Friday, April 25, 2014
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Katherine Dahlsgaard

POSTED: Wednesday, April 2, 2014, 5:30 AM
(iStockphoto)

In my clinical practice, I specialize in treating children with selective eating disorder (aka Avoidant/Restrictive Food Intake Disorder).  In a recent post, I addressed the question of whether picky eating is harmful.  The short answer was “yes:” prolonged picky eating compromises a child’s nutrition, inhibits their ability to eat like their peers at social and school events, and generally makes mealtimes a battleground (harmful to family harmony, not to mention parental sanity).

The following are my recommendations to help your picky eater.  They are probably most appropriate for kids aged 5 to 10, the age group that I generally treat. The list assumes that you have already seen a physician to rule out any medical cause for the picky eating, such as swallowing difficulties or gastro-intestinal problems.

  1. Believe that your child is capable of eating just about any food.  That extreme distress he displays whenever there’s pressure to try a new or nonpreferred food?  It is not the result of a physical or psychological incapability. Rather, it is the result of years of avoidance. A basic rule of the brain is this: The longer something is avoided, the more distressing and impossible it seems. This goes for just about anything, from completing a big homework assignment, to starting a complicated project at work, to calling someone up and asking for a date.  It’s also true for a food.
  2. What’s needed, then, is repeated exposure to foods until your child habituates to them.  Habituation is just a fancy word for “learned safety” or “the brain gets used to it.”  Research has shown that young children need an average of 8 to 15 exposures to habituate to and accept a new food.  Unfortunately, how many times do most parents offer a food before deciding their child will never like it? Just 3-5
  3. For the picky eater, exposure means tasting and swallowing the food.  It does not, in this case, mean merely having the food on the plate, looking at it, touching it, or smelling it.
  4. You are no doubt wondering, “But how do I get my kid to swallow it?”  Answer: By making it worth his while. Plenty of research confirms that kids will eat nonpreferred foods for rewards.  In my experience, the easiest and most motivating reward is access to screen time after a meal.
  5. Establish a consistent pattern, such as requiring your child to taste and swallow a new or nonpreferred food each night at dinner. Start with very small bites and then work up to larger and larger amounts as your child gets over the initial days of distress and comes to accept that a nightly “challenge food” is just another dreary fact of daily life.  
  6. Many desperate parents have tried telling their children that they can’t leave the table until they have eaten a nonpreferred food. In my experience, this leads to a child who sits at the table for hours, whining loudly and often.  My recommendation is to require that he eats that nightly challenge food within the first 5 minutes of a meal. Go ahead and set a timer. The 5-minute rule means he gets it over with right at the start of the meal and then everybody can relax.
  7. Reward successes and mostly ignore failures. He eats the nightly challenge food = lots of praise and access to rewards/privileges. He doesn’t = “No screentime for the rest of the night, but I know you can do it tomorrow” said once, with sincerity and optimism.
  8. Don’t worry about rewarding or restricting privileges based on eating: There are no credible, converging lines of scientific evidence that doing so causes eating disorders or self-esteem problems.  Think about it: parents require their children do things they don’t want to do for their own good all the time (teeth brushing, taking a bath, getting homework done).  That’s called good parenting. Why should it be any different when it comes to insisting your child eat a varied and healthful diet?
  9. Remember, this will not happen overnight.  It will not happen over many nights. It will happen over many months – so be patient.  With enough successful exposures, your child will eventually habituate to enough foods that his diet is greatly expanded and mealtimes are a peaceful experience for everyone.

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POSTED: Tuesday, March 4, 2014, 4:00 AM
Teenage girls are sexually assaulted with alarming frequency and many will go on to develop post traumatic stress disorder (PTSD). (iStockphoto)

Teenage girls are sexually assaulted with alarming frequency and many will go on to develop post traumatic stress disorder (PTSD).  If left untreated, PTSD can make life hell for the sufferer for years after the original trauma, and increase the likelihood of other problems – most common are anxiety, depression, substance abuse, and self-destructive behaviors. 

But what treatment is appropriate – not to mention effective – for PTSD in girls who have been sexually abused?  A very important study, recently conducted right here in Philadelphia, points to a type of cognitive-behavioral therapy (CBT) known as prolonged exposure (PE). 

Typically, sufferers of PTSD go to great – and understandable – effort to avoid memories or reminders of the traumatic event. Even if the individual with PTSD attends therapy for relief, they will often avoid bringing up the trauma. Many well-meaning therapists, fearful of increasing their patients’ distress, will allow the avoidance.

POSTED: Thursday, February 27, 2014, 5:30 AM
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This happens all the time:  A tearful teen sits before me, describing pretty crippling depression or anxiety, and sometimes both. We are in a session, I am her therapist, and I am nodding sympathetically. 

Then I ask the fateful question: “What time did you go to bed last night?”  

I am alarmed by her answer, “like, maybe 1:30?”  I am even more horrified to learn that she typically clocks between five to seven hours of sleep a night and “maybe a little more” on weekends. 

POSTED: Thursday, February 20, 2014, 5:30 AM
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Picky eating can be inconvenient, annoying, and worrisome, but is it actually harmful to your child?  That depends on how long it lasts and its severity. Most children tend to go through a vexing icky-picky phase when they are toddlers – that’s developmentally normal. What’s also developmentally normal is that children gradually come out of this phase and expand their diet beginning in the late preschool/early kindergarten years and then continue to diversify the range of foods they eat comfortably and enthusiastically into adulthood. 

By contrast, long-term picky eaters continue to eat food similar to the color of bride dresses, favoring variations on the theme of white, cream and beige (e.g., cereal, bagels, chicken nuggets, and plain buttered noodles). They are highly reluctant to try new foods, rigidly brand loyal, and uncommonly (often hysterically) sensitive to changes in the appearance, quality, or quantity of a preferred food.

Prolonged picky eating becomes unsafe in several ways.  First, a diet of soft, carbohydrate-based finger foods is naturally lacking in the vitamins and minerals that derive from a diverse diet, which leads to nutritional compromise even if the child remains normal weight

POSTED: Tuesday, December 3, 2013, 5:30 AM

A significant part of my work as a cognitive-behavioral therapist specializing in anxiety and related disorders is providing families with recommendations for good resources. “Good resources,” in these cases, are usually books and websites that offer general, up-to-date information on the disorder for which I am treating the child, as well as sound suggestions for at-home interventions (i.e., parent manuals).  Of course I provide such psychoeducation in session, but I like parents to be able to hear the information more than once, from more than one source, and for it to be accessible to them outside of the therapy hour.

What I do not want is for families to garner information or recommendations for treatments from “unsafe” sources – that is, sources that provide information that is not scientifically supported or has been directly contradicted by science.  In fact, I explicitly warn families about this, because there is so much misinformation on the web. During initial sessions, when giving my families handouts printed with what I think are the best and safest sources of information on their child’s disorder and treatment for that disorder, I typically say: “Please DO NOT put the name of your child’s diagnosis into Google search and hit ‘return.’ You will receive millions of hits, many of them from untrustworthy sources having something to sell, and you will feel even more overwhelmed than you already do.  Instead, start with these I am recommending – you can always read more later.”

I've given my recommendations for resources on obsessive-compulsive disorder, for children who have difficulty with pill swallowing, tic disorders and school refusal. What follows are my current recommendations for good resources on trichotillomania and other habit disorders.

POSTED: Monday, November 25, 2013, 9:42 AM
(iStockphoto)

A significant part of my work as a cognitive-behavioral therapist specializing in anxiety and related disorders is providing families with recommendations for good resources. “Good resources,” in these cases, are usually books and websites that offer general, up-to-date information on the disorder for which I am treating the child, as well as sound suggestions for at-home interventions (i.e., parent manuals).  Of course I provide such psychoeducation in session, but I like parents to be able to hear the information more than once, from more than one source, and for it to be accessible to them outside of the therapy hour.

What I do not want is for families to garner information or recommendations for treatments from “unsafe” sources – that is, sources that provide information that is not scientifically supported or has been directly contradicted by science.  In fact, I explicitly warn families about this, because there is so much misinformation on the web. During initial sessions, when giving my families handouts printed with what I think are the best and safest sources of information on their child’s disorder and treatment for that disorder, I typically say: “Please DO NOT put the name of your child’s diagnosis into Google search and hit ‘return.’ You will receive millions of hits, many of them from untrustworthy sources having something to sell, and you will feel even more overwhelmed than you already do.  Instead, start with these I am recommending – you can always read more later.”

I've given my recommendations for resources on obsessive-compulsive disorder,for children who have difficulty with pill swallowing, and tic disorders. What follows are my current recommendations for good resources on school refusal.

POSTED: Monday, October 7, 2013, 9:37 AM

If Kim Kardashian told you to eat an Oreo, would you do it?  How about if it was Serena Williams?  Or Peyton Manning? Now would you be more inclined to eat that Oreo? Would your kid?

The answer is yes, according to a new study published online today in the journal Pediatrics. The study, authored by a cadre of public policy and obesity researchers from Yale, Stanford, Harvard, and Duke, examined the number of food and beverages endorsed by professional athletes, the nutritional quality of those products, and reach of such television ads to children, adolescents and adults in 2010.

Previous research has already established that celebrity endorsements help sell products and, when it comes specifically to foods and beverages, parents perceive them as healthier when they are promoted by professional athletes.

POSTED: Monday, September 16, 2013, 12:00 AM
(iStockphoto)

Bullying is a risk factor for poor psychological health.  Dozens of research studies have already established that bullied children are at greater risk than their non-bullied peers for anxiety, depression, and suicide ideation, as well as compromised school achievement.  What is not as well-known is that bullying also affects physical health as well.

Bullied children are at least twice as likely as non peer-victimized children to experience with psychosomatic problems such as headaches, stomachaches, vomiting, dizziness, poor appetite, skin problems, sleeping problems, and bed-wetting, according to a study published online today in Pediatrics.

The study complements another published earlier this year in the same journal showing that psychosomatic abdominal pain in children predicts increased rates of anxiety and depression in teens and young adults.

About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, RD Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, MD, PhD Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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