November is National Adoption Month, so I wanted to talk about an often neglected yet critical concern for adoptive and foster families: problems with feeding.
It’s a very complex issue, but kids who are adopted or in foster care tend to be especially susceptible to eating struggles. And, unfortunately, the resources on feeding are scarce. Or, if parents do receive advice, it’s often misguided, exacerbating the problem and leading kids to obsess over food.
That’s why I’m so honored to present my interview with Dr. Katja Rowell, MD, a family doctor and feeding specialist. I’m a huge fan of Dr. Rowell and her positive work in helping parents raise healthy kids. (I’ve also interviewed her before on Weightless.)
Recently, she’s published an excellent book called Love Me, Feed Me: The Adoptive Parents’ Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More. It dispels common — and damaging — myths about healthy feeding and is packed with evidence-based practices for helping your child build a nourishing relationship with food.
It’s a compassionate, practical and safe resource, which I highly recommend to all parents. (By the way, you can win a copy below!)
In part one of our interview, Dr. Rowell delves into why adopted and foster kids struggle with eating and how a healthy relationship with food is at the core of children’s happiness.
Q: What inspired you to write this book?
A: I’d been thinking about developing resources to help adoptive families for some time, but the kick in the pants came one day when I got two calls from moms on opposite sides of the country. Both mothers had preschoolers adopted from Ethiopia, and both girls had been put on diets by their well intentioned but uninformed physicians.
The girls were “obsessed” with food, and it was ruining family-life and affecting their emotional and physical health. It’s just not okay to put a child who has literally starved on a diet (or any child, but particularly a child who has experienced food insecurity).
One mom asked, “How can she trust me if all I do all day is say ‘no’ to her and keep food away from her. It feels awful.”
There is a unique connection between providing food and attachment, and it was all playing out in really sad, and I felt, avoidable ways for the parents who contacted me for help.
I hope to help parents tune into and trust that feeling when something isn’t right. I want to empower parents to question what they hear from their “experts,” from MDs, to speech therapists and nutritionists who often get little to no training in feeding research and dynamics.
So many foster and adopted children have survived trauma, food insecurity, and even starvation, only to continue to struggle with feeding and weight issues. I felt compelled to support these families with the most vulnerable children, whose parents are working so hard to help them, often with little support and poor advice.
This is about foster and adoptive parents (and all parents) getting information and support so they can raise children who are happy and healthy.
Q: In the book you write that “Helping a child have a healthy relationship with food and his or her body is at the core of health and happiness.” Why?
A: We have to eat, we have to do it several times a day. When we struggle with food, it affects our mental health and physical health as well. We know that when young people diet or feel mostly angst around food, or have poor self-image, they end up with less stable weight, more disordered eating and a higher risk of developing an eating disorder.
When eating is a planned-for and joyful part of a balanced life, it supports stable weight and energy, and research is showing that eating well supports health (and happiness) in general, from cholesterol to blood sugar (see the Eating Competence and HAES research).
As others have said, ‘We don’t take care of what we hate,’ so it’s important to help children feel good about their bodies so they take care of them. We live in an era and a culture where the predominant model to motivate healthy eating and behavior has been about avoidance, demonizing certain foods, shaming and self-loathing. I submit that it hasn’t worked, and that there is a better, more joyful way.
Q: Why do adopted and foster kids struggle with eating?
A: This is complex as there can be many reasons, and most times there are multiple factors at play. I break it down into two (oversimplified) categories as to why a child might be more challenging to feed. (See introducing the Worry Cycle and why children are challenging to feed.)
First there may be a challenge “from” the child, like reflux, cleft palate, a history of a drug or alcohol exposure, or any condition that leads to pain, discomfort or mechanical difficulties with eating.
Second is environmental factors: a child who is not attached to a care-taker won’t eat well, a child who has experienced abuse or neglect around feeding will be more challenging to feed. For example, an eighteen month-old who has only had a bottle with thickened liquids will be behind in her oral-motor skills.
Often, there is a combination of factors. Perhaps a child was punished by withholding food, or only was exposed to a limited range of foods and so has anxieties around eating. Stress, chaos, anxiety, poverty and food insecurity play a big role in shaping a child’s early relationship with food. These are occurrences that are simply more common in the more vulnerable population of children in foster care or who were adopted.
Q: What’s the most common feeding concern you hear from parents of adopted kids?
A: Most common issue I hear about is food obsession and worry about weight being too high. Many children who experienced food insecurity have initial behaviors that scare parents. A foster child may be “obese” and not regulating food intake due to food insecurity. (I believe those food regulation skills are not gone, simply buried, and that children can learn again to tune in to hunger and fullness cues.)
A food insecure child may eat quickly, sneak, steal, and hoard food; the child is not being naughty, these are survival behaviors. I believe it is critical to manage the initial food anxiety and heal the history of food scarcity with nurturing, reliable feeding, and allowing the child to “overeat” while she learns to trust her cues of hunger and fullness.
(Many children do need to eat a lot, as catch up growth can be up to 20 times the typical rate.)
Alas, with all the worry about “obesity” many children are put on diets or restricted right from the start. Research tells us that restrictive feeding tends to lead to higher weight and increased eating in the absence of hunger.
I believe that the restriction and efforts to control weight are why I am seeing so much entrenched food obsession, with food-seeking behaviors worsening, not improving over time. I spend a lot of time in the book talking about healing food anxiety, which over time means the food obsession goes away.
The second most common issue is selective eating with or without obvious sensory issues, and often with low weight. I am increasingly hearing from “feeding clinic failures” as more and more children are referred to feeding therapies— some good, some not so good.
Chapter three in my book is a long one, and a primer of sorts around selective eating, sensory issues and what options are out there for helping these children. As one mom said, “Bad therapy is worse than no therapy.”
Again, I want to empower parents to know if the therapy they are undertaking may actually be doing more harm than good. A good litmus test is if you are battling over therapy tasks, or the tasks are adding stress, it probably isn’t helping.
In this scenario, anxiety plays a role too. The common denominator is healing anxiety and promoting trust and attachment. (Chapter four focuses on turning around food battles and helping selective eaters.)
Stay tuned tomorrow for part 2 where Dr. Rowell talks about common myths and facts about feeding kids.
Dr. Rowell is generously giving away one copy of her book. To enter to win, just become a fan of her Facebook page and let me know in the comments below that you did. (Just open to US readers.) You have until next Tuesday at 11:59 EST — and the winner will be chosen randomly.
More about Dr. Katja Rowell:
Family doctor turned childhood feeding specialist, Katja Rowell, MD, graduated from a top-ten medical school and noted in her practice how many of the problems she saw stemmed from an unhealthy relationship with food.
Rowell believes how children are fed is the key to what they eat, and helping kids have a healthy relationship with food and their bodies is the best preventive medicine there is.
Described as “academic but down to earth,” Dr. Rowell is also the family cook, blogger, and mother of a grade-schooler. She helps parents struggling with feeding or weight worries via house-call in the Twin Cities or by phone nationwide. She has developed a passion for supporting adoptive and fostering families.
Her book Love Me, Feed Me: The Adoptive Parents’ Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More distills the support she offers families as they heal difficult feeding relationships.