Page 45 - Today's Dietitian (February 2020)

ignore the children’s hunger/satiety cues, indulgent feeders a sensitive manner and reframing or restating these questions
who give in to the children, or neglectful feeders who don’t pro- if necessary to get the required information can help dieti-
vide adequate food or attention) may be a contributing factor tians adapt their therapeutic approach to achieve success.
to their children’s behavior. 9 To do this, dietitians must pay close attention to the history
and the “story” the parents and caregivers tell, as well as their
Considerations for Further Medical Intervention body language. These are all excellent clues to help guide an
Children who are known to have mechanical difficulty with food impression and plan.
should be referred to a specialist feeding team, an occupational Regardless of their impression, dietitians must remember
therapist, or a speech pathologist for assessment of skills and that providing parents and caregivers with several recommen-
recommendations for safe feeding. These children may require dations at one time can be overwhelming and may not be prac-
altered textures, specialized seating (eg, modified or custom- tical. Multiple consults may be required to gradually change
ized wheelchairs, high chairs, or standard seating) or utensils, the behavior of children (and/or that of their caregivers).
9,20
medication, or aids such as g-tubes to safely feed. Children Picky eating is a complex part of childhood. It may be mild
with extreme selective eating, developmental delay, or who are and easily resolved or a more challenging behavioral or medical
thought to have autism spectrum disorder may benefit from a issue that requires specialist intervention. Dietitians should be
referral to a developmental pediatrician, who can best assess the aware of the intricacy of this issue so they can advise parents and
needs of the child and refer to specialist services. caregivers and provide the best possible care to their children.
For more information, refer to “Guidelines for Managing Picky
Practical Tips for Dietitians Eating,” which can be found in the online version of this article.
Due to the variety of complex circumstances under which
picky eating may occur, dietitians should aim to provide tai- Rivanna Stuhler, MSc, RD, is a Toronto-based acute-care pediatric
lored advice for each case of picky eating. General guidelines and private practice dietitian. Stuhler currently specializes in
exist, but they may not always work for everyone. Parents and pediatric blood and stem cell transplant and works in private
caregivers will respond to suggestions they feel are practi- practice with children and adults. Her graduate work focused on
cal, realistic, achievable, and relevant to their children. Cre- quality improvement and patient safety in health care.
ating a sympathetic and respectful rapport with parents and
caregivers can foster trust, which will only serve to help dieti- For references, a sidebar, table, and extended article, view
tians. Parents and caregivers who feel respected and heard this article on our website at www.TodaysDietitian.com.
are more likely to be open to suggestions. Asking questions in

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