Adam Paronto

3/5/14

Professional Meeting/Conference Report: Mealtime Success

             On Friday, February 28th I attended an all-day seminar, Mealtime Success: Transform Food Refusal into Food Acceptance, which focused on the development of eating skills, nutritional needs of children as they grow, and mealtime behavior issues from a sensorial perspective. The population being discussed was children and specifically children with autism spectrum disorders. The seminar was held at the Roosevelt Hotel in Midtown Manhattan and it was offered by PESI HealthCare. The speaker for this seminar was Susan L. Roberts, MDiv, OTR/L. Ms. Roberts has worked with families of autistic children for over 20 years and is currently working with parents and other occupational therapists to make mealtimes more enjoyable for those families with picky eaters. She has co-authored a book titled ‘My Kid Eats Everything: A Journey from Picky to Adventurous Eating.’

            Ms. Roberts began the seminar by sharing her background in occupational therapy, research of the sensory aspects and neurobiology of healing rituals, and integrative nutrition. This background information provided insight into the origin of the techniques Ms. Roberts discussed. Her methods for addressing picky eaters involve a multi-factorial approach which includes sensory preferences, eating skills, emotional intelligence, motivation and rewards for expanding food choices, nutritional value of those foods, and debunking common myths, among others. The four main facets to overall health that Ms. Roberts focused on were: environment, genetics, food, and play. She discussed how they are interrelated and how a child’s life can be bettered by improving upon one or more of these areas. For example, increasing the amount of time a child participates in play will have a positive effect on their social skills, appetite, and stress levels directly impacting the body. Ms. Roberts spoke about re-establishing healthy mealtimes roles and responsibilities. The adult should be in charge of what, when, where, and how meals should be conducted. Children should only be in control of if and how much food they will eat. This allows the caretaker of the child to provide nutritious meals on a normal schedule while also allowing the child to regulate their intake. By allowing the child to control if and how much they will eat they are able to learn their own hunger and satiety cues which, if acknowledged and not suppressed,  will lead to a healthy eating pattern throughout life.

            Another important topic of the seminar was a process Ms. Roberts calls food chaining. The purpose of food chaining is to increase the nutritional quality of a child’s diet through gradual changes to foods they like to eat but are not necessarily the most healthy. By changing only one detail, for example the brand, color, texture, etc., of a particular food at a time a child may be more willing to try what is being offered. Building on those small but progressive changes will lead to a more varied diet for the child resulting in improved health. An example Ms. Roberts gave started with McDonald’s Chicken McNuggets leading to either Burger King or Wendy’s chicken nuggets then to frozen chicken nuggets to homemade nuggets and finally to other meats formed in a circular shape. Ms. Roberts suggested that the child have knowledge of each change that is made so as not to foster a sense of mistrust. The new food should be purchased or prepared in view of the child and offered to them. Whether the child eats it, especially the first several times that it is offered, is their choice. The new food may need to be offered 15 to 20 times before the child decides to try it. Repeated exposure and modeling by parents and siblings who themselves eat the new food will usually result in the child at least tasting the new food.

            Ms. Roberts’ presentation cited multiple sources and was well balanced. Ms. Roberts’ techniques have been developed through counseling sessions with her clients from which she offered testimonials as to which methods, i.e. food chaining, are most successful in producing positive changes. The studies discussed in the articles Ms. Roberts referenced, among others, provided evidence to support the methods she uses in her practice. Among the sources cited in her presentation were articles in the peer-reviewed journals Science, Obesity Research, Adolescent Health, American Journal of Clinical Nutrition, and the New England Journal of Medicine.

            Ms. Roberts’ presentation included interactive elements which I would also incorporate into the session if I were presenting it. There were several activities which she asked those of us in attendance to complete based on information from a case we had worked on. The activities included checklists to determine a child’s biomedical and socio-cultural health, a nutrition and a sensory food journal, a food chaining map, a food exploration progress chart, and a scale to assess motor skills. I thought this was a very effective way for participants to apply what they had just learned from the lecture portion of the session. There was also time for people to share some information on the case they used for the activities which resulted in feedback from not only Ms. Roberts but from other participants as well. This immediate use of new skills learned from the presentation and the opportunity to discuss cases with a large group of people facilitated a greater comprehension of the session’s concepts. I would include similar activities in a session of this length to help relate the information being presented. An aspect of the presentation that was not as successful and one that I would have changed was the layout of the room. Ms. Roberts was positioned in the corner of an L-shaped room which meant the seating was split into two sections in line with either side of the podium and projector screen. Ms. Roberts made an effort to address both sections as equally as possible but there was also the issue of not being able to hear questions or comments from people in the other section. To facilitate the group discussion Ms. Roberts unfortunately had to repeat information frequently which made for an environment that was not conducive to learning. I would make every attempt to set up an open floor plan that would allow for participants to sit together in one group facing the speaker and any visual aids head-on when presenting a similar session.

            Ms. Roberts was very successful in meetings the goals of the session. She provided evidence-based information on the development of mealtime skills, ways to determine the sensory preferences that guide a child’s food choices, and methods for introducing more nutritious food choices. The information Ms. Roberts presented, the interactive activities completed by the participants, and the interaction amongst those in attendance ensured that each goal was met through applied learing. This is a far more effective way of accomplishing objectives in a presentation as opposed to a straight lecture in which information is obtained passively.

            The only refreshments that were served were coffee and tea. They were provided by the hotel and were not meant to reflect the content of the presentation in any way. There were however some food items included as part of the presentation that were not meant as refreshments but rather as learning aids. The items were dried seaweed snacks and dried anchovies with peanuts. Their purpose was to serve as foods that one most likely would not like to try in an activity which one participant offers them to another participant who is not allowed to used any words in their acceptance or refusal of the food. This activity was an exercise in recognizing non-verbal cues which young children use to tell their caretakers if they like a food or not. Being able to recognize this behavior and tracking it over several exposures to a new food item will give caretakers a good indication of whether or not a child is becoming more willing to try it. Strategies such as this one and the many others Ms. Roberts provided in her presentation have given me a lot of useful tools that I will incorporate into my practice as a dietitian.