Feeding Development: Understanding the Spectrum of Eating in Children.

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Course description and overview

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Feeding Development: Understanding the Spectrum of Eating in Children

Educational Level:

Intermediate

Course Description:

Feeding Development: Understanding the Spectrum of Eating in Children is an online course that includes PowerPoint and video teaching by Melanie Potock, MA, CCC-SLP and three health professionals.

Pediatrician Nimali Fernando, MPH, MD joins Melanie to teach Module One: Feeding Development & Strategies to Encourage Adventurous Eating. This module teaches parents and professionals how feeding disorders develop and offers strategies on what can be done to support the infant, toddler or school-age child who presents with feeding challenges. Course content includes foundational knowledge on medical issues and physiology that may impact feeding development. Dr. Fernando and Ms. Potock explain sensory processing and how motor skills and learned behaviors may impact a child’s ability to interact with new tastes, textures and temperatures. The range of picky eating can vary, and the discussion includes red flags that may indicate a need for a feeding evaluation and possible treatment.

In Module Two, registered dietitian nutritionist Sarah Moran, RDN joins Ms. Potock to provide essential research-based facts on childhood nutrition applicable to children from 6 months to 6 years of age.

In Module Three, psychologist Dr. Jonathan Dalton, a national expert on pediatric anxiety and Ms. Potock teach critical foundational concepts regarding anxiety disorders in children and how they may be related to pediatric feeding disorders.

Module One: Feeding Development & Strategies to Encourage Adventurous Eating

Duration:

5 Hours Total

Time Ordered Agenda:

Introduction – 2 minutes
Part One: How Feeding Challenges Develop – 100 minutes
Part Two: Babies – 31 minutes
Part Three: Toddlers – 112 minutes
Part Four: School Age Children – 21 minutes
Part Five: Strategies for the Whole Family – 26 minutes
Part Six: Hesitant Eater or Something Else – 10 minutes

Key Learning Outcomes:

As a result of this module, the participant will be able to:

Discuss how protective behaviors develop when gastrointestinal discomfort, sensory processing challenges, delayed gross and/or fine motor skills impact a child’s willingness to eat.

Recognize the signs that arise when Upper Lip Ties and Posterior Tongue Ties (Tethered Oral Tissue) influence the development of feeding skills.

Understand how feeding development can be supported in babies and toddlers through proper positioning, correct use of the spoon and self-feeding methods.

Describe how growth can be affected in picky eaters who are overweight or those who are underweight and how a processed diet can influence a child’s food preferences.

Recognize how the swallow pattern changes as children mature and discuss the impact it may have on picky eating.

Implement basic strategies to help children interact with new foods while keeping mealtimes joyful and relaxed.

Recognize the red flags that may indicate a need for a feeding evaluation and possible treatment and how to seek help.

Module Two: Pediatric Feeding and Nutrition

Duration:

2 Hours Total

Time Ordered Agenda:

Hour One: Babies 6 to 12 Months 60 minutes

What NOT to serve to babies

Which nutrients are important?

Where to serve meals and snacks, and why

Positioning at the table

Choking risks and how to avoid them

When to start solid foods, and how

Baby Self-feeding, including purees

Safe finger foods

Balancing bottle and breastfeeding with solids

Early signs of food allergies in babies & guidelines for introduction

Hour Two: Toddlers, Preschoolers and Young Children 60 minutes

Toddlers (12 to 24 months)

What and what not to serve for health and safety

Which nutrients are important?

Where and when to serve food to a toddler

Serving sizes

Encouraging water

Toddlers with Food Allergies & the nutritional risks

Preschoolers and Young Children (ages 2 to 6 years)

What and what not to serve

Where to serve meals and how much?

Food allergies in older children

Key Learning Outcomes:

As a result of this presentation, the participant will be able to:

Understand the overlap of nutrition information amongst health professionals while respecting each health professionals’ scope of practice.

Identify what safe and nutrition-rich foods are appropriate for children 6 months to 6 years and utilize this basic information if a registered dietitian (RD) has not been identified as a necessary part of a child’s care.

Understand why these nutrients are important for child growth and development.

Utilize basic guidelines for portion sizes and balanced nutritional meals if the child does not require specialized support from an RD.

Identify alternatives to dairy when appropriate if a child follows a dairy-free lifestyle.

Understand the differences between food allergies and food intolerances.

Implement simple strategies to help children interact with new foods while keeping mealtimes joyful and relaxed.

Module Three: Pediatric Feeding Disorders & Anxiety

Duration:

2.5 Hours Total

Time Ordered Agenda:

Introductions and Overview – 10 minutes
Understanding the Spectrum of Picky Eating – 10 minutes
Understanding Pediatric Anxiety Disorders & Avoidance – 90 minutes
Cognitive Behavioral Treatment & Exposure Therapy – 10 minutes
First-step Strategies – 30 minutes

Key Learning Outcomes:

As a result of this presentation, the participant will be able to:

Discuss four different types of anxiety disorders that may be associated with pediatric feeding disorders.

Understand the role that avoidance plays in both anxiety disorders and pediatric feeding disorders.

Identify five strategies to improve treatment outcomes for children with feeding difficulties associated with anxiety.

Know which professional treats anxiety disorders and which evidence-based practice has been found to be successful.

Faculty Information and Disclosures:

Melanie Potock, MA, CCC-SLP

Melanie Potock, MA, CCC-SLP is a feeding specialist and international speaker who presents a variety of live ASHA and AOTA approved courses listed on her website www.MelaniePotock.com or www.MyMunchBug.com. Melanie treats children with feeding challenges from birth to age seventeen years while balancing her career as an author and media expert on parenting and feeding children.
Financial: Melanie Potock, MA, CCC-SLP is the author of Adventures in Veggieland: Help Your Kids Learn to Love Vegetables with 100 Easy Activities and Recipes. Ms. Potock is the co-author of “Raising a Healthy Happy Eater: A Stage-by-Stage Guide to Setting Your Child on the Path to Adventurous Eating”, for which she receives royalty payments. She is the co-author of Baby Self-Feeding: Solid Food Solutions to Create Lifelong Healthy Eating Habits and was paid to write the book but does not receive royalties. She is the author of Happy Mealtimes with Happy Kids: How to Teach Your Child about the Joy of Food!, for which she receives royalties. Melanie is the executive producer of the children’s music CD titled Dancing in the Kitchen and profits from song purchases. Ms. Potock owns My Munch Bug, LLC and the online educational courses and profits from registrations online. Ms. Potock is an international speaker who presents a variety of courses and is paid to present these courses at various events. She owns a therapy practice for the assessment and treatment of feeding challenges in children and is paid for that service.
She may receive a stipend for some articles that may appear online or in magazines.
Non-financial: Melanie Potock is a past contributor to the American Speech-Language-Hearing Association’s blog, The ASHA Leader, and she was not compensated. She may not receive a stipend for some articles that appear online or in magazines and this varies month to month, depending on media needs. She is the co-author of Doctor Yum’s Preschool Food Adventure, a preschool food education curriculum and does not receive compensation for her role supporting that program.

Dr. Nimali Fernando, MPH

Dr. Nimali Fernando, MPH is a Fellow of the American Academy of Pediatrics who has gained national attention for her focus on healthy eating in children. Her practice, Yum Pediatrics in Virginia, features a teaching kitchen and garden, and has gained national attention as a hotspot for nutrition education. Her website is www.DoctorYum.org.
Financial: Dr. Fernando is the co-author of Raising a Healthy Happy Eater: A Stage-by-Stage Guide to Setting Your Child on the Path to Adventurous Eating, for which she receives royalty payments. She is a full-time pediatrician and founder of Yum Pediatrics in Virginia. Dr. Fernando’s non-profit, The Doctor Yum Project benefits financially from the registration of some of the courses on her co-author’s website, www.melaniepotock.com. Dr. Fernando may receive a stipend for some articles that may appear online or in magazines.
Non-financial: Dr. Fernando is the founder of the non-profit The Doctor Yum Project and does not receive compensation for her role.

Sarah Moran, RDN

Sarah Moran, RDN is a Registered Dietitian Nutritionist and founder of Sarah Moran Nutrition. Through her work with individuals, groups, and her online community, she helps people and families take the stress out of eating and feel more comfortable in their own skin. Her website is SarahMoranNutrition.com.
Financial: Ms. Moran received an honorarium for co-teaching the course with Ms. Potock. She receives a percentage of the proceeds of some of the registration fees.
Non-financial: Ms. Moran has no non-financial disclosures.

Dr. Jonathan Dalton

Dr. Jonathan Dalton is a licensed psychologist, public speaker, and author who founded the Center for Anxiety and Behavioral Change (CABC) in Rockville, MD, which is a private treatment center dedicated to using evidence-based treatment for patients with anxiety disorders. He received his undergraduate degree in psychology from Villanova University, a master’s degree in psychology from The Catholic University of America, and a doctorate in clinical psychology from Fordham University with a specialization in child and family psychology. He completed two years of pre-doctoral training at the Johns Hopkins School of Medicine – Kennedy Krieger Institute, and advanced postdoctoral training at the Maryland Center for Anxiety Disorders at the University of Maryland. He specializes in the treatment of anxiety disorders in children and adolescents with a focus on anxiety-based school refusal.
Financial: Dr. Dalton received an honorarium for co-teaching the course with Ms. Potock. He receives a percentage of the proceeds of some of the registration fees.
Non-financial: Dr. Dalton has no non-financial disclosures.

Audience: Parents and Family Members, Child Care Professionals, Speech-Language Pathologist and Assistants, Occupational Therapists and Assistants, Physical Therapists and Assistants, Lactation Consultants, Nurses, Pediatricians and Assistants, Dental Professionals, Early Interventionists and Assistants, Educators and Assistants and Appropriate Others in Pediatric Health Professions or Care.

Sponsor Disclosure:

This course is a cooperative presentation from CEU Espresso, Incorporated and Melanie Potock, M.A. CCC-SLP.

Content Disclosure:

This learning event does not focus exclusively on any specific product or service.

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Successful Completion:

To receive CE credit, you must meet the following requirements:

View the entire 9.5 hour course

Attest to your attendance of the full 9.5 hour course

Answer 80% of the quiz questions correctly

Partial credit will not be awarded.

Time limit: 0

Quiz Summary

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Question 1 of 30

1. Question

1) Children can develop protective feeding behaviors when

A. They have medical or physiological issues that cause discomfort

B. They have delays in motor skills

C. They have difficulty with sensory integration

D. All the above

Question 2 of 30

2. Question

2) In feeding therapy, crunchy, meltable foods like crackers are often offered as a first food to build oral skills. However, children who eat too many carbohydrates may experience:

A. Spikes in blood sugar

B. Spikes in insulin

C. Cravings for high-carbohydrate foods

D. All of the above

Question 3 of 30

3. Question

3) Gastroesophageal reflux is not a disease unless

A. It’s diagnosed in infancy

B. There is accompanying pressure and heartburn

C. It’s chronic and impacts other functioning

D. B and C

Question 4 of 30

4. Question

4) Tethered oral tissues may impede feeding function by

A. Causing early fatigue at the breast or bottle

B. Compensatory methods to propel the bolus posteriorly

C. Development of lateral chewing, but not munching patterns

D. A and B

Question 5 of 30

5. Question

5) Constipation may impact picky eating habits because it can

A. Decrease appetite in children

B. Make a child drink more water and feel full

C. Decrease symptoms of gastroesophageal reflux

D. Stretch the smooth muscles of the esophagus

Question 6 of 30

6. Question

6) The sense of taste and the sense of smell are intimately related because

A. Taste varies from child to child, but aromas do not

B. Children are sensitive to smells more than taste

C. Taste plus smell equals flavor

D. When our nose is stuffy, we tend to eat less

Question 7 of 30

7. Question

7) When positioning a child in a feeding chair, always consider

A. The size of the child and the size of the chair

B. The angle of the hips, knees, and ankles

C. The height of the tray or table

D. All the above

Question 8 of 30

8. Question

8) Applied Behavior Analysis focuses on behavior, but also

A. What cues the behavior and what reinforces the behavior

B. Nutrition

C. Only negative behaviors

D. Medical analysis of feeding challenges

Question 9 of 30

9. Question

9) When supporting a family who wants to focus on self-feeding and skip purees, therapists can share the following benefits of purees

A. Purees are a thickened liquid and can provide safe practice in the early stages of learning to eat

B. Purees can be spoon-fed in a reciprocal, responsive nature by reading the child’s cues

C. A & B

D. Purees can be served via a pouch, so no need to read baby’s cues.

Question 10 of 30

10. Question

10) When spoon feeding a 6-month-old baby, which of the following is an appropriate technique?

A. Use a wide spoon and scrape upward so baby can engage his top lip to clean the spoon.

B. Use a small, flat spoon and help baby open his mouth.

C. Use a small, flat spoon and wait for baby to open his mouth before placing the spoon in his mouth and wait for lip closure before removing spoon.

D. Use a small, flat spoon and scrape upward so baby can engage his top lip to clean the spoon.

Question 11 of 30

11. Question

11) The quality of the pincer grasp is important in feeding development because it contributes to

A. confidence in self-feeding

B. the development of the suck, swallow, breathe coordination

C. the ability to pick up small pieces of food with ease

D. A & C

Question 12 of 30

12. Question

12) The American Academy of Pediatrics recommends the following qualities when choosing a pacifier:

A. Choose one that’s cute.

B. Choose one that’s made of silicone and all one piece.

C. Choose one that’s easy to keep around the child’s neck, so it won’t fall on the floor.

D. None of the above

Question 13 of 30

13. Question

13) Pouches filled with puree can be misleading because

A. They may contain more fruit and fruit sugars than vegetables.

B. The convenience can lead to overuse and thus, less exposure to whole foods that are not pureed.

C. When filled with fruits, they can cause a spike in blood sugar and stop appetite.

D. All the above

Question 14 of 30

14. Question

14) Sugar consumption among children, especially picky eaters, may be influenced by

A. a tendency to feed picky eaters packaged, convenient, processed foods

B. a tendency for parents to choose high-calorie foods for their children who are underweight, yet parents are not aware of the sugar content

C. A & B

D. none of the above

Question 15 of 30

15. Question

15) Early tooth decay in children can be due to

A. a change in pH in the mouth

B. overuse of juice

C. Constipation

D. A & B

Question 16 of 30

16. Question

16) Healthy, low sugar calorie boosters for children who are underweight may include

A. nut or seed butters

B. ice cream

C. avocado

D. A & C

Question 17 of 30

17. Question

17) Fine motor skills are always dependent on

A. gross motor stability

B. oral motor skills

C. the development of the pincer grasp

D. all the above

Question 18 of 30

18. Question

18) Ways to develop the mature pincer grasp by twelve months of age include

A. “cheerio therapy” by feeding our kid’s O-shaped cereal

B. deep sections of an ice cube tray to retrieve morsels of food

C. giving kids large pieces of food to grasp with their fists

D. All the above

Question 19 of 30

19. Question

19) Children typically develop a mature swallow pattern by

A. about twelve months of age

B. lots of practice with purees

C. not letting a child use a sippy cup for frequent, prolonged periods

D. A & C

Question 20 of 30

20. Question

20) Sippy cups can be marketed to parents as a necessity, but

A. they are not part of the developmental process of learning to eat

B. were just invented to keep your carpet clean

C. prolonged use may inhibit development of the mature swallow pattern

D. all the above

Question 21 of 30

21. Question

21) When teaching straw drinking to a child, be sure to

A. cut the straw down once the skill is mastered, to ensure development of the mature swallow pattern

B. use lots of juice to encourage them to sip

C. use a wide straw, so they get a larger bolus

D. use a longer straw so they can reach it

Question 22 of 30

22. Question

22) When teaching open cup drinking, be sure the cup you choose for toddlers

A. has an opening that’s the right size for little mouths

B. is one that’s very lightweight for little hands

C. has delicious juice inside, to encourage them to sip

D. all the above

Question 23 of 30

23. Question

23) When introducing new foods to children, keep the portions

A. underwhelming

B. about 1 TB of each food

C. offering small bites or tastes

D. all the above

Question 24 of 30

24. Question

24) Words that help hesitant eaters learn to be positive about new food experiences include

A. Just try it!

B. Don’t yuck someone else’s yum.

C. It’s ok, we’re just practicing it.

D. B & C

Question 25 of 30

25. Question

25) When teaching a toddler about temperature, one strategy is to introduce

A. icy cold foods whenever possible

B. an anchor word, to pair a specific temperature with a descriptive word

C. teach the spectrum of temperature

D. B & C

Question 26 of 30

26. Question

26) When having a family meal, mark the end of the meal by

A. keeping the child at the table till he finishes everything on his plate

B. having dessert

C. taking the plate to the counter to signal “all done”

D. telling the kids they’ll get dessert in an hour

Question 27 of 30

27. Question

27) Marking the beginning of the meal communicates to the family that

A. this is a special time with a focus on “family”

B. we only have a little time to eat

C. if you don’t come to the table, you don’t get to eat

D. kids under the age of three can come to the table when they are ready

Question 28 of 30

28. Question

28) Plan, prep and prioritize is a slogan that helps parents

A. create more time for family mealtimes

B. take the time to understand how food makes you feel

C. get meals on the table, especially in our busy lives

D. all the above

Question 29 of 30

29. Question

29) Red flags for feeding disorders in babies include, but are not limited to

A. consistent coughing

B. consistent fussing when food is presented

C. stress for you, or for your family

D. all the above

Question 30 of 30

30. Question

30) Red flags for feeding disorders in toddlers to school age kids include, but are not limited to

A. irritability at mealtime and preference for a limited number of foods

B. reliance on calorie boosting drinks to meet nutritional needs

C. stress for you, or for your family

D. all the above

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Question 1 of 12

1. Question

1) The American Academy of Pediatrics recommends

A. breastfeeding at least up to 6 months of age, whenever possible

B. introduction of first solids at 6 months of age

C. limiting solid foods to purees only for the first few weeks

D. A & B

Question 2 of 12

2. Question

2) The potential negatives of waiting too long to introduce solid foods include

A. Baby’s taste buds won’t develop

B. Baby will become dependent on breastfeeding due to taste preference

C. Possible link to the development of food allergies

D. Delay in gross motor development

Question 3 of 12

3. Question

3) Important advice about iron-rich foods for babies includes:

A. Offering a daily cup of juice to increase vitamin C, which is important for iron absorption.

B. Iron-rich foods are essential as early as the first year, especially if baby is breastfeeding.

C. Infant cereals are a required food for babies under the age of 12 months.

D. Beans, never rinsed, and smashed to ensure they are not a choking hazard.

Question 4 of 12

4. Question

4) Baby Self-Feeding can include

A. purees and safe, hand-held solids.

B. anything the family is eating – one meal, one family!

C. Anything. The tongue-thrust reflex just pushes the bigger pieces out of the mouth.

D. strictly purees for as long as baby is self-feeding, for up to 12 months of age.

Question 5 of 12

5. Question

5) Which of the following statements are true?

A. Iron helps carry oxygen throughout the body to support brain and body growth

B. Zinc supports our immune system

C. Vitamin D aides in calcium absorption

D. All of the above

Question 6 of 12

6. Question

6) Babies need more fats than adults for

A. cute, chubby thighs

B. brain growth & energy

C. calcium absorption

D. none of the above

Question 7 of 12

7. Question

7) Choking hazards for children under the age of 4 include

A. hot dogs, popcorn, and chunky raw vegetables

B. popcorn, marshmallows, and whole grapes

C. globs of seed or nut butter

D. all of the above

Question 8 of 12

8. Question

8) Kids with multiple food allergies can fall short on

A. the growth curve

B. academics, even if they are getting good nutrition

C. certain nutrients, like Vitamin D

D. A & C

Question 9 of 12

9. Question

9) Mixed non-IgE mediated reaction often corresponds to various gastrointestinal disorders, including

A. FPIES or an Eosinophilic Disorder

B. Celiac disease

C. A & B

D. Food Positivity Intolerance

Question 10 of 12

10. Question

10) Celiac disease is

A. often outgrown

B. never outgrown

C. occasionally outgrown if the child avoids gluten

D. not typically diagnosed in school-aged children

Question 11 of 12

11. Question

11) Children are more likely to outgrow allergies to

A. Soy and dairy

B. Shellfish

C. Peanut

D. Egg white only

Question 12 of 12

12. Question

12) According to the Children’s Hospital of Philadelphia, signs of gluten sensitivity include

A. joint pain and numbness on the tongue

B. distended stomach and headaches

C. cravings for carbohydrates rich in gluten

D. A & B

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Question 1 of 15

1. Question

1) Physiology refers to how our body functions, including

A. cognition, emotions, and sensory processing

B. body and brain functioning

C. A & B

D. none of the above

Question 2 of 15

2. Question

2) Criteria Avoidant Restrictive Food Intake Disorder may include but are not limited to

A. Significant weight loss or failure to achieve expected weight gain

B. Significant nutritional deficiency

C. Marked interference with psychosocial functioning

D. All of the above

Question 3 of 15

3. Question

3) Which of the following statements is false about pediatric anxiety disorders?

A. Kids can show signs as early as preschool age.

B. Pediatric anxiety disorders always coexist with pediatric feeding disorders

C. 1 in 3 adolescents will have an anxiety disorder before age 18.

D. The median age of onset is 11 years.

Question 4 of 15

4. Question

4) Anxiety disorders that may be associated with pediatric feeding disorders include, but are not limited to

A. Generalized Anxiety Disorder

B. Social Anxiety Disorder

C. A and B

D. Praxis Anxiety Disorder

Question 5 of 15

5. Question

5) A panic attack can

A. peak at about 10 to 15 minutes of duration

B. make the patient feel as if they are choking

C. cause sweating, shortness of breath and trembling

D. all of the above

Question 6 of 15

6. Question

6) Social Anxiety Disorder is a persistent fear of social situations and can at times, impact a child’s willingness to eat because

A. they may have a fear of how their eating habits will be perceived by others

B. they have a language disorder that may impact ordering food at restaurants.

C. they have no desire to engage in social activities that include food

D. they have a lack of social awareness at restaurants

Question 7 of 15

7. Question

7) Obsessive Compulsive Disorder is not always fear-based, but may contribute to feeding disorders because

A. the need is compulsive and not just a preference

B. the compulsion is always related to food

C. the obsessions are always related to food

D. the disorder is commonly caused by food allergies

Question 8 of 15

8. Question

8) Research shows that working with the parents of children with anxiety disorders is

A. as effective as working with the kids themselves

B. an essential piece in helping children with anxiety and/or feeding challenges

C. is a small component of the child’s treatment

D. A and B

Question 9 of 15

9. Question

9) Strategies for helping children who are anxious to try new foods include

A. Building familiarity with new foods

B. Making them eat the food, even if they are scared

C. Helping a child be comfortable in the face of uncertainty

D. A and C

Question 10 of 15

10. Question

10) A successful strategy to help children stop avoiding new foods include

A. Assure them when they react in a fearful manner

B. Give them time to grow out of it

C. Start with tolerating new foods on the plate

D. None of the above.

Question 11 of 15

11. Question

11) “Calm is contagious” is a phrase to describe which strategies?

A. Modeling coping aloud

B. Validate the child’s distress in a calm, even tone of voice

C. Ask the child, “What strategies can you use to help yourself feel better?”

D. All of the above.

Question 12 of 15

12. Question

12) Paired association means

A. pairing a positive coping self-statement with the anxiety itself

B. pairing a preferred food with a non-preferred food

C. pairing two similar textures to help a child build familiarity

D. A and B

Question 13 of 15

13. Question

13) Exposure therapy changes the way the child interacts with

A. waves

B. water

C. the feeling of anxiety

D. none of the above

Question 14 of 15

14. Question

14) Cognitive Behavioral Therapy (CBT) is the only evidence-based therapy shown to be successful to treat

A. improving the parent-child feeding relationship

B. feeding and anxiety disorders

C. anxiety disorders

D. ARFID

Question 15 of 15

15. Question

15) When a child’s suspected anxiety disorder is impeding function, regardless of whether diagnosed with a feeding disorder too, an essential member of the team is

A. Board Certified Behavior Analyst specializing in anxiety-based feeding difficulties

B. Speech Language Pathologist specializing in dysphagia

C. Occupational Therapist who specializes in sensory-based feeding difficulties

D. A professional with advanced training in cognitive behavioral therapy and exposure therapy, most often a psychiatrist or psychologist.

Time limit: 0

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1. Question

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