Making Sense of Selective Eating Ep 7
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[00:00:00] Announcer: Welcome to SLP Learning Series. A podcast series presented by SpeechTherapyPD. com. The SLP Learning Series explores various topics of speech language pathology. Each season dives deeper into a topic with a different host and guests who are leaders in the field. Some topics include stuttering, AAC, sports concussion, Teletherapy ethics and more.

[00:00:42] Announcer: Each episode has an accompanying course on speech therapy pd.com and is available for 0.1 ASHA. CEUs now come along with us as we look closer into the many topics of speech language pathology. 

[00:01:10] Madi Metcalf: Welcome to Making Sense of Selective Eating, This Child in This Moment, featuring Marsha Dunn Klein. My name is Madi Metcalf, and I'm a speech language pathologist with an interest and passion for pediatric feeding disorders. I'll be your host for the SpeechTherapyPD podcast mini series. Today's course is one hour and offered for 0.1 ASHA CEUs.

[00:01:30] Madi Metcalf: If you're a part of the ASHA registry and want your CEUs reported, you must have your ASHA number and address in your speechtherapypd. com profile. Please allow one to two months from the completion date for your CEU to be reflected on your ASHA transcript. Now, without further delay, I'd love to welcome Marsha Dunn Klein, OTRL, MED, FAOTA. Marsha Dunn Klein is a featured guest on this episode of Making Sense of Selective Eating.

[00:01:55] Madi Metcalf: Marsha is an occupational therapist from Tuscan, Arizona, who has a career spanning over 53 years with a specialty and passion for pediatric feeding. She has been a clinician. clinic owner, author, inventor, and is co founder of the Get Permission Institute.

[00:02:11] Madi Metcalf: She has co authored Pre Feeding Skills, First and Second Editions, Mealtime Participation Guide, and Homemade Blended Formula with Suzanne Evans Morris. Welcome, Marsha. How are you doing this evening?

[00:02:24] Marsha Dunn Klein: I'm doing well. It's hot here in Tucson. I think it's a hundred and some degrees, so. 

[00:02:30] Madi Metcalf: Oh my word. I live in Arkansas and we are having a nice little cool front after some storms this weekend.

[00:02:36] Madi Metcalf: So it was like 85 today. It was delightful. 

[00:02:39] Marsha Dunn Klein: Lovely. Lovely. 

[00:02:41] Madi Metcalf: Well, Marsha, I'm so thrilled to have you on the podcast . When I was Fresh SLP, having my first feeding client, the pre feeding skills textbook was my bible. And so you've just had a huge part in my growth as a clinician and I am thrilled that you wanted to be part of this podcast series.

[00:02:59] Marsha Dunn Klein: And I'm thrilled that you're doing this podcast series. I spent some time catching up on some of the previous episodes in the series and you're doing a great job getting a real diversity of human beings talking about feeding. And so I'm happy to be a part of it. 

[00:03:14] Madi Metcalf: Well, thank you so much. Well, let's jump into it.

[00:03:18] Madi Metcalf: So, the last couple weeks we've talked so much about pediatric feeding disorder and ARFID. So, can you kind of talk to us tonight a little bit about the importance of sensory and relationship? To PFD and ARFID. 

[00:03:31] Madi Metcalf: I can. . I, so I know that you've been talking about PFD and ARFID and our focus today for this part of the series is on looking at sensory. And many of us learn sensory in lots of different ways. And, you know, when I first learned sensory, it was way back in, you know, Jean Ayres was teaching us about sensory integration disorders and, and sensory processing years ago, and we've evolved and have a whole lot more information now.

[00:03:58] Madi Metcalf: But when I think about PFD I think that you can't think about PFD or ARFID without thinking about sensory. Because, for example, the medical aspect for PFD, if you don't, if you can't breathe, You don't feel well enough, that's a sensory feeling in an interoception, you don't feel well enough to eat. If you don't, if you don't like the feeling of the food in your mouth, that's a sensory thing and who's going to want to learn how to chew it if you don't like the feeling of it.

[00:04:27] Madi Metcalf: If you eat food and you have a gut dysfunction with, with allergies, for example. You don't feel well. So there's a lot of sensory with the medical. There's sensory with the nutritional because if you're not getting a full on great nutritional diet, you may not feel your best if you're only eating carbs, right?

[00:04:47] Madi Metcalf: You may not know what your best could even feel like because you have such a narrow diet. Feeding skill. It is very hard to learn to chew and learn anything about eating. If you don't feel well enough to want it to be motivated enough to eat it. And the psychosocial part the psychosocial part looks at the impact of feeding on relationships with the, with the feeder and with the family.

[00:05:11] Madi Metcalf: It looks on relationships with people at the mealtime. It looks like the child's interaction with food and learning to, Eat and utilize utensils and for a lot of kiddos that, that we are talking about really looking at those kiddos that are described often by some people as behavioral or picky or selective or all of those words meaning somehow that child is not eating the things somebody else thought they might be eating at this stage of their life.

[00:05:40] Madi Metcalf: And there's something therefore amiss. And I believe that all of those descriptors. Have, can have a sensory component and then, and then ARFID, the description, the definition of ARFID describes sensory differences. People who have ARFID have a narrower diet, maybe restricted to brands, to textures, to food groups.

[00:06:07] Madi Metcalf: Those are sensory kinds of things. So I do not think in any of these challenges that we're talking about that we can, we can ignore sensory. It's, it's just. foundational. And I think we have to be curious and wonder, I wonder why this isn't working for this child. Because you and I know babies when they wake up and, and, or when they're initially offered foods, you know, they learn how to eat because they have the foods that they have to move differently with.

[00:06:37] Madi Metcalf: And then they learn how to chew because the food's inspired and they just learn how to eat. We don't meet the kids in feeding therapy, they just learn how to eat. We meet the kids. For whom there is a difference, where, for whom there is something for that child that's getting in the way of their being able to be comfortable, enjoyable, and skilled in their eating. So absolutely, I love that you had an entire topic just on this, on this topic of sensory.

[00:07:06] Madi Metcalf: So you mentioned interoception but can you tell us what other sensory systems and sensory processes can impact feeding? 

[00:07:14] Marsha Dunn Klein: Yes, absolutely. Great question. So feeding is sensory. Period. You know, what inspires you to eat or me to eat?

[00:07:22] Marsha Dunn Klein: You know, it looks good. It smells good. It tastes good. It, it sounds crunchy. It, the, the presentation is great. You know, there's something about the food itself that has, that impacts. Five of our sensory systems, right? Right. And traditionally, those are the systems we paid attention to. And then we started paying attention to proprioceptive and vestibular.

[00:07:44] Marsha Dunn Klein: So we get the person in a, in a state where they can feel their body and their posture. And we've, we've all been pretty good at looking at those seven systems for, for decades. And more recently, we're paying a lot more attention to the eighth sensory system, which is the, intraception. And that is that internal awareness of how do I feel?

[00:08:08] Marsha Dunn Klein: How does that food make me feel? How does it feel in my mouth? How does it feel after I've eaten it? How, how is my inside Feeling. Am I feeling hungry? Am I feeling disgust? Am I feeling bloated after I, I have all that pediasure in my stomach? Right. What's the inside feeling? Because That interoception, that inside what's going on inside of me, influences whether I even want to try it.

[00:08:42] Marsha Dunn Klein: Influences whether I'm motivated to come even near that food or not, because what we know is if you don't feel good, you don't want to eat. Right. If I didn't like the smell of it, would you eat something you didn't like the smell of? You know, I would not know, would you put something in your mouth that made you gag because the texture is crappy?

[00:08:59] Marsha Dunn Klein: No. If you didn't like the sound of people chewing, are you going to want to chew a big crunchy soundy thing that's going to crunch in your ear? Nope. If you hated what it looked like, it's personal. Our sensory systems are personal. And the thing that we need to pay attention to is not only are our sensory systems personal, they are unique.

[00:09:25] Marsha Dunn Klein: They are neuro diverse. Diverse. We are all different. So if you think about maybe people could put a message in the chat if you wouldn't mind and tell me a food that really is particularly disgusting to you because we all have those foods, you know, kind of a disgusting food. And if you throw that up there while I'm chatting for a second, it would be great.

[00:09:44] Marsha Dunn Klein: But some food that's disgusting, but so. But I would bet your disgusting food is different than my disgusting food. Oh, Elise, my husband hates cooked mushrooms. The texture makes him a little crazy person, right? Olives, eggplant, tongue, yeah. Those tape buds on the tongue don't make me very happy either.

[00:10:02] Marsha Dunn Klein: Eggplant, beets, sardines, mushrooms, liver. Alright, so a couple stories that need to come out of this is, first of all, when you are disgusted by food, Chicken and dumplings. That's an interesting one. One of my favorite foods. So what this reminds us is we are all unique. And so I am not going to say to KK, you should like chicken and dumplings because I like it.

[00:10:27] Marsha Dunn Klein: That's not fair because for you, KK, It's not a, it's a disgusting food, right? And so it's very unique. So it's not fair to me, to you for me to say, you should like that because that's sort of invalidating of what you're actually feeling. So what I say about the uniqueness of each person is that we are, we are unique and we should believe children.

[00:10:52] Marsha Dunn Klein: We should believe their parents. When a child says to me that salting cracker feels like glass in my mouth, I am not going to say. Oh, no, it's fine. No, no, no. I want to validate because that's a real response the child is having, right? We really want to make sure we, we validate that child and not make them feel bad because they don't like the crackers or that somebody doesn't like chicken and dumplings, right?

[00:11:16] Marsha Dunn Klein: We want to just acknowledge that's your unique self. So, so we wanna, and, and not everybody needs to eat everything. So the story you and I talked about when we were getting ready for this talk was my grandmother was Scottish. And when she would come to visit my grandmother and my mother would make steak kidney pie.

[00:11:36] Marsha Dunn Klein: Honestly, it's disgusting to me. , I could smell it from the bus stop. I knew that my grandmother was visiting and, and there was steak and kidney pain. My mother knew enough to cook hot dogs for us kids. Thank you, mom, but it was disgusting to me. And so imagine your disgust food that you mentioned here.

[00:11:57] Marsha Dunn Klein: Imagine you're in feeding therapy and somebody says to you, you need to eat three mushrooms without any refusal behaviors, without gagging, vomiting, or pushing it away, three out of four times in the clinic over the next four months. A three out of four times a time, a presentation. Now, most of you. Who have defined a disgusting food will say, no way, there's just no way and how dare I disregard your disgust food, right?

[00:12:37] Marsha Dunn Klein: How dare I do that? Because, and how dare I tell you, you don't get your dinner until you eat those things. So one of the things that happens, oh, and I just have to say, I just was in Berlin a month ago and they have a museum called the Disgusting Food Museum. Which of course I went to was amazing. But so I want us, I bring you this sort of extreme example about discuss Madi, because I think we need to be sensitive that we're all so unique from a sensory perspective.

[00:13:08] Marsha Dunn Klein: It may not make sense to me that somebody else doesn't like beats, but I love beats. Right. That may not be logical sense to my brain, but I have to be respectful of that. And in feeding. And when we're helping kids learn how to eat, we want to build positive memories and we'll help them learn to find new foods that they might be interested in trying, but I want them to come back.

[00:13:31] Marsha Dunn Klein: I want them to be not feeling pressured. I'm not going back to you and feeding therapy. If you made me eat that steak and kidney pie, 

[00:13:38] Marsha Dunn Klein: I would not come back. I would cry. I might cry in the parking lot. I might cry at home before my mother put me in the car. I might cry when I came into the room. I would not want you to send my mother away because this is a traumatic story, right?

[00:13:51] Marsha Dunn Klein: So. As an extreme example, but disgust is a sensory reaction to food, you know, and, and so our job is to really try to understand the person in front of us. So I know you and I talked about talking about this child in this moment as the theme for tonight. And so when I, when I'm teaching, when I'm meeting families, when I'm mentoring, I always try to think about that phrase, who is.

[00:14:24] Marsha Dunn Klein: this child in this moment, and how can I support that child at learning about eating? How can I support that family to be successful in offering foods to their child? And the reason I say this child in this moment, number one is because we all have unique systems. Not only do we have unique sensory systems in terms of the characteristics of food, but we have unique emotional systems that are highly related to our sensory experiences.

[00:14:54] Marsha Dunn Klein: And we have different experiences in terms of safety and regulation. So those are also highly related to our sensory experiences. So for example, when children come to us for feeding therapy, we, we want to help them. We want to do well, we want to give them food experiences. And so if we, in order to give them food experiences, we might have foods around We want to teach them something.

[00:15:19] Marsha Dunn Klein: We want to have a positive interaction. You know, we want all the right, the best things, right? But if that child comes in today in this moment, because maybe they had a tough day at school. Maybe they are constipated and feeling awkward in their stomach. Maybe they had a reaction to some food that they were eating.

[00:15:37] Marsha Dunn Klein: Maybe they're just not regulated that day when they come in dysregulated. They are not ready. We have all had that experience when I've talked about that. They're not regulated. They're not ready. They're not feeling safe enough and ready to participate in our experiences. So if the child's starting point is pushing food away and crying and protecting themselves, they're not ready to learn.

[00:16:05] Marsha Dunn Klein: They're not ready to think about, let's make a new positive memory around foods. And so we have to look at, so even though the child last week had a great time, and you've, you've described that, last week we had a great time, this week, oh dear, this was a different day. What we have to do is not say, you liked it last time, why don't you like it today?

[00:16:26] Marsha Dunn Klein: Because today is a different day. reaction to that child's nervous system. What we have to look at is, okay, this is where the child is now. We have to start out finding a way to help this child feel safe. There's a okay, I'll tell you that other one in a second. I want to say one more thing about this, and that is, you know, many people come to us because they want kids to try new foods, and that's a sensory experience for a lot of us.

[00:16:48] Marsha Dunn Klein: We try to create sensory, positive sensory experiences in our But I want us to remember that we nourish children. That's a goal for parents and for us, right? with food. That's one way we do it. But we also nourish children with positive memories, positive relationship connected support, a pleasant environment, a meal time that the child wants to come to, that they're motivated to come to and feel good about, that they have choices.

[00:17:25] Marsha Dunn Klein: That they can trust us as grownups, that nobody is going to force them to eat something that they're not comfortable eating. Yet, we're going to find other ways to help that child without pushing right into their worry and pushing right into their fear. So we want to remember that nourishing is not just calories, it's also with connection.

[00:17:44] Marsha Dunn Klein: And those of you, some of you may know this book and you know, when I talk, I like to give lots of things for people to read nourished. I don't know if you know this book but it's called Nourished Connection, Food and Caring for our kids and everyone else we love and it's Deborah McNamara and it's just a really lovely book to help us pull our video camera back and think about food as a part of a big picture not just the the how many bites we got in the child.

[00:18:18] Madi Metcalf: I love that and I I definitely needed to hear that because you know, I talk a lot like as a feeding therapist, you get into having some like uncomfortable conversations with parents sometimes, and you're meeting parents at a potentially hard place because as like the number one job of your parent, you have to keep them safe.

[00:18:37] Madi Metcalf: And what do you have to do that? You have to keep them fed. Hydrated and sleeping and if a parent's coming in and they're not able to keep their child fed. Well, that's one of those like foundational things and so like one like that is one way they're being nourished, but you could use that to shed positive light on the ways that they are nourishing their child.

[00:18:58] Madi Metcalf: Because we get nourishment in other ways and then also just remember that in our sessions that we can still have a positive session making positive impacts with a child because we're nourishing that relationship, that connection to foster those positive relationships. So that, I love that take on nourishment.

[00:19:15] Marsha Dunn Klein: Yes, and I heard I was listening to the first talk in the series with Stephanie Cohen and talking a lot about our roles. And I really have changed the way I think about our roles in my 53 years. I don't believe anymore. I did believe that it was our job to get food in kids and, but, but I also believed it was my job to help them like new foods, but, but I was going to be a cheerleader.

[00:19:40] Marsha Dunn Klein: It was never going to be pressure. There would be no crying. It would be pleasant. I mean, you know that that's the planet I've come from as the gentler kind of approach, but I also realized I was trying really hard to get them to like it and try. I was trying it in a comfortable way. I was trying to get them to lick it and smell it in a playful way.

[00:19:59] Marsha Dunn Klein: But I was trying all those things and. It was still my idea, and that's what we call an externally motivated idea. We want feeding to come from the child to be an internally motivated idea. And I've had people say to me, but you know, I give them a reward, so they'll eat it, and I'll say, but that's external.

[00:20:19] Marsha Dunn Klein: Then they're doing it for you. Then they're doing it for the reward. And, and we want children to be doing it because they want to. And I've had people say to me, how do you get kids to eat anything without a reward? All the time, all the time, because we're, we're looking for ways to invite the child into the mealtime and be comfortable with it.

[00:20:38] Marsha Dunn Klein: So that all came from nourishing more than just. food and nourishing who they are and nourishing their trust with their parent and, and relating to roles. So it's not our job to get food in. It's our job to provide food in a way that the child's comfortable can learn about it. The child that the parent can feed their own child, not that we're going to take them back in a room and work with them and then give them back to the parent, but the parent's a part of the interaction.

[00:21:05] Marsha Dunn Klein: But it's also the child's job to protect themselves because the default. Setting for our nerves. Nervous system is protection and suspicion. And so our nervous system, what we know in 2024, so much more than we knew when I was first came out of school. And we know that the nervous system neuroception some of the work of Stephen Porges It's always on constant alert.

[00:21:27] Marsha Dunn Klein: Am I safe? Am I not safe? Am I safe? Am I not safe? Because if the child comes into a therapy session and they're not feeling safe because there's something about the environment, the sensory experience for that child, if they're not feeling safe, the right answer Is to push you away. That is the right answer.

[00:21:47] Marsha Dunn Klein: Right? If I'm disgusted with a food and my sensory reaction is saying that's a terrible food, the reason we have a disgust reaction is to protect us from eating poisonous things or rancid things or You know, that disgust is a reaction that helps us survive as a species. And some of our more unique eaters will have disgust reaction, full on disgust reaction with a banana or some food that, because their system is, is off balance.

[00:22:21] Marsha Dunn Klein: And so when you are in a disgust reaction, the proper answer is to protect yourself. So we've got to make sure we find a balance back with kids with these reactions.

[00:22:34] Madi Metcalf: Oh man, that is really and I don't, I think that's the hardest part with some of these kids is finding that way to like invite them in in a way that feels safe and easy and comfortable for them, especially when I've gotten a lot of kids on my caseload that have been in feeding therapy for years.

[00:22:50] Madi Metcalf: And. Then they come to me and it's like, Well, we've been in feeding therapy. We've lost foods at our last feeding therapy This is my last resort and if they don't like coming i'm not bringing them back Like we're just going to try one more and if this doesn't work, we're done And those are always really tricky.

[00:23:09] Madi Metcalf: But so many of them came from that like really intensive Just got to do it. You just have to do it. You just have to do it Oh, man, they had five new foods today and then they go home and You A girl that I'm fixing to get on my caseload cries whenever mom moves a bag of frozen vegetables to get her favorite bag of chicken nuggets.

[00:23:28] Madi Metcalf: And so it's like, okay. And so I always tell them like, you know, I am going to take probably a very different approach than you've been to before. But I think that it'll be a good idea because it's going to be working on building that connection relationship. We had a question or a chat pop in. So admittedly, I'm a feeding therapy novice.

[00:23:50] Madi Metcalf: Welcome. I'm so happy you're here. Happy you're learning and interested. We need feeding therapists out in the world. But it is this idea, straying away from food training and delving more into providing multiple options for the child gravitate to independently. 

[00:24:06] Marsha Dunn Klein: I didn't mean to sound like I said that exact thing, so I think I was a little confusing.

[00:24:12] Marsha Dunn Klein: So, in the Get Permission approach, we talk a lot about starting with the food that the child trusts and helping them tiptoe in the direction of new foods, and it, there's a, it can feel a little bit like food chaining. It's not food chaining, but we call them stretches. But like, for example, if a child likes yogurt you know, we might try to help that child.

[00:24:37] Marsha Dunn Klein: Sometimes those children are eating that yogurt out of the container, a certain brand, mom has to open the container, they can't move it out of the brand, you know those kids, right? And, and so in my way of thinking about kids, a lot of our kids that we work with that are particularly selective are very particular and don't want anything to change in their world.

[00:24:58] Marsha Dunn Klein: Nothing can change. Well, how are you ever going to change yogurt if they only want it opened in front of them, one brand, one container, one flavor by mom, you can't change anything about that. So one of the first things we do with that child is to help them get comfortable with their yogurt in a bowl, because from a bowl, we can help that child interact with that food in a lot of different ways.

[00:25:23] Marsha Dunn Klein: And so we'll help kiddos find, you know, 17 kinds of yogurt. Well, some people would say, well, Marsha, They already like yogurt. Why are you working on yogurt? Because the starting point has got to be safety. And if that child only wants one kind of yogurt, when mom goes to the store, there are now five foods she can buy.

[00:25:41] Marsha Dunn Klein: One of them is yogurt and waffles and mac and cheese or whatever those five are. If they now like. 12 kinds of yogurt. There are five and 12, 17 things the parent could buy at the starting point. But what the child is learning is, you know, yogurt comes in different flavors and, and I lived through it. I'm okay.

[00:26:00] Marsha Dunn Klein: And it was kind of fun and it was interesting and I learned how to drink it from a straw and I learned how to make it into a smoothie and I learned, you know, there are lots of things where places will go with there, but we're going to start closer to where the child is comfortable. So we're not waiting for the child to sit back and go, yeah, today I'd like steak and salad.

[00:26:15] Marsha Dunn Klein: That's never going to happen ever. You're right. One of the things that I have to say about trying new foods. I'm doing a whole new redefining try it course through the get permission Institute in November that keep an eye out for if you're interested in this in depth. It's three hours. But one of the things we want to think about is is that when a child comes to a meal, they're already many of our kids that are have a lot of sensory edges around their eating will come to a meal and they're going to see their plate and on their plate.

[00:26:52] Marsha Dunn Klein: Somebody put broccoli and salmon and maybe they put their cheese stick or not. So when the child, from a sensory perspective, looks at that plate, something's different. You've contaminated my plate with some other kind of foods. And some children we know will fall apart there. Now we could say to them, you may not fall apart.

[00:27:13] Marsha Dunn Klein: You need to sit here and put your hands on your lap and you need to be good. I mean, we could, Do a compliance based something. But instead, we could use it as an opportunity to figure out, okay, what's going on here? So one of the things we suggest to families is instead of plating the food for kids that are highly visually worried about change, is we, we have a buffet and we let the child, where the family's food and the child's foods are there and there's enough of the child's foods that they can fill up.

[00:27:40] Marsha Dunn Klein: But the child learns, begins to learn to take their own foods and put it on their own plate. And you're going to say to me, somebody will say to me, but Marsha, they're never going to take salmon or salad. And I said, maybe not. And maybe they will, but they will never meet a new food ever. If they only eat their waffles on their plate in the corner.

[00:28:02] Marsha Dunn Klein: So at least at the buffet table, they're learning, they're seeing and smelling and meeting new foods. And so we want children to be in a world where they can meet new foods, maybe cut them up, maybe make a fruit salad for somebody else. Maybe cut a sandwich in a different shape for somebody else so that they're learning that foods can come in different ways.

[00:28:21] Marsha Dunn Klein: And so we help children build their trust with interaction with foods from a visual, from a smell, from a texture perspective, with their interactions with those foods. 

[00:28:31] Madi Metcalf: So, I'm currently taking the Get the Anxious Eaters Anxious Mealtimes course. And you talk about choosing your foods like working on a food that's worth it.

[00:28:41] Madi Metcalf: so much. So you give, like, the example of, like, working really, really, really, really hard for months and months, and then they eat a Cheeto. And so, how do you kind of balance that, this is a food that's going to be meaningful, and worth it, and maybe expandable to other foods, versus working on a new crunchy chip?

[00:29:02] Madi Metcalf: Or is that chip, could that chip be meaningful? Like, how do you make that distinction? 

[00:29:07] Marsha Dunn Klein: That's a good question. So, it clearly depends on every single child. 

[00:29:11] Madi Metcalf: Sure. Oh yeah. 

[00:29:12] Marsha Dunn Klein: We are going to start with helping the child find trust and comfort and safety at the table. And that may be interacting with foods in a variety of ways where nobody's pressuring them, nobody's making them eat it.

[00:29:23] Marsha Dunn Klein: They're, so that they can be comfortable. And it may be that we start with interacting with foods that they already know about in different ways. So, for example, let's say that that child, Like, well, I have a sandwich that's that's like one sandwich, a peanut butter sandwich cut in triangles with the crust cut off. Now that child, if that child can only have that sandwich and if the child, if the sandwich comes to their plate in a square, they fall apart, well, you're not going to get them to interact with anything in any way, right?

[00:29:59] Marsha Dunn Klein: So what we might do is to help that child learn about that food in a different way, but not for their plate. but for a plate nearby. So we might have them help make round peanut butter sandwiches for their siblings. So they're making them for over here. So the child is learning, you know, peanut butter sandwiches could come around.

[00:30:19] Marsha Dunn Klein: We're not making the child eat it, we're not scaring them with something different on their plate to start with. And then, and then we're, we're also teaching that child you can take the food that's comfortable to you off the plate in front of you. So then now pretty soon there's triangle peanut butter sandwiches and round ones.

[00:30:34] Marsha Dunn Klein: And so many kiddos, after they've had experience making the round ones or the different shaped ones, will just start eating either one. Why is that important? Because that child has learned I can do something around food with some change in it because their starting point is often so rigid that change can't be achieved in any kind of a way.

[00:30:55] Marsha Dunn Klein: So another example, sometimes we have dieticians that say to us, you know, they're only eating, you know, potato chips and and Cheetos and, you know, they're going to need a feeding tube or something's a problem. So if they don't get some better nutrition, but so sometimes it's worth it to work on a vitamin.

[00:31:13] Marsha Dunn Klein: And one of the ways we work with kids on taking the vitamin that the dietician is recommending is through crumbs. So we do a lot of work with crumbs. And why crumbs? Because from a sensory perspective, crumbs are really little, they're a small smell, they're a small texture, they're a small flavor, right?

[00:31:33] Marsha Dunn Klein: And so we will work with the child on a, like a goldfish cracker or something that they already like. If they let us crush it up, some kids won't, so we're going to be careful. But if a child is comfortable crushing it up and making it with a rolling pin and a hammer and all kinds of things, they're going to make their cracker into a crumb.

[00:31:52] Marsha Dunn Klein: And then from crumbs, If the child's, all of their, their foods that they eat, the crunchy things are all gluten, right? We might go to Rice Krispies. Now we've got a new food group. We might go to freeze dried blueberries and strawberries or bananas through crumbs. So, so we're trying to find what is it for this child that is a comfortable way for them to try and approach new foods.

[00:32:17] Marsha Dunn Klein: And then how could we stretch from there? So we're looking for where is the safety place to start with. They like one kind of pancake. You know, I know kiddos that like pancakes, so we might work with them to, to make pancakes. And then as they're making pancakes, we, the parents can learn to bulk up the nutrition in the pancakes and add extra protein powder and extra, from the concept that pancakes are safe to that child.

[00:32:43] Marsha Dunn Klein: So from that place. We go from pancakes to can we pour the pancake, can we make shapes on the pancake griddle, but also can we put some in a muffin tin and we can help the child go towards muffins, right? So we're looking for that starting point, but we're not just sitting around waiting for that child to just decide they want something new.

[00:33:04] Marsha Dunn Klein: I don't know if that answered it well enough. 

[00:33:06] Madi Metcalf: So we'll how can, so thinking back to that interoception, if you put a steak and salad in front of a kiddo that's having a difficult time or you just throw their yogurt and that they only eat out of a package into a bowl, and you say, okay, you have to eat this, and then we're adding pressure and then maybe that makes them feel anxious, which is going to impact their interoception.

[00:33:28] Madi Metcalf: How can all of that from like a neurobiology standpoint impact how they're processing that experience? 

[00:33:36] Marsha Dunn Klein: Great question. So we know so much more Madi in 2024 about neurobiology and the nervous system ever did in 1969 when I learned my neurology course, right? And so, but one of the things we know is that that pressure, dress pressure, trauma can, wires the nervous system differently.

[00:33:59] Marsha Dunn Klein: And when you are. Feeling pressure your body goes towards that fight flight kind of reaction goes towards you. Well, we can all feel it. We can just sit here and just imagine that, right? Imagine you're outside out to dinner at a restaurant and somebody is saying to you, well, eat that first. Well, no, two bites of this before you know, you should drink that.

[00:34:19] Marsha Dunn Klein: Now you should, you know, your, your, your, your whole experience with eating is angsty, right? Pressuring. What pressure does to the nervous system neurobiologically. It suppresses appetite. It can cause slower emptying of the stomach, right? Because, because think of it, if you're in fight flight, if your adrenaline is up and you're worried and you're highly stressed and running away from that mountain lion, you know, your, your blood shunts to your, Arms, not your digestive system.

[00:34:49] Marsha Dunn Klein: So it's not going to help. We have a lot of our kiddos with chronic pressure, chronic stress, chronic constipation, that could be a reaction. What we know from research is that. Pressure can cause appetite suppression. Absolutely. So if we think about it, when we're trying to help kids want to eat more, be more motivated to eat, because we're looking for internal motivation, then we don't want our starting point to be, they're trying to run away, they're trying to get away from the table, they're trying to protect themselves, and they're feeling a lot of pressure.

[00:35:22] Marsha Dunn Klein: So we have to change it. So, so, does that mean we never do feeding therapy? No, we do feeding therapy with food all the time. The issue is I'm not going to require you to eat it today and I'm looking for, you know, of the five or eight foods that we're interacting with, which ones are you kind of interested in?

[00:35:41] Marsha Dunn Klein: Let me share an example here. So a little girl that I worked with Came from another state and she had a tube, feeding tube, she was two and a half. And she had been in a therapy session, setting for a year. And the parents said they were working on, you know, first put a dry spoon in her mouth and then a diluted, then water, then diluted apple juice and apple juice.

[00:36:07] Marsha Dunn Klein: And, and it had been a year and they were just trying to introduce baby food into the apple juice to make it a little different And I understand that the theory was, let's go slowly. I get it. And, you know, maybe let's not stress her out too much. And one of the things that I do when we're doing intensives, where we're doing three or four days in a row of supporting that child and family, is we, we eat with the family.

[00:36:35] Marsha Dunn Klein: We order food. We find out what do they like, and we order food. So one day we had Indian food, and one day we had Italian food, and one day we had Mexican food, and these parents were foodies. So the second day there, nobody had been forcing her to eat. We're doing a lot of food interactions, a lot of sensory food play.

[00:36:52] Marsha Dunn Klein: We learned how to drink from a straw. There were lots of things going on, but We weren't requiring her. She was having fun, enjoying herself, making choices. We had Indian food. So, the parents and we were dipping naan in an Indian spicy sauce, right? We're dipping it and we're talking and we're not paying a lot of attention to her.

[00:37:14] Marsha Dunn Klein: She dipped the naan. Nan, in an Indian curry kind of sauce, loved it and kept doing it. Oh man. First food she ever ate. Now, the moral of this story is, some grown ups who meant well, were starting with a food they thought everybody should like applesauce because kids like applesauce. 

[00:37:37] Madi Metcalf: Mm hmm. 

[00:37:37] Marsha Dunn Klein: From a sensory perspective, it was a food that kids would like.

[00:37:40] Marsha Dunn Klein: But she showed us, when we let her make the choice, but we gave her the opportunity, she showed us, wait, I like this. And so what can happen sometimes is we can inadvertently narrow the experiences we're giving that child, where if we had a variety of foods in front of that child, and we're eating together, and we're cutting it, and we're spreading it, and we're doing things with it, kids can figure out what, what's working for them and go in that direction.

[00:38:07] Marsha Dunn Klein: So that was a really, really important lesson for me. And you think about Madi, what do we have? Can everybody write in the chat room? What are the foods we have in our therapy rooms, right? In our therapy clinics, you know, Cheerios, goldfish, veggie straws, that I swear to you, veggie straws is one of those food groups that I swear to you, every parent that I've ever met who comes from any other therapist says, and my child eats veggie straws as if it's a food group, right?

[00:38:35] Marsha Dunn Klein: I mean, my clinic was the same way. We have And, and some yogurt maybe or some pudding and, and maybe some juice boxes and, but think about it. If that child's sensory system says, I don't want any of that. And quite frankly, a lot of tube fed kids don't want anything sweet. They tend to want In my experience, spicier, saltier, savourier kind of stuff.

[00:38:58] Marsha Dunn Klein: And I don't know, I just believe that it's probably because they spent a whole early part of their life throwing up the sweet formulas, right? Right? But anyway, so if we think about it, we want to offer variety. We want to decide you need to get the food that the hospital cafeteria is creating. And this is what we're doing today.

[00:39:17] Marsha Dunn Klein: And it's going to be coarse ground and dah, dah, dah, dah, dah, you know? Why do kids like processed foods? Because they can count on them. They're the same every time you bite into a Ritz Cracker. It's always a Ritz Cracker. So if you are a person who needs same and you're worried about change and you're worried about a sensory surprise, then a Ritz Cracker is always mac and cheese from a box.

[00:39:40] Marsha Dunn Klein: It's always going to be the same. There are standards that require these companies to make those foods the same. So you could understand that fruits and vegetables can be complicated because. A tomato isn't always a tomato. A tomato could be sweet, it could be not so ripe, it could be ripe. Vegetables and fruits are not always the same.

[00:40:01] Marsha Dunn Klein: And my husband's always teasing me that I really love strawberries when they're really freshly picked. I grew up in the country and we picked fresh strawberries and they were so sweet. And now we get them from the store and they're hard and they're sour. So you could understand if you are on the cautious side of being an eater, because of your sensory systems and the way your body reacts.

[00:40:24] Marsha Dunn Klein: Then fruits and vegetables are pretty terrifying. Meats, kind of terrifying. Chicken nuggets are always the same. So, so, my goal when I'm working with children is for the parents to be successful offering food to their children and to start where there's comfort. So what we're starting with is really building trust.

[00:40:43] Marsha Dunn Klein: And one of the things that kids know when they come to our clinic is we are not going to force you to eat anything. And we're still going to have lots of interactions with food. That's right. You're going to make food for somebody else and hand it to people and we're going to do things with foods if, you know, if that works for that child.

[00:40:59] Madi Metcalf: So, go ahead. Oh, you can finish your thought. 

[00:41:02] Marsha Dunn Klein: No, no, I'm just going to say so one of the things that in relating to that as when I think about the pressure and the neurobiology of eating is that we want to make sure We are building positive memories with children about eating because many of the children that have come to see that come to see us have had negative experiences.

[00:41:21] Marsha Dunn Klein: They've had choking and gagging or they've had well meaning loving parents that really wanted to just eat a different kind of food or. Or three more bites or that they have often come with experiences that that their nervous system could decide is traumatic, that is difficult for them and that negative memories.

[00:41:38] Marsha Dunn Klein: So if we want to help that child make any change, I, I believe in my experience says we want to build on positive memories. We want to create new memories around food that help that child go, Oh, that's good. That's a different kind of yogurt. And I could drink that with a straw. That would be fun, you know, and, and learn to expand their confidence in interacting with food in a variety of ways.

[00:42:03] Marsha Dunn Klein: And so, in the extreme of negative experiences, we have trauma. And so many of our kiddos, Have come to us with trauma experiences and we have so much research that talks about the influence of trauma on the nervous system, that it actually rewires our system. It actually can cause our system of vigilance to be hypervigilant at all times.

[00:42:28] Marsha Dunn Klein: And, and, and that's just, we know from the neurobiology of eating that it, that does not support. appetite, motivation for eating, you know, it just doesn't work that well. 

[00:42:41] Madi Metcalf: So as therapists, knowing that our patients are probably coming to us with some level of trauma, how can we engage in trauma informed care and keep that kind of at the forefront of our mind?

[00:42:51] Marsha Dunn Klein: You know, we want to do some really good listening and talking with parents about what's been the experience of the child and the parent, because both can come to us with trauma. Absolutely. And, and start from a perspective of. Trust start from a perspective of connection and relationship. And, you know, if you if you think about it, when Children are learning to regulate themselves as babies, the person who helps them learn self regulation.

[00:43:17] Marsha Dunn Klein: Is the loved connection of the parent, right? So, we should be thinking about having the parents participate and be right there. I mean, when we say to a child, you can't have your parent back into the therapy session until you eat this, but it's a, it's steak and kidney pie. Thank you anyway, but I'm just mad at you.

[00:43:37] Marsha Dunn Klein: I'm just gonna be mad at you. I, I don't want you in my life, I mean, as a kid, you know, I don't want you to make me eat that mushroom or that steak and kidney pie, or that beet or that chicken and dumplings, right? I I and, and if we're gonna interact with chicken and dumplings in some way, let's do it. Let, let me help serve my mom some of that, or my brother, or let me be around it in a way that you can notice and be curious.

[00:44:04] Marsha Dunn Klein: How is that chicken and dumpling working for that kiddo? Are they interested? Because when we're curious about this child, Madi, in this moment, we're going to be, we're going to give them opportunities to be around food. And you should notice I'm not saying exposures, give them opportunities to be around food.

[00:44:21] Marsha Dunn Klein: And notice their reaction, be curious. So when they're not wanting it, when they're having a big reaction, instead of pushing into it and say, yeah, but you should do it because I'm bigger. We could be saying, I wonder why they're having this reaction. Because what I believe in my heart is when a child behaves in a way that wasn't what you expected.

[00:44:40] Marsha Dunn Klein: I don't call that behavior problems. I call that communication, communicating something isn't working about this situation. And our curiosity could say, I wonder why this isn't working for this kiddo. What needs to happen? What's going on? How can we help that child get back to trust and safety? And so maybe for me, I would think instead of going right at that child with that food at that moment, I will keep the activity going, but go, whoa, whoa, whoa.

[00:45:06] Marsha Dunn Klein: Can we give that to your mom? Could we give that to your sibling over there? Could we go over here and, you know, we're going to pivot, but not just end the activity because they didn't like it. 

[00:45:18] Madi Metcalf: So you mentioned that you're not using the word exposures and but that's very, I don't, we've heard a lot.

[00:45:26] Madi Metcalf: We have to have exposures, it takes this many exposures to get comfortable around a food. What are you kind of, how are you rethinking exposures and try it in your practice? 

[00:45:37] Marsha Dunn Klein: You know, I think the word, well, I think the word exposure isn't a bad word. However, I think that for many children and families, it has gotten a bad reputation.

[00:45:51] Marsha Dunn Klein: And what I mean by that is, we've said to families, you need 10 exposures before you're going to like it. So parents go home and they do 10 exposures and the child is crying and they didn't like it. And parents feel like they did something wrong because there's something magical about 10. There is nothing magical about 10.

[00:46:08] Marsha Dunn Klein: Even in the literature that talked about it took 5 to 10 exposures, 10 to 12. 10 to 15, 15 to 20. There's a, there's different literature that describes different numbers. Those weren't the most selective kiddos in our world. I mean, if you expose me to steak and kidney pie 943 times, thank you anyway, I'm not going to like it, right?

[00:46:30] Marsha Dunn Klein: You didn't pick a food that I want to work with you on trying, right? You didn't pick that food. So number one, that number business is a little complicated. Number two, in the name of exposures, many of us, Me included have done things like, Madi, could you just smell this? Wait, now that you've smelled it, could you, could you just kiss it?

[00:46:51] Marsha Dunn Klein: Wait, wait, could you just lick it? And I'm directly, like, laser focused on getting you to put that food in your mouth. Direct. I'm right there. I do believe, and I've always done that in the most playful, happy, gentle way. I do believe that those experiences, do influence eating. Because when children are learning, or toddlers, and they're learning how to eat, they smell it, they squish it, they put it in their mouth, they take it out.

[00:47:20] Marsha Dunn Klein: They're rehearsing the sensory properties of that food in a way, right? So I do believe that that's kind of an important to have interactions. so that the child can decide when they're ready to put it in their own mouth. So exposures, and I do believe if you don't like the smell, you're not going to eat it.

[00:47:41] Marsha Dunn Klein: So if you don't like the, the look, you're not going to put it in your mouth. I do believe all those things are important. However, I, I think In the name of exposures that we have inadvertently gotten ourself a little off balance where our idea of an exposure is I'm going to get you to do something with it, I'm going to get you to put it in your mouth, I'm going to get you to to sniff it and try it and lick it and stuff like that.

[00:48:06] Marsha Dunn Klein: So instead, I like to say, can we give you opportunities to be around food? And the idea that I use opportunities, is that I'm giving you the opportunity, take it or leave it, it's your choice, but I want to interact with the food, to see what's comfortable with you or not, as opposed to requiring it, because I'm taking your level of worry down, I'm taking your level of trust up, and trying to help you find some comfort in food interactions.

[00:48:37] Marsha Dunn Klein: And so opportunity, to me, is, is a better way to go forward. We're inviting children into the meal. Like square triangle peanut butter sandwiches with the crust cut off. But you know what? Let's, together, let's invite you in. And here's a cookie cutter. And can you make a cookie cutter sandwich in the shape of a flower?

[00:48:56] Marsha Dunn Klein: For your brother. So the pressure isn't on the child, it's for the other person, but it's the opportunity to interact. And I can't tell you how many times the child learns, Oh, well, I could have a flower shaped peanut butter sandwich, you know, so it, it, it happens that way. So what we want to do is be curious.

[00:49:15] Marsha Dunn Klein: How can we be curious about what's going on for this child? So a 13 year old person with selective eating that I know I said to him, you know, you like. Nutella sandwiches, and you've told me you're upset when your mom isn't right there to fix you one when you need it. So I said, What about if we learn how to make it?

[00:49:35] Marsha Dunn Klein: Could, could I help you learn how to make that? And he, and he's not in the kitchen much because kitchen's not been, he doesn't like food touching much. And he said, okay, I can do that. So we went in the kitchen and he took, and I said, how do you make your sandwiches? What bread do you use? What Nutella? Gave him some choice and some power, right?

[00:49:53] Marsha Dunn Klein: He went to open, The bread, the wonder bread and put his hand in and he pulled his hand out and he said, I can't touch that. I wouldn't have known that about him if I didn't give him the opportunity to have agency and to, to interact with that on his own. Right. So I said, so I could say, yeah, you don't have to do that.

[00:50:14] Marsha Dunn Klein: But that's not what we do. What we do is we figure out, we're curious like, Oh, you didn't want to touch that today. Hmm. What would help you touch that? So we have tongs and we have we have these gloves and you know, what would make it better for you? So now what we've just done is I've learned, I was curious.

[00:50:33] Marsha Dunn Klein: I learned, Whoa, how are you ever going to make a Nutella sandwich? If you can't touch it. Number two, I validated him. Wow, that was an uncomfortable touch for you today. Well, what should we do about it? And then I'm including the child in the discussion. And what do I need to do? And he picked, I want gloves.

[00:50:50] Marsha Dunn Klein: And so for three weeks, every day, he made peanut butter sandwiches after sorry, Nutella sandwiches after school. Every day. Three weeks into it, one day he forgot to put the gloves on, reached right in, took the bread out, and he called me up on the phone, Morris, did you make gloves today? And so, but it was at his pace.

[00:51:10] Marsha Dunn Klein: So now it's a fully learned skill he has for life to make his Nutella sandwiches. And I didn't require him to, you know, cry through making it for the first three days until he just got over it and we flooded him. Instead, we let him go at his pace, but we gave him, we validated. And we gave him, Agency and figuring out how to support himself because when you're 13 and you're selective eater, is it more important that I teach you to eat broccoli?

[00:51:38] Marsha Dunn Klein: Or is it more important that I teach you a strategy for when 

[00:51:41] Marsha Dunn Klein: you include this? That's complicated for you, right? 

[00:51:45] Madi Metcalf: I love that too. Cause it just hides so nicely into like those responsive feeding principles. So kind of like putting it in action. So like you had the relationship with him to like, Feel comfortable to go into that kitchen together.

[00:51:58] Madi Metcalf: You gave him autonomy. How do you wanna make this? And I mean, just empowering him to make his own sandwich was kind of encouraging autonomy in itself, but you also gave him choices and then you found the competency level that he was able to do it at, and then he was able to kind of. You know, built towards that intrinsic motivation and whether it was a natural intrinsic motivation or I don't want to take, I'm so hungry today, I don't want to take two seconds to put the gloves on, whatever it was that led him in that moment to take that out, it was his decision to do it.

[00:52:30] Madi Metcalf: So yeah, I just love how that kind of fits so nicely in that like responsive, you know, feeding kind of paradigm. 

[00:52:35] Marsha Dunn Klein: So in responsive feeding, we focus on the relationship and the connection. So we want the, the safe food trying person to be nearby. Maybe that's us and maybe that's the parent, you know, but we want to be that safe person.

[00:52:47] Marsha Dunn Klein: We want to we want the motivation for the activity to be internally motivated so we can put lots of choices in the activity so it can go at his pace and his motivation. We want to give him agency and autonomy to do it himself and we have all kinds of research that says when you're internally motivated you're more likely to eat it.

[00:53:05] Marsha Dunn Klein: We have all kinds of research that says when you're when you are have agency in the activity, you're more motivated when you enjoy the activity, you're more motivated, right? And, and then we gave him some adaptation because his sensory system is unique. He's 13. It hasn't changed. He has a unique system.

[00:53:27] Marsha Dunn Klein: He will be 40 and have a unique system. He needs to learn how he can live in the world where. He doesn't have to feel bad because he's not trying things. And this is a kiddo who earlier on his life example during COVID, you know, the therapist would put the food in front of him and say, okay, you've got that food and I've got that food and mom got it ready and now we're going to, we're going to try it.

[00:53:48] Marsha Dunn Klein: And, and there were times when she described him just sobbing.

[00:53:57] Marsha Dunn Klein: So just to summarize the sensory part of this, so when we're helping kids try foods, I think one of our jobs, because we want parents to be successful and how they introduce foods, is to teach kids how to try new food when they meet one they want to try. So when you meet a new food, You know, we, we, we talk about the smaller ways to try it.

[00:54:20] Marsha Dunn Klein: So one thing that people who know me know about is I have a story about grasshoppers. You can see my grasshopper over there. You can see my grasshopper over there. You can see my grasshopper over there. So you can go to the Get Permission Institute website and look at the grasshopper story, where, where we're just trying a new food that's angsty because it's grasshoppers, and talking about how we could do that.

[00:54:41] Marsha Dunn Klein: But I, I, I'm gonna, I'm gonna end it with one. big story about trying something, two big stories about trying something new. I met an adult woman, 40 years old, who has ARFID, and she said to me, I need to learn to find new foods that I like, because I just married a foodie. And she likes potatoes, rice, bread, more potatoes, potato soup, french fries.

[00:55:07] Marsha Dunn Klein: baked potatoes, right? And so she's, and I said, well, how do you try new foods? And she said, well, I put it in, in my mouth and then I plug my nose and then I drink down water and she gets the spades. And I said, how's that working for you, sweetheart? And she said, yeah, it doesn't. I never find anything new.

[00:55:28] Marsha Dunn Klein: I like, so she wanted to like, to learn, learn to like salmon because her husband likes salmon. So first thing I said to her was. What, what food would you be eating with it? Oh, bread. Okay, fine. Let's talk about bread. And then the second thing I did with her was, what do you think of this smell? So who cooks it in your house and where is it cooked?

[00:55:47] Marsha Dunn Klein: It's cooked outside on the grill. Her husband cooks it and she doesn't mind the smell. That's an important starting point because if she hated the smell, salmon's a big smell and that wouldn't be a food we would practice trying, right? Okay. So I said to her, could you take a piece of bread and put a little bit of salmon on it?

[00:56:04] Marsha Dunn Klein: A little, as tiny as you want. She's doing it herself, right? And put bread on top. Why? Because she's diluting the smell, diluting the flavor, diluting the taste, diluting the texture. She's diluting it all. And she said, yes, I could do that. And so it's giving her the power to go at her own pace. And I said, if you like it, you can go a little more and a little more and a little more and a little more.

[00:56:28] Marsha Dunn Klein: And really, if you decide it's okay, you could just take the lid off of it and just have bread and salmon. And eventually, if you want to, you can put it in your mouth. I saw her two weeks later. She, she was a woman who worked with my husband, so I saw her at an event. She said, Marsha, I have found eight new foods that I like in two weeks.

[00:56:45] Marsha Dunn Klein: And what happened was, what we did was we gave her strategies to try new foods. So we're going to talk to kids about, you know, when I made a new food and I'm drinking a new juice, first of all, I'm going to probably put a lid over it. You know, one of those one of these kind of lids. because if you put your nose right into a new drink, there's a big smell right there, right?

[00:57:07] Marsha Dunn Klein: So I'm going to dilute that a little bit probably. But we say to kiddos, you know, when you meet a new food, when I meet a new food, I sometimes I smell it. See if I like the smell. Okay. Cause if I like the smell, that gives me an idea what it's going to taste like. So that's a role model that I would do.

[00:57:23] Marsha Dunn Klein: Sometimes when I try any food, I just rub my finger on it in a little way and I take the tiniest taste. Now I could put it right on my tongue if I wanted to, or I could put it right on my lips. To check it out because if you put a brand new food inside your mouth from a sensory perspective, that's a big wow.

[00:57:40] Marsha Dunn Klein: That's a lot in your mouth at the same time. And we have research that tells us, even if you like the flavor, the texture can just talk you out of it right away. And so I want to find the flavor first and see. if that's okay before they've overwhelmed themselves. So, and then sometimes we say, sometimes you can put that little new food, the grasshopper with the tortilla and the guacamole or the sandwich and the bread, you can dilute it with other things.

[00:58:05] Marsha Dunn Klein: So, and then go at your own pace. And so honest to gosh, those, those kinds of stories that made me really realize that we need to teach children how they could try a new food when they're ready. and go at their own pace and we give them lots of strategies and we roll them out of that in therapy. And I mean, I, I can just tell you story upon story about how, what a difference that makes with so many kids.

[00:58:32] Marsha Dunn Klein: And in my opinion, in the therapy session, if a child learns to try a new food, they're We teach new food trying on foods they already know, right, that they're already safe with. We're not teaching new food trying on a Brussels sprout, or a mushroom, or chicken and dumpling, right? But if they can learn how to try a new food when they're ready, they have that strategy built in.

[00:58:54] Marsha Dunn Klein: And so we are helping them not flood themselves when they're trying new things. And it's amazing to me how many parents think, here, try this and it's a big plop, you know, or here, try it. That's what kids thinks they have to do. Or, or adults. This is a 40 year old smart woman who thought that trying a new food was plopping a big amount in her mouth.

[00:59:13] Marsha Dunn Klein: So what we can do as therapists who are curious about sensory systems and unique sensory systems, neurodiverse sensory systems is appreciate their system. Be aware of that. This is who they are without judgment. Support them in taking care of themselves and defending themselves in trying new things and give them strategies.

[00:59:36] Madi Metcalf: Mm hmm. Okay. I have one last question where this will be my last one. I could spend hours talking to Marsha. What do you do with the kids that They don't want to use a new food trying skill. They just want to eat it. You teach them and they're like, I'm just going to eat it. Do you make them go through the new food trying skills?

[00:59:57] Marsha Dunn Klein: I'm going to teach the new food trying skills so that they're there so that you have those in their repertoire. Yeah, child meets a food and just wants to try it. They should just try it. I mean if that motivation is coming from them, right, they should try it. However, so I think we have time for one other quick story and that is a young man, Arfid has Arfid and he and his twin brother are both autistic and he thought I'm supposed to be trying new foods, and my brother likes Caesar salad, and mom, I like chicken and croutons and lettuce.

[01:00:30] Marsha Dunn Klein: This is an interview that's on the GetPermission website, it's the Janus interview. So check it out, it's free. But he said, Mom, I want to try a Caesar salad because my brother likes it. So she made him a Caesar salad with lettuce, chicken, and croutons, but also put shaved Parmesan and a bunch of dressing on it.

[01:00:49] Marsha Dunn Klein: He said, Ms. Marsha, I sat there and I looked at it for an hour and a half. I could not eat it. It, and, and it just distressed him. And he finally took it downstairs and made himself spaghetti. And so this is how I reacted with him. So, first of all, good for you. The thought, thinking that you wanted to try a new food.

[01:01:10] Marsha Dunn Klein: You know, I wanna validate him. He thought he would try something new. Good for him. I'm sorry you had to wait an hour and a half before you allowed yourself to go get spaghetti. So maybe next time, you know, you could just say to yourself, this isn't a good day. But so you could just say, this isn't working for me today, mom, or whoever's making the food.

[01:01:29] Marsha Dunn Klein: I, I'm gonna try something different. So that's okay to just say what that is. On the other hand I, I said to him, but next time if you're thinking of trying something new, could you do it without overwhelming yourself? What would happen if your mom gave you the croutons, chicken, and lettuce that you like, and the dressings on the side?

[01:01:48] Marsha Dunn Klein: So you could decide today, Okay. In this moment, I'm feeling kind of interested in that, and I'm going to dip my finger in it, or I'm going to put a little bit on the lettuce and lick it, or, you know, so he has strategies, emphasis on the tiny amount to begin with. And then, or you could say to yourself, you know, I see the dressing today, I thought I wanted to try it, but no, it's not the day, not ready for it.

[01:02:13] Marsha Dunn Klein: And allow yourself. The grace to go. Okay, wasn't my system's day. My sensory system wasn't ready for it at that time. So when we can teach people to be aware of their own system and be willing to advocate for themselves and when we can help them come up with strategies to get better To get, to get to compensate, to try it differently.

[01:02:35] Marsha Dunn Klein: I think kids win. I think this child in this moment, 

[01:02:42] Madi Metcalf: Marsha, thank you so, so much for coming on the podcast tonight and sharing a little bit about sensory trauma informed care. And about your Get Permission approach it's been a game changer in my personal practice, and I'm super excited that I was able to have you on to share that with the podcast for seasoned therapists, in between therapists, and the novice feeding therapist.

[01:03:07] Madi Metcalf: So, It was fabulous. Thank you so much, Marsha. 

[01:03:11] Marsha Dunn Klein: Thank you. If anybody else has a quick question or comment, you know, if you had an aha moment that you particularly liked, we love hearing those also. Absolutely. I love sharing it. And, you know, this is a topic, Madi, that we could have spoken about before. Four days.

[01:03:28] Marsha Dunn Klein: Mm-Hmm. . So, I, we just tried to do a smattering and so thanks for having me. 

[01:03:33] Madi Metcalf: Absolutely. And really quick, because I forgot to do these at the beginning, I'm gonna read our financial and non-financial disclosures. So my financial disclosures is that I receive an honorarium for hosting this podcast.

[01:03:44] Madi Metcalf: My non-financial disclosures is that I am a volunteer for Feeding Matters, a member of ASHA and Aha, and a member of SIG 13 Marsha's Financials. Disclosures is that she receives an honorarium for speaking, and she receives royalties from Pro Ed, Archway Publishing, Amazon, Special Supplies, and Get Permission Institute.

[01:04:02] Madi Metcalf: And she also received an honorarium for being a guest on this podcast and her non financial disclosures is that she is the co founder and board member of Nourish, a 501c3 nonprofit

[01:04:13] Marsha Dunn Klein: and thank you. I'm glad that people are finding something positive here. 

[01:04:18] Marsha Dunn Klein: Aaron says this was a wonderful hour. Thank you for sharing this information with us.

[01:04:21] Marsha Dunn Klein: I am not a feeding specialist, but a CDC teacher. And this information could apply to countless students of yours. Yes. Thank you for sharing. Glad I joined the podcast. Thank you. Thank you so much. And then Clarissa, an SLP, but never did any feeding therapy. My youngest daughter has down syndrome and an ileostomy due to losing her colon at 34 weeks.

[01:04:43] Marsha Dunn Klein: We have started feeding therapy and she's making progress. It's a hard road and there are good days and rough days. And, and so what we want to believe is when, when it all works for babies. They can eat and something's not working and your gut doesn't feel good. And, and, you know, when you've had an ileostomy and your gut's rearranged, it takes a while to kind of figure out, am I hungry?

[01:05:03] Marsha Dunn Klein: Do I want to eat? So, I'm sending you a hug Clarissa and and good luck with all those days. 

[01:05:10] Madi Metcalf: Absolutely. Well, thank you everybody for tuning in on another episode of making sense of selective eating next week. And we'll see you next time on another speechtherapypd. com course. Thank you so much. And thank you again, Marsha. 

[01:05:24] Marsha Dunn Klein: Thank you, Madi, for having me.

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