The following questions and answers are adapted from my responses to some specific feeding questions from friends via email.
Q: My child loves bread and crackers but is refusing almost all fruits, veggies and most proteins. What can I do to help introduce healthier options into his diet?
You may want to try baking pureed foods into his waffles or pancakes since this is already an accepted texture of his. While he is becoming comfortable with these other textures and tastes, etc That would be an excellent way to still give him nutrition in a way that is likely fun and yummy to him! Example...I make 'savory' waffles for Adalyn sometimes and give her ranch to dip them in. I just use a baby food processor or the regular one. You can use a blender if you don't have either. I use the steamer bags because they are quick and easy and you can steam broccoli, cauliflower, whatever!
I also recently tried a potato pancake mix and added chopped onion and some bacon crumbles as well as sea salt and some rosemary which was all very good! Of course I was fixing this for my family and would adapt this recipe depending on likes and dislikes. This morning I opted to make some pancakes instead of our usual quick routine of the frozen kind and I used the rest of our strawberries and a container of mixed fruit to toss in the food processer. You can always take an hour or so on a weekend to freeze the purees or make a bunch of pancakes or waffles and freeze them. These are options to help ease the transition back into these other foods he has dropped out of his diet. Deceptively Delicious, the cookbook, has great recipes and examples, a little more elaborate than the ones I’ve just made up, but they look good. I tend to find easier, simpler versions of something similar.
You mentioned that he likes all things with bread, breading or cracker consistency. You are basically just taking his fruits veggies that he is not eating on his own...and putting them into a way he may accept. I think it is important to always expose him to those foods regardless but since they are causing him anxiety, just go at his level...even if it is just sitting on the table while he is eating his other foods! Things will start to look up, I promise. I do feel your frustration as I've spent lots of time with parents who have often cried in the evaluation or therapy room---sometimes friends and even family do not understand how complicated or frustrating a meal can be until they have been in your shoes. Everyone has their "Well I just fix it and if he doesn't eat then I do this..." etc, and it is just NOT true for all children--if that were the case then you would have it all figured out by now!
**It is very important to rule out underlying conditions such as reflux, food allergy, other gastrointestinal complications as these are often present in children with feeding difficulties. If you have concerns about this please talk to your pediatrician about these issues and a referral for a feeding evaluation.
Q: We are noticing several signs of possible milk intolerance in our child. Since she is so limited in her diet already and eats so many foods containing dairy, what will we do to replace milk?
As far as trying a dairy elimination--its not too hard, it just sounds intimidating. You wouldn't believe the foods out there that are actually milk free and still very good (duncan hines cake mixes and most of their frostings, even the chocolate and buttercream) You just have to look at it as a trial process and take it one day at a time. I can help you with really good butter, milk and cheese alternatives. Cheese--you may want to just limit or leave out because the substitutes, in my opinion, do not taste as good as other milk alternatives; however, there is a pretty good, "meltable" casein-free rice cheese and that is the one that I would recommend. But Smart Balance, Earth Balance and Fleishman's light butters are milk free and are good...you can also cook with oils, etc.
Feeding is so involved and the environment plays a huge role as well. I have had kids come in for feeding therapy who would initially cry at the sight of the chair or the spoon...so we had to work on making that a positive place first and sometimes that meant using the high chair just for some play to create more positive associations. Sometimes a cd with calming or rhythmic music can be helpful as well as making things predictable . Small portions when introducing new foods is key in my opinion. Too much food on the plate or surrounding her can be overwhelming and she may refuse everything in that case. Since she loves crackers, dd some cracker crumbs on top of the foods with softer textures (use similar colors paired together if possible)--if she works hers hardest to pick off only the tiny crumbs, that OK because she is at least getting exposed to the 'new' food or texture. When I watched her eat I stuck a cheeto on top of a bean and she ate the cheeto with the 'bean juice' on it and then copied me dipping it into it. This is a step! So if she has a favorite crunchy food, like the cracker, you can keep some pieces plain and some with a bit of mashed food on it. Might sound strange but she will be in control of what she is eating and will surprise herself! I mentioned the Veggie stix in my email because they have green, orange and yellow mixed in and she may be more likely to try the green 'crunchy' food before a green vegetable but then you can pair the two green foods (squishy one and crunchy) or do crumbs...and gradually she becomes comfortable with that. This is not to have to rely on everything always being textured, but a way to help her lessen her anxiety with those foods that she is really objecting. Use those foods for the exposure and food play for now. This takes patience and that is ok--you want her to enjoy the feeding process, not just endure it!
**Again, consult your pediatrician if you have concerns of food allergy or intolerance as a nutritional consult may be recommended.