Food Hoarding & Integrating Kids' Diet Preferences - Q&A w/ Dr. Rowell on Adoption/Foster Feeding Issues- Part I

I am so grateful to Dr. Katja Rowell, MD, for not only giving two copies of her new book Love Me, Feed Me: The Adoptive Parent's Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More (aff) away to my readers (see this post - giveaway now closed!) but also for volunteering her time to answer my readers' questions. During the giveaway readers were given the opportunity to ask questions about adoption- and fostering-centered feeding issues and in this post Dr. Rowell (aka The Feeding Doctor) answers two of them. In a second installment, Dr. Rowell will answer a few more. You can find much more on both of the topics addressed here in the book.

This information is educational. It is not meant to replace careful evaluation and treatment by medical, nutritional or mental health professionals.

Reader Question #1 (from Gabby): Do you recommend foster parents leave food accessible, such as bowls of fruit on the counters/basket of snacks on the shelf at kids' level; or just provide healthy meals and snacks on a set schedule? In training we've heard conflicting strategies up to, and including, giving the child their own container to keep wherever they please and allowing them to "hoard sensibly" while helping them clean out the container weekly... What is your best suggestion for dealing with foster children with food issues?

The best way to lessen hoarding behaviors is to lessen anxiety about food.

Too often, the food stash is presented as the solution to hoarding and food anxiety. It seems to have been presented to you as an either/or scenario: food stash, or healthy food on a schedule? I think the answer is both, or no stash, and that it may change with time. One of my main goals is to empower you, to help you know there is no perfect solution or anything that says you have to get it “right” from day one. That’s not how parenting works. We figure it out with each of our kids…

What I am firm about is that if you offer a food stash, it is not an “out” for providing regular meals and snacks. (Note I did not say “healthy” as I believe that to learn to handle and enjoy all foods, meals and snacks need to include “healthy” and not-so-“healthy” options.) My main concern with the stash, or allowing the child to help himself to the pantry, is that it misses the opportunity to complete bonding cycles and deepen the attachment with your child. For the older child who had to be self-reliant with feeding, showing that you will take care of him is important, and feeding is a concrete way of doing so. Feeding is about trust and nurturing, whether your child is 15 months or 15 years old.

Allowing the child to help himself to food at will can also undermine self-regulation, or knowing how much to eat, which is a skill your child may need to relearn.

Here are two scenarios from my book Love Me, Feed Me: The Adoptive Parent's Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More:

“Consider Marcus, who did not want to let go of his biscuit. He certainly can be allowed to hang on to the biscuit for a while, and maybe even have one in a baggie in his pocket. Follow his lead. If he throws a tantrum about having it taken away, allow him to carry it with him. But the parent also has to be absolutely reliable about regularly providing food. You may need to offer food more frequently at first, perhaps every hour or so.

In a different case, three-year-old Arielle, adopted at 11 months, was on calorie restriction and was experiencing intense food anxiety and preoccupation. Mom tried to let her carry food in an attempt to address her anxiety, but Arielle gobbled it up and begged for more. In this scenario, Arielle’s actions were not the “hoarding” behaviors seen when a child first arrives from a place of food insecurity, but were actually symptoms of a feeding relationship disruption due to her food restriction (see Chapter 5). Letting her have her own stash of food to carry around didn’t work for this family in this situation.

Feeding your child directly shows your child that you will take care of her and builds trust. Completing that cycle of need and meeting her needs, over and over again, is the basis for attachment.”

A few other thoughts:

• Offer frequent reassurances such as, “There will always be enough food.”
• Show him the pantry during the day, perhaps even as you end a meal, “See, there is always enough food here.”
• Plan on pleasant family meals—if you’re battling over broccoli or a therapy task, that’s not helping him feel more secure.
• Structure is critical. If you go to the park, don’t forget to bring a balanced and filling snack.
• Offer food every 2-4 hours depending on your child’s age. Include fat, protein and carbs.
• Institute the Division of Responsibility. At meals and snacks, he gets to eat as much or as little as he wants from what you provide. Even if he eats a lot initially, this will reassure him.

What it boils down to is this: with reliable, pleasant, and satisfying meals and snacks, hewill learn over time that he doesn’t have to worry about when or how much he will get to eat. You get to worry or think about the food, so he doesn’t have to.

Reader Question #2 (from Ben): How do you respectfully integrate your own family's eating habits and preferences with a child's? For instance we eat a lot of vegetarian only meals, and not a lot of processed foods. How would we honor a child's past experiences while also, hopefully, demonstrating our own?

This question is so thoughtful. Rather than ask, “How can I get her to eat my way?” I think you are asking how can I help her feel honored, safe and nurtured while helping her learn to eat a variety of foods as part of our family. By using the word integrate, you sense that it will take time and is a process. How we frame these questions matters.

I recommend handling this how you might handle an entrenched selective eater. Familiar foods feel safe. Early on especially, it is best to focus on “heart needs” as one client put it, rather than worrying too much about nutrition. All too often, adoptive and foster parents find themselves so caught up in nutrition and weight worries that they push and pressure children to eat only “healthy” foods. Alas, this can lead to conflict and power struggles, and doesn’t help the child learn to eat a greater variety of foods. Often, in fact, it makes matters worse. (Particularly with older or traumatized children, or children with sensory issues.)

• If you are fostering an older child, consider asking her what her favorite foods are. Also ask if there are foods she likes in general or if there are foods she doesn’t like “right now.” (You never know, she may have been forced to eat foods she has gagged or vomited, or held down and forced to eat.) Hopefully her list of favorite and accepted foods will include a few foods that you are comfortable serving: bread, tortillas, rice, pasta, crackers, corn, canned mandarin oranges, baked beans…
• Provide her favorite sauce or condiment. Keep a Ketchup bottle at the table, or mustard, or hot sauce that she can use as she sees fit. She may put ketchup on everything for a while, and that’s okay. (Research shows that condiments help children branch out.)
• If she likes crunchy foods, consider offering new foods that are also crunchy. If she tends to like more smooth textures, consider offering puddings or applesauce.
• Offer meals and snacks every 2-3 hours for younger children, and 3-4 for older children, maybe more frequently when a child first arrives if they are food insecure.
• Sit and eat together, whenever possible, without TV or other distractions.
• Reassure her that there will always be enough food, and that she doesn’t have to eat anything she doesn’t want to.
• You can consider asking her to try a new food, and see how she reacts. Some children will try it, others will rage or protest if required to take a “no thank-you bite.” Take her lead.
• Always have at least one thing from her accepted list on the table. She needs to feel that she can come to the table and feel that her hunger will be fed.
• Consider leaving herbs on the side for now. If you make a Curry, put the cilantro in a little bowl on the side and serve it with rice. If your child isn’t fond of spicy food, prepare foods more mild than usual, and add hot-sauce to your own at the table.
• Perhaps serve corn bread or one of her favorite sides with your lentil dish.
• Invite her to help you meal-plan if she is old enough. Perhaps you can say, “We’re having lentils for dinner. Would you like cornbread or rice with that?” Resist the urge to argue, pressure or fight, even if she refuses the food she chose.

When children feel anxious (adults too for that matter) or there are battles at the table, it makes it close to impossible to learn to eat. Stress can kill the appetite or make some children (food insecure or restricted) eat more, so a pleasant table is important. Try to focus not on who is eating how much of what, but on each other. Ask about whom she sat next to at lunch, or how her favorite are class is going. Talk to other family-members too.

Other ways to help children feel safe and “in control” at the table:

• Set out paper napkins and let her know that she may politely spit out any food she doesn’t want to swallow. Children are much more likely to try a new food if they can spit it out.
• Don’t worry about enforcing manners right away. Lead by example.
• Serve foods family-style (so she can serve herself)

Try not to worry if all she eats is bread and milk for a little while. Make up for balance where you can. Fruit leathers or dried fruit, 100% fruit juices or nectars, smoothies at breakfast, popcorn for fiber, maybe a good chewable multivitamin. And hang in there. As sixteen year-old Yiseth said, “Think of it from the kid’s point of view. What is the kid thinking? It shouldn’t be ‘how can I get her to try this,’ but ‘how can I help my child do this at her own pace.’

Over time, and it may take a lot of time if your child has been neglected or abused around foods or if she has sensory issues, she will feel safer with these tips and will be more likely to enjoy your family’s foods.

A lovely resource that helped me “see it from the kid’s point of view” is the book Three Little Words: A Memoir by Ashley Rhodes-Courter, who describes her ten years in foster care. She explores her neglect and even abuse around food, and how at thirteen, she bristled at the nutrition lectures and pressure from her loving and concerned adoptive parents.

Congrats to the Winners of the "Love Me, Feed Me" Giveaway

Congrats to COLEN B. and GABBY C. for winning the Love Me, Feed Me giveaway! Please e-mail your mailing addresses.

 Sorry it's taken me a little while to draw the winners - We're dealing with the fallout from Hurricane Sandy (thankfully we are all well, just still out of power).

Colen and Gabby will each receive a signed copy of the book Love Me, Feed Me: The Adoptive Parent's Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More (aff) by Katja Rowell, M.D., aka The Feeding Doctor. You can buy yours at Amazon.com or order it from your local independent bookstore.

Stay tuned for an upcoming Q&A with Dr. Rowell on this blog.

Adoption Book Giveaway: "Love Me, Feed Me: The Adoptive Parent's Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More" by Katja Rowell, MD

I was eager to receive the copy I ordered of Love Me, Feed Me: The Adoptive Parent's Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More (aff) by Katja Rowell, M.D., when it was finally released last month. I've been following feeding specialist Dr. Rowell's blog and tweets for a while, and have found her approach to the parent-child feeding relationship so sane that it almost seems insane. I knew I'd like the book but I didn't know I would literally read it cover-to-cover (all 354 pages!) in 24 hours. And I certainly didn't know it would seriously challenge me to think about what my actions and words are teaching my children about food and eating and weight.

Parents I know who have children adopted from foster care and orphanages deal are parenting kids with food/feeding issues such as:

• Slow growth / failure to thrive, sometimes leading to feeding tube placement
• Difficulty transitioning from formula to solid food
• Picky/selective eating
• Sensory issues including texture aversions
• Malnutrition
• Underweight and overweight
• Vitamin deficiencies
• Anemia
• Food hoarding
• Meltdowns at meal time and other difficult behaviors
• Bingeing
• Control issues regarding food
• Oral motor and other physical feeding challenges

This book deals with all of these issues, and more. It focuses on trusting children's ability to learn to self-regulate around food and rejecting the common approaches of coercion, game-playing, force-feeding, guilt trips, pressure and bribery that many of us use to get our children to eat more of what we consider healthy foods. Dr. Rowell's book really turns everything you think you know about feeding picky, overweight, underweight, vegetable-hating, malnourished or even totally average children on its head. It forces you to rethink your own relationship to food and all your beliefs about whether or not children can be trusted to choose what foods they wish to eat and still get their nutritional needs met. It may even go against advice given to you by your dietitian, doctor or speech therapist. But, as many adoptive and non-adoptive parents can attest, it is a proven method that works for so many families. Dr. Rowell has seen this non-coercive, low-pressure, shame-free approach to eating help even children with severe feeding issues thrive and learn to be "competent eaters."

Love Me, Feed Me reflects the authors' familiarity with the issues of foster and adopted childrens from backgrounds of abuse, neglect or institutionalization. She goes over adoption-specific issues such as the cultural differences in feeding practices that may challenge your internationally adopted child when they arrive in your home, the transition diet to help a child get accustomed to a very different diet in your home than what they experienced in a foster home or orphanage, dealing with malnutrition, food hoarding, and more.

You will learn from this book how dysfunctional and emotionally fraught many adults' relationship with food is, and how we pass this on to our children unintentionally... especially if they are "picky eaters" or are "overweight". However, the book spends a lot of time showing us how to break this cycle and get out of thinking of foods as "good" or "bad" in favor of a balanced and healthy relationship with our bodies (at any size) and with foods. It's a book about the feeding relationship between parent and child, a relationship which is an important part of attachment for an adopted child.

What's that you say? You want me to cut the chase and get to the giveaway? Fine, then. Here you are: Dr. Rowell has generously offered two autographed copies of the book to give to my readers! There are a number of ways to enter below.

Whether or not you're entering the giveaway, please be sure to leave a comment with your adoption- and foster-related feeding and food related questions for Dr. Rowell to answer in the upcoming Q&A she's generously offered to do here at Fostering Thrifty Families.

a Rafflecopter giveaway

NOTE: This giveaway is only open to residents of the U.S. and Canada. 

BPA-Free Childrens' Divided Plates & Food Storage - Limited Time Offer

Boy oh boy do I love these Kinderville products! Zulily is currently having a (limited time) flash sale on Kinderville BPA-free divided plates, food storage, bibs, cups and more. The products start at $5.99. According to the website, "Kinderville was founded by parents who had difficulty finding toxin-free ways to serve and store their daughter's food. Now that they've done all the hard work, every family can enjoy these products knowing that they're free of BPA, phthalates, and lead. All are safe to use in the dishwasher, freezer and microwave as well. Kinderville products are made of high-grade silicone, which is a safe, durable and pliable rubber-like material. It's great for food storage because it's hygienic, hypoallergenic and resistant to bacteria. Plus it doesn't contain any toxic chemicals, nor does it react with food or beverages. You'll also love how easy it is to clean. From plates to jars and ice-treat molds, Kinderville helps families stock kitchens with everything little ones need (or simply want!) to make snack time safe, colorful and simple."

You can order (or join the members-only Zulily site, free of charge) here (aff), for a limited time only. Check out the rest of the sales, too.

An Important Update on Efforts to Save the Adoption Tax Credit

Here's some news on a significant issue that's close to the hearts of both foster-adoptive parents and parents who are adopting domestically or internationally, as well as all of us who hope to adopt in the next few years. You may have heard about the fact that the Adoption Tax Credit expires at the end of 2012, meaning that if no new bill is passed people who adopt in the future will receive no tax credit. Although the new bills to extend the tax credit beyond 2012 (HR 4373 and S 3616) now have a list of sponsors, there have been rumors and concerns circulating regarding whether these bills will be sacrificed for political reasons as election day approaches.

An online campaign called Save the Adoption Tax Credit issued the following statement today in response to these concerns:

Many of you have been asking about what will happen with HR 4373 and S 3616 now that Congress is out of session. We expect that Congress will consider extending and enhancing the adoption tax credit as part of broader tax reform negotiations that take place after the November election. It is unlikely that there will be votes on these individual bills. It is still very important for you to ask your Representative to co-sponsor HR 4373 and both your Senators to co-sponsor S 3616. The more support these bills have—meaning the more members of Congress hear from their constituents and understand the importance of extending the adoption tax credit and making it refundable—the better chance that a refundable adoption tax credit will be included in the final tax package agreed upon by Congress. For more information about the adoption credit and the legislative process, see http://adoptiontaxcredit.org/faqs

What's most important right now is that you voice your support for this bill with your own Representatives and Senators. If they are not already sponsoring these bills, please ask that they do.

You can track the progress of HR 4373 here (and click on "Take a Position" to contact your Representatives).

You can track the progress of S 3616 here (and click on "Take a Position" to contact your Senators.)

Don't be discouraged that the GovTrack site shows a low chance of these bills passing - If enough support is shown, these bills may be incorporated into a larger tax package. What's important right now is not that these individual bills pass but that the tax credit is included in some type of legislation that passes in Congress. E-mailing and calling your elected officials on these specific bills is the best way to show them how important this issue is to Americans who may not be able to afford to adopt without this tax credit.

Please make sure to mention the following key points:

• The credit should be refundable so that low and middle income Americans can benefit from it, not just wealthier families with more tax liability who can use the non-refundable credit. The tax credit should be focused on supporting adoption by working and middle class Americans who most need the financial help to make adoption a reality.
• The credit should be permanent, and made part of the tax code rather than being at the whim of politicians.

More "talking points" can be found on the Save the Adoption Tax Credit site. Consider "liking" their page on Facebook.

Our Foster/Adoption Financial Story: Rita's Family

This post is part of our new guest blogger series, "Our Foster Adoption Financial Story." As new posts are added to this series you will be able to find links to them at the bottom of this post.

RITA'S STORY

We became foster parents in September 2009.  At the time I was a nanny and I was able to bring our foster son (16 months at the time) with me to work.  However, he had a lot of issues as foster kids tend to.  In particular, he had post-traumatic stress disorder (PTSD) and an attachment disorder and many developmental delays.  By the end of that spring, I was asked not to bring our son to work anymore.

We felt that our son would not do well in day care since it was important to build attachment with him, so I chose to stay home with him.  It was actually the best decision for him and once we began staying home and cut back on his plethora of visitations and appointments and let him "just be a kid," much of his aggression was gone.  I left work and became a "therapist/doctor mom" trying to help my child heal.

However, living on one income in the pricy D.C. area is not easy.  We cut back on everything we could and did what we could but we still are facing foreclosure.  Our only hope right now is to find a job in a different part of the country where housing is cheaper or move into the basement of my parents home.

Regrets? No. To help our son, I would stay home all over again for him.  He needed me.  We are now thinking he may need to be homeschooled, too.  Currently we have a special ed preschool that is funded by MA that we are hoping will help him (he is still socially/emotionally delayed).  That gives me 3 hours a day to so something to make money... but what can I do?  I've also thought of doing afterschool baby sitting, but we're not sure if our son can handle that either.  It's a tricky situation due to his needs.

My husband and I suffered infertility and 3 failed IVF's and chose to foster-to-adopt since we thought we could help more kids this way... Ironically, our son is the only one we have fostered so far.  I was a teacher for almost 10 years prior to that and have a Master's degree in education. You would think I could find SOME kind of job, but it's tricky with a child who is special needs and requires me to be there 24/7, and it's not like we can afford a baby sitter anyway.

This is also putting a huge strain on our marriage... we have been married for 17 years this summer but 14 of those years were child-free.  Suddenly we had a 16 month old child who is pretty much feral and needs me to be with him 24/7 so he can get the help kids with reactive attachment disorder (RAD) so badly need in attaching to a caregiver so they can function in life! Seriously, this kid never slept through the night or alone until about 4 months ago (at the age of four).  Even now, we are up/down with him or need to crawl in bed with him most nights.  I tried to do so much of it on my own that I got burnt out and any chance that my husband could get a second job went out the window because I needed a break!  It is very, very difficult to be alone all day with a child who has PTSD, attachment issues and developmental delays.  It can be even harder to go out in public!  For a long time the grocery store had to be a planned event or I would go in the middle of the night when my husband came home.  There were too many people and too many noises and things to look at for our son and he would freak out.

Before our son, before fostering, we were just average Joes who went to the beach every summer and had cook outs on the deck.  I worked, my husband worked.  We had friends and family and belonged to a church (my son can't handle church either).  When you get kicked out of Sunday School so many times, and preschool as well... you know you have to stay home with your child.

Our son is now four and things are a bit better, although we still have to follow a very structured schedule or he's thrown for a loop and the behaviors come out.  However, the financial damage is done.  Will it ruin  us? No.  But it sure did set us back a few pegs, and we don't feel like we can share our financial situation with friends and family.  All that said, for us it was well worth the financial setbacks in order to see our son's progress and know in our hearts we did what was best for him, even if that meant to sacrifice a few things.  He deserved it!

Bio: Rita lives in the Washington, DC, area with her husband and 4 year old son who was adopted through foster care. Her husband works at a radio station. Rita has a Master's degree in education but is currently a stay-at-home mom to her special needs son.

Our Foster/Adoption Financial Story: Sofia's Family

This post is part of our new guest blogger series, "Our Foster Adoption Financial Story." As new posts are added to this series you will be able to find links to them at the bottom of this post.

SOFIA'S STORY

In February three frightened little kids arrived on my doorstep. In the past four months I’ve watched them blossom into happy, healthy kids, but it has been a bumpy road getting here. I would like to say that my experience with Department of Youth and Family Services (DYFS) has been a good one, but largely it has been difficult and messy.

As a family friend I was able to take custody of the children almost immediately based on a presumption of eligibility. In other words, as long as I could pass a background check and demonstrate that I had enough room in my home, DYFS would let the kids move in right away and I would go through the training and the home study process after they were already in my care. While this is a great thing for the kids, the newly minted foster parent finds themselves suddenly expected to function as part of a system they know nothing about yet.

Here are some examples of things I wish I’d known sooner:

• The monthly stipend a foster parent receives doesn’t kick-in until month #2 (as in, after I had already spent my entire monthly budget buying a crib, car seats, clothes, toys, diapers and daycare).
• DYFS has handbooks and tons of pamphlets, publications and training materials– I only wish they wouldn’t have waited until PRIDE trainings* (three months after the kids arrived) to give them to me!

If I could give advice to another kinship foster caregiver as they embark on their journey it would be this:

• Ask if you can get the handbook and training materials used in PRIDE as soon as you get the kids, if not sooner.
• Be prepared for lots of conflicting emotions and have a plan in place for dealing with them. As family or friends, we often have lots of complicated feelings to work through about what has happened that regular foster parents don’t have to deal with, everything from anger, to grief to resentment, all of which can affect not only our mental health and our family relationships, but our parenting as well.
• Network with other foster parents as soon as possible, they will be an invaluable source of advice and moral support.
• Ask lots of questions about what your expenses are covered, how the stipend is calculated and what other financial assistance might be available, either through your agency or other county resources.

If you are a single-parent, like me, and funds are always tight, try the following:

• Get a chest freezer, either full or half sized for your basement, or quarter sized for your kitchen. I bought mine new, but you can look for used on Craigslist or Freecycle.
• Shop and cook in bulk for said freezer. I take one Saturday a month to make a couple batches of pizza dough, meatballs, chicken cutlets and casseroles to freeze.
• Cooking ahead buys me precious down time on those busy weeknights when I’m too tired to cook without having to blow extra money on takeout. I even freeze half gallon cartons of milk so I’m never stuck having to get three kids into the car for an unexpected run to the corner store.
• Keep a running grocery list hanging on the side of the fridge, then do one huge shop each month, preferably online. Shopping online really helps me stick to my list, save time and avoid impulse spending. I consider the $20 fee to have it delivered to my home to be money well spent.

The future outcome for my kids and their parents continues to be a defined by a question mark, so for now, we are all just taking things day-by-day. During the difficult moments I take comfort in knowing that my kids are with me, somebody they have known their whole lives, and that being here has helped them to feel as safe and secure as they possibly can during this difficult time in their young lives.

Bio: Sofia is a Central NJ single mom, writer, and graphic designer happy to be cruising through life in an 18 year old Honda. 

*Note: Many states use the PRIDE curriculum for training, while others use MAPP or other curricula.