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 in Early and Persistent Feeding and Eating Challenges
Common Misperceptions and Opportunities for Healing
Embedded within a relational understanding of feeding, Dr. Rowell will explore why a person might develop avoidant eating. Understand how early challenges impact how a person learns to relate to food - with lifelong implications. Explore how common misperceptions and parental anxiety around growth, nutrition, and appetite fuel counterproductive feeding and provide opportunities for healing.
List three common worries/misperceptions parents have that may fuel counterproductive feeding
Describe three recommendations that support appetite
Describe why telling parents a child “can’t” sense hunger is particularly harmful
Session Two: Jo Cormack MA, MBACP
Child autonomy: the cornerstone of genuinely responsive feeding
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.
Session Three: Virginia Sole-Smith
Learning To Eat in Today's Food Culture: Perspective from a parent, and activist-journalist
Sole-Smith's older daughter Violet was born with a rare congenital heart condition and became feeding tube dependent at just one month old. The experience upended everything Sole-Smith, a longtime health and nutrition journalist, thought she understood about "eating well." The two-year journey of helping Violet learn to eat again forced Sole-Smith to reconsider again and again the standard advice we are given around good foods, bad foods, and good and bad bodies. It also brought her into the heart of the debate between the behavioral and responsive therapy feeding models. In this presentation, Sole-Smith intertwines her personal story with her broader reporting and a history of modern diet culture to explore why behavioral approaches to pediatric feeding disorders reinforce the same kind of restrictive, metric-based thinking that underpin most eating disorders. She calls for the responsive feeding model to revolutionize the way families approach feeding their children — and how parents approach feeding ourselves.
1) Beyond fuel (calories), describe the three essential experiences that food and eating provide to humans.
2) Give two examples of how diet culture and other societal pressures around eating impacts families, and contributes to the stress they face when children are struggling to eat.
3) Compare the goal of number of bites taken from a behavioral approach, to a "responsive" goal such as less anxiety at mealtimes, and the child's increased confidence in themselves as an eater. Consider how it may feel different for parents, both positive and negative.
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
Panel discussion and audience Q and A
Tentative timed schedule CENTRAL TIME, US
8:30-8:45 Welcome & Introduction/housekeeping
8:45-9:45 Session 1 speaker: Katja Rowell
9:50-10:50 Session 2 speaker: Jo Cormack
11:10-12:10 Session 3 speaker: Skye Van Zetten
12:10-12:30 Breakout Session #1
1:15-2:15 Session 4 speaker: John Baker
2:20-3:20 Session 5 speaker: Heidi Moreland
3:35-4:30 Panel discussion
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
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
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.
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
Tentative Day 2 Agenda
8:30-8:35 Intro and housekeeping
8:35-9:35 Session 6 speaker: Jenny McGlothlin
9:40-10:40 Session 7 speaker: Erin Vandenlangeberg
10:55-11:05 Special Presentation
11:05-11:50 Session 8 speaker: Marsha Dunn Klein
11:55-12:40 Session 9 speaker: Suzanne Evans Morris
1:25-1:45 Breakout session #2
1:50-2:50 Session 10 speaker: Grace Wong
3:00-4:00 Panel discussion with Day 2 speakers
4:00-4:15 Farewell, what's next?
4:15-4:20 Callier CE’s and wrap-up