Transcriber: Luke DiNardo Reviewer: Maurício Kakuei Tanaka
Parenting -
it’s just so simple, isn’t it?
I mean, even if you don't have kids,
Facebook and Instagram show you exactly how wonderful parenting life really is.
I know you’ve seen those pictures of that wee little baby
resting peacefully in his father’s arms
or passed out with his arms and mouth wide open
after a delicious feeding of mother’s milk.
Let’s not forget those videos of baby laughter
bellowing from those teethless smiles
or those delicate arms wrapped around mama’s neck
to be calmed from crying.
I mean, parenting comes so naturally, doesn’t it?
You just hold them, love them, feed them, and teach them.
Simple, right?
Well, that's what our eyes are telling us.
We’ve been watching others parent for years.
Using our eyes, we can see exactly what goes on.
Let’s take this picture, for instance.
My eyes tell me exactly what that is.
It's a horse, right?
What?
You see something different?
You see a frog?
Okay. Let’s just try another one.
Now, this.
This is a rabbit for sure.
We have to agree on that.
No way.
You see a duck?
Well, from my past experience,
this animal with a small face and little nose and long ears
is definitely a rabbit.
But you -
you see a duck.
How is that possible?
Could it be an illusion?
What we see and what is could be two totally different things.
I experienced this with my son.
There’s a common misconception
that children who don’t like to eat many foods
are just “picky eaters.”
All we see is a child’s refusal to eat certain foods
when in reality, he’s struggling with a feeding disorder.
Let me share a story with you about my son.
I was so excited to be a mom.
I mean, all I had to do was hold him, love him, feed him and teach him.
I was ready.
At least, that’s what I thought.
When it came to feeding him, I was dedicated to nursing
because that was the most natural thing,
and it would give him the most health benefits.
From watching others,
I had learned all I had to do was lift him to my breast,
and he would latch on.
So that’s what I did.
Well, I quickly learned that the ease of breastfeeding
is all an illusion.
I would lift him to my breast.
He would struggle to latch,
feed for a short time,
and then he would choke.
Okay. That was just a fluke, I thought.
Let’s try this again.
Over and over,
feeding after feeding,
he would struggle to latch,
feed for a short time,
and then he would choke.
Milk came spewing out of his mouth and nose.
One episode was so bad I called 911.
Each feeding was a nightmare.
I’d get him to eat for a short time,
battling through all of the choking episodes,
and then finally, lay him down to rest.
Well, that didn’t last long.
Just when I thought we were safe, he would awaken with this piercing scream,
or I would hear this glub, glub sound coming from his crib.
(Whispering)
That sound is still so vivid in my mind.
As I glanced over the side of his crib to check on him,
I was met with the sight of milk spewing from his mouth and nose.
I quickly grabbed him up.
I was terrified.
Would he have died if I wasn’t right there?
This just can’t be happening.
Feeding him is supposed to be automatic.
What am I doing wrong?
Feelings of failure and shame came rushing over me.
He depends on me.
And I can’t even feed him.
All of the feeding experiences I had seen before
came cycling through my mind.
I kept questioning,
“How could what I had seen be so different than my reality?
Was it all an illusion?”
I never knew that these early feeding experiences
could impact him as he grew.
I noticed when he started eating solid food.
He was very hesitant.
He didn't want it on his hands.
He would push it to the floor
or even turn his head away from the spoon as it approached his mouth.
Unfortunately,
I resorted back to what my eyes and past experiences had taught me.
Kids are supposed to eat what's on their plate.
So like typical parents, we coerced them to just take a bite
or even threaten to have them sit there until all the food was off of their plate.
I hate to even admit it now,
but when we got desperate,
we even resorted to bribes or sneaking food into his mouth,
only to have watched him gag and vomit.
After doing much research,
I learned it wasn’t that he didn’t want to eat it,
or that he was just being a “picky eater.”
He couldn’t eat it.
Psychologically, a fear of food had been built up over time
due to his choking,
the pain he felt in the throat and stomach,
and the pressure from us trying to coerce him.
Physically, he didn’t have the oral motor abilities
to break the food down,
move it around in his mouth,
and safely swallow it,
nor did he have the muscle maturity to keep the food down in his stomach.
If you think of chewing and swallowing as a chain reaction,
you will better understand that it's all related.
Each phase relies on the coordination of the phase before it
to function properly.
Eating is not as simple as it looks.
In fact, it is very complex.
Eating is the only bodily task that requires the use of every organ
and all of your senses.
There are three phases to swallowing:
the oral phase, the pharyngeal phase, and the esophageal phase.
Let’s briefly discuss these phases.
During the oral phase,
the tongue and jaw move food around in the mouth
to chew it to the right size and texture.
Saliva mixes with the food to make it easier to swallow.
The second stage is the pharyngeal phase.
This phase begins when food or liquid is pushed to the back of the throat,
which triggers a swallowing response.
Waves of muscle contraction push the food or liquid to this pharynx.
During this process, your larynx closes tightly,
and breathing stops,
so that no food or liquid will enter into the lungs.
The third phase is the esophageal phase,
and this phase begins when food or liquid leaves the pharynx
and enters into the esophagus.
This tube is responsible for carrying food or liquid to the stomach.
For my son, the breakdown occurred in the oral phase,
but it impacted the entire chain reaction
because he didn’t have adequate oral motor skills
to contain the milk in his mouth until he was ready to swallow it.
It would spill over the back of his tongue too quickly,
causing him to choke
and swallow an excessive amount of air.
This buildup of air pressure made the receptors in the lower esophagus
think that there was something there
that needed to be emptied into the stomach,
therefore messing up the timing of the muscle that relaxes
to allow food in,
and then tightens to keep it down.
Timing, coordination, and strength
are all essential components to a safe and efficient swallow.
My son was trying to tell us that something was going wrong.
This is why we can’t rely solely on what the eyes can see.
We must remember that communication comes in many forms.
His crying, turning away, pushing it away, spitting it out, and avoidance
were all ways he was trying to tell us something was wrong.
Research has identified that a child’s refusal to eat
is usually due to a combination of factors,
some of which include pain or discomfort,
immature motor and swallowing skills,
and sensory processing problems.
It’s so important that we figure out what that child is trying to tell us
through his or her behaviors
and food preferences.
Ultimately, that child is trying to select foods
that he or she considers safe,
easy to chew,
and that won’t cause pain or discomfort.
So I know you’re probably thinking,
“Now, how am I supposed to know if my child is just, say, a ‘picky eater,’
or if this is a bigger problem?”
Well, I’d like to list a few distinguishing characteristics
outlined by Dr. Kay Toomey, the developer of the SOS Approach to Feeding.
If the child is a picky eater,
he or she will usually eat greater or equal to 30 different foods.
They can tolerate new foods on the plate.
They will usually touch and taste new foods
and typically eats at least one item
from most every food texture and nutrition group.
Now, the child with a bigger problem
will have a very restricted variety of foods.
This child typically eats less than 20 different foods,
has aversive behaviors to the introduction of new foods,
and may refuse to eat entire categories of food textures and nutrition groups.
To help me make this distinction with my son,
I used an online infant child feeding questionnaire
through an organization called Feeding Matters.
While researching, I learned that leading experts had come together
to ensure that there was a clear definition and diagnosis
for this bigger problem many families were facing,
including myself.
It is now being recognized as Pediatric Feeding Disorder, or PFD.
PFD is defined as impaired oral intake that is not age-appropriate,
and that’s associated with a medical, nutritional feeding skill
and/or psychosocial dysfunction.
It is usually the direct result of a complication,
breakdown or intolerance.
Often, children with PFD go undiagnosed for months
and even years.
And this can have a negative impact on the child’s growth,
nutrition and development.
We must explore beyond the illusion of what the eyes can see
to determine whether these struggles at mealtime are “just a phase”
or an unidentified problem.
So as you go home to nurture and bond with your families over food,
I want you to remember three things.
Eating is not as simple as it looks.
Communication comes in many forms.
So pay attention.
And Pediatric Feeding Disorder is often disguised as “picky eating.”
So seek beyond what the eyes can see
because it may just be an illusion.
Thank you.
(Applause)
(Cheers)
(Applause)