The mission of this two-day conference is to foster a supportive community for providers to learn about and hone their skills around "responsive" feeding and therapies. Too many children and families who struggle with eating aren't able to access help or are referred to therapies that increase conflict and even worsen feeding challenges. In addition, with the newer ARFID diagnostic code, many children who "fail" therapies or didn't "grow out of it" are treated by eating disorder professionals who may feel unprepared to work with children or adolescents who have struggled, often since early childhood.
This workshop will be the first of its kind to bring together professionals working from birth to adulthood on: feeding and eating challenges including ARFID (Avoidant Restrictive Food Intake Disorder), anxious eaters, problem feeders, low appetite, and selective and extreme picky eating.
An international and transdisciplinary panel of speakers will explore early challenges that predispose to feeding and eating difficulties and how professionals can support clients and families around responsive feeding and therapies. Speakers will explore feeding practices, issues around assessing weight and nutrition, therapeutic strategies, and how to decrease anxiety and increase comfort and competence around new foods. The speakers will provide background information as well as concrete tips that clinicians can use right away. Speakers will highlight how to support and improve appetite, bodily autonomy, and internally driven eating to help clients be the best, most confident and joyful eaters they can be.
The evidence base supporting responsive practices will be woven throughout.
for: registered dietitians, pediatric specialists including speech and language pathologists and occupational therapists, therapists treating eating disorders, medical doctors and GI specialists.
tentative schedule and content
Session One: Katja Rowell M.D.
Getting to WHY: A Relational Understanding of Early and Persistent Feeding and Eating Challenges
Embedded within a relational understanding of feeding, Dr. Rowell will explore why a person might develop avoidant eating: including the role of early challenges, anxiety, autonomy, weight worries, feeding dynamics, and aversive experiences and therapies.
Setting the stage for the rest of the conference, Rowell will examine the critical importance of a thorough assessment, exploring the role of each provider as a specialist who must have a general understanding of typical development and red flags that might require intervention. Assessment tools will be introduced around eating routines, feeding dynamics, and uncovering opportunities to help families and clients transform maladaptive feeding practices, to supportive and responsive feeding in the home.
List three challenges that might increase the risk that a child will struggle with eating.
Describe how "oral aversion" can develop for a variety of reasons beyond "sensory."
List three assessment tools that can help practitioners understand the feeding environment in the home.
Session Two: Jo Cormack MA, MBACP
Prizing Autonomy: A Qualitative Exploration of Parental Use of Mealtime Pressure and a Theoretical Framework to Support Responsive Feeding Therapy
Cormack's presentation will center around the essential role of autonomy support in relation to child-feeding practices, relevant to professionals involved with feeding as well as eating disorder providers and front-line healthcare practitioners. Following a brief discussion of ‘autonomy’, Cormack will cover three key topics: her primary research findings, a related theoretical framework, and implications for professionals.
Cormack will discuss the findings from her doctoral research in the context of the literature on parental feeding practices. She will explore the main themes in her qualitative data collected from parents of children aged two to five years seeking help with feeding challenges. Cormack will then present her work on the application of Self Determination Theory (SDT) to support responsive child feeding, with an emphasis on autonomy support (this work is summarised in a theoretical paper, co-authored with Rowell and Postavaru, currently under review). Cormack will explore how SDT can be used as a framework for a responsive approach to child feeding, linking the Basic Needs of autonomy, relatedness and competence to her research findings on parental use of mealtime pressure and feeding and eating challenges. Finally, she will explore the implications for professionals with a focus on the importance of autonomy support when working with children and adolescents, as well as supporting their parents and educating families about best practice in relation to child feeding.
Lunch provided on-site, and poster presentation
Session Three: Skye Van Zetten
Mealtime Hostage: Food Refusal From a Parent-Activist Perspective
VanZetten will share her family’s journey of healing with ARFID, as well as speak to her years of advocacy and listening as the founder and administrator of the private Facebook support site, Mealtime Hostage, with over twelve thousand members. Van Zetten will introduce the findings of the Parent Science Survey on ARFID and selective eating, published in 2019 the Journal of European Psychiatry, which discussed the notion of avoidant eating as existing on a continuum.
Parents looking for resources and support are flooded with information, but rarely knowledge, to manage their feeding problems. Among other challenges, VanZetten will examine the complexities of the diagnostic label to the limitations of looking at the child’s eating behavior in isolation. From being let down by the very experts they turn to for help, to the fact that accepted therapies can feel diametrically opposed, parents are struggling.
Van Zetten will explore many facets of supporting parents and thereby children and youth with ARFID, from the language they use, to the role of permission, helping children move themselves along a sensory hierarchy, and the difficulties of expecting parents to act as feeding therapists.
Session Four: John Baker M.D.
“Look at the Baby!”: Assessing Nutritional Status and the Critical Role of Hunger
Charts and calculations can be helpful, but “Look at the baby!” was a statement made by a pediatric endocrinologist in Dr. Baker’s early training, a statement he took to heart. Overfeeding and excess body fat can be a significant factor in oral feeding aversion and tube feed intolerance. Forcing infants and children to eat when they are not hungry is miserable and interferes with hunger and satiety. While it is difficult for many feeding and medical professionals to consider, children who have been fed beyond hunger may need to be allowed to lose weight in the weaning process to get to the point when hunger kicks in.
Hunger is an often missing, but critical piece of the puzzle in the treatment of oral feeding aversion. Baker will explore the importance of the clinical assessment of nutritional status as opposed to focusing on growth curve percentiles. He will review the physiology of hunger and growth, including children with GI and medical issues and prematurity. Using case examples from Baker’s decades of work in this field, he will discuss adjusting caloric intake to allow body fat stores to reach a level that supports internally driven eating as an important aspect of treatment. Included are specific strategies for adjusting the feeding goals and monitoring nutritional status.
While this session focuses primarily on infants and young children, it will introduce how early regulation is impacted, with potentially life-long consequences in terms of appetite, interoception and weight trajectory.
Session Five: Heidi Liefer Moreland, MS, CCC-SLP, BCS-S, CLC
Hunger and Trust: Bringing Both to the Table
Liefer Moreland will lay the foundation for the development of self-regulation and the role it plays in responsive feeding. She will explain how both external and internal influences can impact the child’s ability to develop and sustain functional self-regulated eating, and the impact of hunger on the development of those skills. The philosophy and outcomes of the Thrive feeding tube-weaning program will be discussed.
Attendees will summarize the literature on the development of self-regulation of intake.
Attendees will identify the interplay of body, mind and emotion in the development of self-regulation
Attendees will identify the impact that a complex medical history, a feeding tube, or non-responsive feeding practices can have on the development of self-regulation, or the ability to sustain self-regulation.
Attendees will identify ways to support families as they develop a balance between hunger and trust in mealtimes.
Attendees will identify subtle stressors that can impact the development of responsive mealtimes
3:45-4:30 Panel discussion and audience Q and A
Networking Happy Hour 5:15 pm at Rodeo Goat outdoor patio
Walkable from conference
Session One: Jenny McGlothlin MS, CCC-SLP, CLC
Moving from Get to Let: Building Trust in a Therapeutic Relationship
Much of the struggle around feeding stems from a child’s need for autonomy. Feeling in control of one’s own body is a critical part of that autonomy. It is hard to get children to do things, and when it comes to feeding, it is almost impossible without sacrificing trust. Indeed, our job is not to get a child to eat more or differently than they can right now. This involves a major shift in thinking. Instead, our job is to pay attention to the cues the child is giving us as to what they need and how they feel, which makes us better able to react to those needs. We can gently facilitate the child’s progress through presentation of options that the child gets to opt out of if they so choose. Through video and case examples, this session will provide clinicians with the tools they need to build trust within the partnership they have with caregivers and clients in therapy.
Session Two: Erin VandenLangeberg Ph.D., MPH
Responsive Feeding and Therapy in the Context of Psychological Practice
Avoidant/Restrictive Food Intake Disorder (ARFID) is a lesser known and treated diagnosis for many mental health therapists. Providers have pulled from various clinical treatment modalities when working with children and youth with ARFID, trying to make sense of feeding disorders within the context of the mental health world. Many children with ARFID are more complex than clients with classic eating disorder symptoms, with longer treatment histories and more complicated medical backgrounds. Despite this, when they show up in eating disorder clinics, they have largely (until more recently) been treated from an eating disorder framework.
Understanding the common factors that help people heal within a therapeutic context, along with her treatment expertise in eating disorders, anxiety and OCD, VandenLangenberg has developed a practice of working with children and adolescents with ARFID/SED using an adapted, responsive exposure based approach. She will share practical tips and strategies, illustrated with case examples, of how she builds trust and creates a safe space to help children and adolescents reduce their anxiety around trying new foods and rely on their own intrinsic motivation to help guide exposure-based work. In addition, she will share how she works with parents to create a non-pressured feeding environment at home. VandenLangenberg reframes the goal of expanding food variety to reducing stress around feeding and mealtimes. Through this trusting, bidirectional relationship, she works to help clients reduce anxiety around novel foods while building a supportive and empowered family structure to continue the work outside of the therapeutic walls.
Session Three: Marsha Dunn Klein, OTR/L, MEd, FAOTA
New Food Trying FROM Mealtime Peace (30 minutes)
Marsha Dunn-Kline will define and describe Mealtime Peace as the foundation for enjoyable, confident and successful mealtimes. Klein will share new food trying techniques, offered from the calmer and trusted foundation of mealtime peace that is at the heart of her Get Permission approach.
Session Four: Suzanne Evans-Morris
The Happiness Option at Mealtimes (30 minutes)
Personal beliefs play a major role in every aspect of our lives. They are the filters through which we observe our world and the most important aspects that influence the choices we make. Different approaches to research, assessment and treatment of children with feeding disorders emerge from different beliefs of the clinician, parent, and child. Barry Neil Kaufman, in his book, Happiness is a Choice, discusses why choosing happiness as a foundational belief can move us toward a positive and fulfilling life. He describes six “Shortcuts to Happiness” that illustrate ways in which we can become happier. This brief presentation describes these shortcuts with multiple examples of their application at mealtimes with children who experience difficulties with mealtime relationships, comfort and skills.
12:15-1:15 Lunch onsite with poster viewing
Session Five: Grace Wong MSc, RD, CEDRD-S
Theoretical Foundations of Responsive Feeding Therapy
Responsive feeding is an evidence-informed practice evolving from time-tested theories as well as practice-based knowledge of experienced feeding and eating disorder professionals. With growing interest and evidence to support the application of responsive feeding in clinical interventions, this session aims to provide an overview of Responsive Feeding Therapy (RFT) as a treatment framework.
Wong will discuss the guiding principles of RFT and its theoretical foundations. She will explore how to apply a responsive framework to enhance current practice, incorporating the tools and skills clinicians already have.
Panel discussion and audience Q and A