for banana and she ate bananas like they were going outta style for three or four months and then didn't eat 'em 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 en enjoy to eat into adulthood.

Katja Rowell (22m 12s):

So that's one of the, the kind of key things I wanna 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, 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? Am I worried they're too small? Am I worried 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, of offering the best opportunity for feeding. So anyway, so that's kind of a picture of typical picky eating.

Katja Rowell (22m 53s):

So they'll get upset if they don't have their favorite food, but they usually can calm 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 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.

Katja Rowell (23m 37s):

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. Sometimes kiddos will sort of fall where they stopped gaining weight for a little while. Some of that is a normal growth pattern, but it really needs to be investigated and, 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 wanna look at the big picture. So any weight loss we need to take very seriously.

Katja Rowell (24m 17s):

Any signs of pain or discomfort or anxiety. You know, if you put your child in the high chair and they're writhing 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, if meal times are fraught with anxiety and you're worried, then you need to learn more and get support.

Katie Ferraro (24m 44s):

And I love that you mentioned that 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. 'cause they, they see these portion guides and and then they worry, my baby's not doing that.

Katie Ferraro (25m 26s):

But I love that you point out, listen, you know, one or two meals, they might have a few days where they don't have great intake, but if it doesn't affect their growth and their weight and their staying on their growth pattern, you know, we really need to look at the bigger picture here. 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.

Katja Rowell (25m 50s):

Absolutely. 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 seesaw, you know, a zigzag. But that is typical eating and, and absolutely 6, 7, 8, 9, 10, you know, at the early time most of the intake is still from the breast milker formula. And then by 1215 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 you have the 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 too when parents get sort of worried like, oh they're, they haven't eaten for five days and well they, you know, they're completely congested, maybe their sense of taste is off.

Katja Rowell (26m 35s):

So, So I think that the more we can just sort of take a breath and, and if we're worried to, to find out do we really need to be worried and you know, know growth is such a tricky thing 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 you know, the more we try to feed to either to get kids to eat more or get them to eat less generally, the more we mess with that internal wisdom.

Katja Rowell (27m 16s):

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, 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 gonna eat really big meals maybe and sometimes, you know, just like half a blueberry And that it's okay, you know, to, to see this wide variety And that the, you know, the portion guide is just mostly, I see that as like a tablespoon or this, and then if they eat it and want more, they can have more.

Katja Rowell (28m 0s):

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 okay and then usually we'll see like, oh well there's a little bit of a height growth spurt.

Katja Rowell (28m 45s):

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 up.

Katie Ferraro (28m 52s):

Or even at that same appointment. Sometimes if you watch the way they obtain height in a 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, I'm 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 rewe or re height, especially if it looks like the baby's falling off the growth chart. Same thing with iron checks, 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 and we need to acknowledge that.

Katja Rowell (29m 34s):

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 to feeding professionals is that we're super inaccurate. Like I had a parent oh yes, of an almost 3-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 and she said last week they weighed my child in boots and like jeans and the undershirt and this time just in underwear and they're like panicking that she's lost two pounds and I'm going, are you people? You know, are you 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 or they're

Katie Ferraro (30m 16s):

Super busy and there's like a bunch of patients backed up and they, they mark your baby's head and they mark your baby's foot and measure in between that when your baby can stand, they should always be using a sta diameter with your child 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 the 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 dietitian 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 (31m 8s):

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 this situation where you're gonna 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 help?

Katja Rowell (31m 41s):

I'm so glad you're training these upcoming physicians and 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 dietitian come in and talk to us about low fat, you know, fat free cream cheese and whatnot.

Katja Rowell (32m 23s):

So.

Katie Ferraro (32m 23s):

We've changed our tune since the 19.

Katja Rowell (32m 25s):

Yes, I know it's wonderful. Absolute, and I know you've changed your tune, but the problem is, is that a lot of the, the folks you know who've been in practice for a long time haven't. 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 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 saying things like, just make them eat it or no child will starve 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, you know, I think starting with your pediatrician is a good thing and hopefully they'll listen to your concerns and be able to do a physical exam.

Katja Rowell (33m 23s):

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, maybe lead or some other lab work. 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 a, a, an appropriate step. 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.

Katja Rowell (34m 13s):

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, 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. 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?

Katja Rowell (34m 52s):

And we actually spend a lot of time reassuring and, and we spend some time on how much protein do they actually need. And it's usually less than parents think.

Katie Ferraro (35m 1s):

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 dietitian I'm qualified to talk about what you can eat, but the logistics of learning how to eat 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.

Katja Rowell (35m 32s):

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 it's really difficult and I think that whatever the challenge or the struggle is, learning how to maybe not make it worse is also a really important point. And so, you know, recognizing that the battles that the trying to force out of that worry or 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, a three-year-old where at 10 months they had hand foot and mouth illness. 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.

Katja Rowell (36m 19s):

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 ki 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. So if you're struggling is trying to find out, you know, how do I not make this worse?

Katja Rowell (37m 1s):

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, a pediatric dentist who could help them figure this out.

Katie Ferraro (37m 12s):

I think for some we're scared of that word therapy. So thank you for shedding light on this, you know, 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 self 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.

Katja Rowell (37m 42s):

Yeah, 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 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 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 there, leaving space for that connection, that relationship and where children feel safe at the table, they're enjoying the company of other people.

Katja Rowell (38m 57s):

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. So we might 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 lethal in many situations.

Katja Rowell (39m 45s):

I've seen folks in the middle years and beyond really struggling with their relationship with food 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 of 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, and tune into their bodies in terms of hunger and fullness.

Katja Rowell (40m 26s):

And we know also that adults who are eating competent, it's this construct from Ellen Satter that adults who are eating competent also tend to be happier and and healthier in measurable ways and less disordered eating and dieting. 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.

Katie Ferraro (40m 50s):

Hey, we're gonna take a quick break, but I'll be right back.

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Katie Ferraro (41m 31s):

I'm so happy that you mentioned the eating competence as well as the autonomy. I knew I was gonna love your book. I opened it up. The very first page has part of the, the forward or the advanced praise is from Jessica Satnick, the eating disorder expert, who's one of my dear, dear friends, and she calls your 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. Yeah,

Katja Rowell (42m 10s):

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 than 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, it's

Katie Ferraro (42m 26s):

Also 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 spoonfeeding, wait a minute, if I take it a little slower, wait till 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 of the resources that Dr. Rowell mentioned in the podcast episode today on the show notes for this episode, which is at blwpodcast.com/36, 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 and a number of different feeding resources. So thank you so much again, Dr.

Katie Ferraro (43m 8s):

Rowell. I really appreciate it.

Katja Rowell (43m 10s):

My pleasure.

Katie Ferraro (43m 11s):

Well, I hope You guys enjoyed that interview with Dr. Katja Rowell. I just love talking to a physician who literally gets it. I love that she calls herself a family physician turn feeding specialist because that's literally what she is. Most physicians, as we've talked about, don't know a lot about nutrition, but I love the work that she's done with families. Again, her book is called Helping Your Child with Extreme Picky Eating. I'll put a link to that on the show notes page, which is at blwpodcast.com/36. If you are interested in exploring more about the Baby-Led Weaning approach and helping your baby achieve diet diversity and get those a 100 First Foods in before they turn one, in an effort to help prevent severe picky eating, I'd love to invite you to check out my program.

Katie Ferraro (43m 53s):

It's called Baby-Led Weaning with Katie Ferraro. I have a full 100 First Foods Daily Meal Plan in there so you can follow it day by day, step by step. We do five new foods a week that I show you exactly how to prepare them as we move your baby along a texture continuum. And we slowly and gradually get into more complicated multi textured foods. We're gonna do all those allergenic foods in the first nine weeks that's inside of the program, as is my 100 First Foods content library, which is over 300 recipes, videos, instructions on how to prepare all the foods for your baby's age and stage. You can check that program out at babyledweaning.co/program. And thank you to our partners at AirWave Media. If You guys like podcasts that feature food and science and using your brain, check out some of the podcasts from AirWave Media. We're online at blwpodcast.com. Thanks so much for listening and I'll see you next time.

Dressed: The History of Fashion (44m 50s):

Hello, I'm Cassidy. And I'm April. And together we are fashion historians, friends and co-hosts of Dressed The History of Fashion, a podcast about why the clothes we wear matter throughout history and around the world From the cultural and societal to the personal and often political. With each episode, we explore the multitude of meetings, quite literally sewn into the clothes we wear. Please join us and unraveling the hidden histories reside in your closet over the course of our newly launched eighth season. New new episodes are available on Wednesdays and Fridays on Apple Podcast, Spotify, or wherever else you listen to.