Corntney Modelewski

Helpful Suggestions: For Parents of Elementary Students

This article was written by Cortney Modelewski, MA, LPC professional counselor at Cognitive Behavior Solutions and an active member of SMEDA.

For Parents of Elementary Students:  Working to Create a Positive Relationship with Food

My daughter decided she didn't like jelly after coming home from a sleepover. Her friend declared hatred of all fruit-flavored spreads, and my daughter soon followed suit and has not eaten jelly, jam, preserves, or marmalade within the last three years.
    
She is eight, and she continues to struggle with the conflicts between her wariness of food, her environment, and her hunger. These challenges are typical of elementary age children, especially younger ones.  Dovey et al (2008) provided a review of the research on children's eating behaviors. They outline the difference between what people call “picky eating,” which is having inadequate variation in diet, and “neophobia,” which is refusal or reluctance to try new foods. Environmental (i.e. home, school, and culture) and genetic factors play roles in how and why children develop these eating behaviors.

While you can't change your child's genetics, you can make changes to their environment. Here are a few tips from my household, which consists of a couple of vegetarians and a meat-and-potatoes guy, who collectively have food neophobia, sensory processing issues, food intolerance, and a food allergy.

1.    Caretakers are role models. I am not a big fan of breakfast. My child has started to say she doesn't like breakfast. I decided to suck it up and eat some toast in the morning because I want my child to eat breakfast before going to school.
2.    Enlist authorities. Our pediatrician gave my child the same speech I had given, but my child responded to the pediatrician because she's a doctor. She also started eating red peppers after a dietitian came to her school and talked about how vegetables are awesome.
3.    Make food fun! Kids like to make their own creations, and also like it when they have surprises at mealtime.
4.    Negotiate packed lunch menus. Say, “Would you like baby carrots or cucumbers in your lunch?” If my daughter has a better idea, such as broccoli, I am all for it.
5.    Try to have everyone in the family eat the same things. My husband may throw some meat on his plate of spaghetti, but we're all still eating spaghetti. This ties into the first tip. Also, your family does not pay you to be a short order cook, so don't do it. It's more frustrating and reinforces problematic beliefs and behaviors your child may have.
6.    It's okay to be frustrated when your child doesn't eat, but try not to fight. I have had many dinner wars in my time as a parent, especially after a cooked meal has followed a twelve-hour workday. Not worth it. Ask your child to taste the food – which doesn't need to include chewing and swallowing – and then drop it for the night.
7.    Unless you have a specific diet due to religious beliefs, there is no reason to call food good or bad, and if a person in your family has a medical problem that restricts certain foods, giving the restricted menu to your entire family every so often may help the child and others in the family understand the need for meals.

If you are concerned about your child's eating habits, do not be afraid to make an appointment with their primary-care provider to discuss these concerns.  UWHealth (2014) notes some red flags including weight loss, choking on food, frequent complaints about stomach pain, vomiting or diarrhea after eating, and moodiness. Your child may have a treatable eating disorder, anxiety disorder, or medical condition.

References and Resources

Terence M. Dovey, Paul A. Staples, E. Leigh Gibson, Jason C.G. Halford, Food neophobia and ‘picky/fussy’ eating in children: A review, Appetite, Volume 50, Issue 2, 2008, Pages 181-193, ISSN 0195-6663, http://dx.doi.org/10.1016/j.appet.2007.09.009.

University of Wisconsin Hospitals and Clinics Authority [UWHealth] (2014). Health facts for you.  https://www.uwhealth.org/healthfacts/parenting/518.pdf

We Can! Ways to Enhance Children's Activity and Nutrition. https://www.nhlbi.nih.gov/health/educational/wecan/index.htm

ED Therapy - Exposure and Response Prevention?

Corntney Modelewski, MA, LLPC, an active member of SMEDA and a Kalamazoo therapist that specializes in Cognitive Behavioral Therapy and DBT.  She has written this months blog article on Exposure and Response Prevention (ERP).  http://www.southwestmichiganeatingdisorders.org/directory/

     Exposure and Response Prevention (ERP) is a therapy for Obsessive Compulsive Disorder (OCD) that requires being in the presence of something that causes fear – exposure – and not avoiding the feared situation – response prevention. It can also be used during eating disorder treatment, with growing research to support its use in Anorexia Nervosa and Bulimia Nervosa. For example, in 2011 the International Journal of Eating Disorders published an article about data support ERP use to aid in weight restoration, fear of eating, learning to tolerate fear, and relapse prevention in those with Anorexia Nervosa when used as part of a treatment plan.

     With a licensed mental health therapist, a list called a hierarchy is made up of feared situations to be used as exposure tasks. Distress ratings on a scale of 0 – 100, called Subjective Units of Distress (SUD), are included on the hierarchy as well. The hierarchy gives the frame for treatment.

As an example...

Anorexia Hierarchy

Feared Situation                                                                    SUD (0-100)

Skip one day of exercise                                                                 55

Eat at a Chinese buffet restaurant                                                  95

Have friends over for dinner and eat in front of them                  100

Walk through a grocery store without buying anything                35

Fill pantry with canned food                                                           70

Eat apples with therapist                                                                 60

 

     It's common for individuals to have more than one mental health concern, especially anxiety or OCD. It helps to treat eating disorders and anxiety at the same time when doing ERP.  Kind of like killing two birds with one stone.

As an example...

Anorexia and OCD with Contamination Fear Hierarchy

Feared Situation                                                                                               SUD (0-100)

Eat sucker that has touched a grocery cart seat                                                     70

Hold a raw steak for five minutes before cooking                                                   75

Eat a bag of M&Ms off of therapist's office floor                                                     30

Eat an egg salad sandwich in the bathroom at home                                             45

Play with neighbor's dogs, eat meal without washing hands afterwards               80

 

Treatment structure will look like this:

  • One hour weekly appointments for 14 – 16 weeks.
  • Agreeing to one-half to two hours per day working on exposure tasks outside of session.
  • Getting hands-on help from the therapist to show how to complete the exposure tasks and prevent the person from trying to avoid fear.
  • Time to talk about feelings with the therapist after exposure tasks.
  • Exposure tasks outside of sessions may include help from friends, family, or members of the treatment team.
  • Tracking distress on a sheet of paper, including lessons learned from the activity, and other homework as assigned by the therapist and other treatment team members.
  • Repeating exposure tasks until SUDs go down.

     To sum it up, ERP is a process that addresses fears unique to the individual's needs. One of ERP's main goals is to help people learn skills to use when therapy is complete and encourage people to use their own ERP as needed. In other words, ERP is to help people with eating disorders to become their own ERP therapist.

Recommended YouTube video:

 

https://youtu.be/ZTwVb_3koCU

 

Sources:  (Many of these sources can be found in PubMed.)

Foa, Edna B., Elna Yadin, and Tracey K. Lichner. Exposure and Response (ritual) Prevention for Obsessive-compulsive Disorder: Therapist Guide. Oxford: Oxford UP, 2012. Print.


(Exposure and Response/Ritual Prevention for Obsessive-Compulsive Disorder: Therapist Guide, Edna Foa, Elna Yadin, and Tracey K Lichner, 2012)

Simpson, H. B., et al. (2013). Treatment of obsessive-compulsive disorder complicated by comorbid eating disorders. Cognitive Behaviour Therapy, 42(1), 64-76. doi:10.1080/16506073.2012.751124

(Treatment of Obsessive-Compulsive Disorder Complicated by Comorbid Eating Disorders, Cognitive Behaviour Therapy, 2013, Simpson, et al)

Steinglass, J. E., Sysko, R., Glasofer, D., Albano, A. M., Simpson, H. B. and Walsh, B. T. (2011), Rationale for the application of exposure and response prevention to the treatment of anorexia nervosa. Int. J. Eat. Disord., 44: 134–141. doi:10.1002/eat.20784

(Rationale for the Application of Exposure and Response Prevention to the Treatment of Anorexia Nervosa, International Journal of Eating Disorders, 2011, Steinglass et al)

Toro, J., Cervera, M., Feliu, M., Garriga, N., Jou, M., Martinez, E., & Toro, E. (2003). Cue exposure in the treatment of resistant bulimia nervosa. International Journal of Eating Disorders, 34(2), 227-234. doi:10.1002/eat.10186

(Cue Exposure in the Treatment of Resistant Bulimia Nervosa, International Journal of Eating Disorders, 2003, Toro, et al)