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Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question comes from a parent whose child received treatment from us for feeding problems. The parent writes:

Hi Missy, James is doing well following feeding therapy. We couldn’t be more thrilled. Do you know if eczema is associated with milk? We ask because James had horrible eczema. Once we weaned him off the milk as you suggested, his eczema cleared right up.

Thanks for the update on James! We love hearing how great our clients do following treatment for feeding therapy! Maybe we will feature James in an upcoming What Works Wednesday!

As much as I would love to give you a definitive answer, medical conditions such as this are out of my scope of practice. Some people such as medical professionals at the Mayo Clinic, claim that the reasons for eczema are unknown. However, the UK Dairy Council suggests that milk may be directly associated with eczema. Other groups such as Talk Eczema suggest that dairy is associated with eczema.

I can tell you that I have met a number of children in our practice whose medical conditions improved as a result of moving some type of food. For some children, removing milk improved sleep whereas for others removing milk stopped seizures. But I also know from my clinical experience that other foods and allergens may be guilty culprits. Foods like gluten, soy, peanuts, seafood, and other allergens like pet dander, pollen, and mold have all been associated with eczema.

The best strategy is for you to remove one food at a time. Because Jack’s eczema cleaned up when you removed milk, chances are milk may be the evil substance for him.

If you have a behavioral question for me email me directly at askmissy at applied behavioral strategies dot com. Thanks!

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Hi and welcome to “What Works Wednesdays” where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be.

Nathan

Today’s success story is about a little guy named Nathan. At the time of intervention, Nathan was 6. Nathan had beautiful black hair, a heartwarming smile, and a contagious belly laugh. Nathan also had a pretty healthy belly–his nutritionist diagnosed him as obese. So, you ask, how could a picky eater be obese?

We cannot answer that question. However, we can tell you that Nathan was diagnosed with a genetic deletion syndrome as well as autism. Nathan demanded food at all hours of the day. If his parents did not feed him, he screamed, tantrummed, and hit himself in the head (also known as Self Injurious Behavior or SIB). When his parents offered him a non-preferred food, the tantrum and SIB worsened. As parents, they did not know what to do so they fed him preferred foods.

Nathan’s mother reported that Nathan would wake as early as 3 or 4 demanding food. He had never slept through the night. As you can imagine (or possibly even relate if you are a parent of a child with autism), this lifestyle caused a great deal of stress for Nathan and his family.

Given the presentation of demanding food at all hours of the day, combined with the fact that he was overweight and had low tone, we first suspected that “little” Nathan had Prader Willi Syndrome. However, his mother reported that he had been tested for this condition on more than one occasion and doctors had confirmed this was not the case.

Before Our Therapy Started

Nathan had been receiving feeding therapy for about 2.5 years from a speech therapist who specialized in feeding disorders. Nathan also had feeding objectives in his IEP. However, Nathan failed to make progress in eating a variety of foods. Thus, his mom contacted us. Prior to our services, we suggested that Nathan be seen by a nutritionist. As part of the services there, the nutritionist discovered that Nathan had a milk allergy. Nathan’s mom stopped all dairy products the weekend before we started therapy. Nathan was not happy about this change so you can imagine his distaste when he discovered that we had additional plans for him. Surprisingly though, Nathan immediately started sleeping through the night once dairy was removed! (Since Nathan started a dairy free diet, he has experienced a couple of dairy infractions. Each time this occurred, Nathan awakened during the night.)

Our Therapy

We originally scheduled 5 days of therapy with three one-hour sessions each day (one for each meal). However, Nathan was sick on the first day so we postponed therapy leaving 4 days of scheduled therapy. (More therapy is always provided when necessary.) We started therapy by finding a highly preferred item that Nathan wanted to work for (interactive book on the iPad). This is also called a preference assessment. We allowed Nathan to play with the item and then we removed it and told him that when he tried his new food, he could have the item back.

At first, we only asked Nathan to touch the new food to his lip. This is called shaping. Nathan screamed, cried, and attempted to hit himself in the head. We simply blocked the behavior from happening by inserting our hand between his fist and his head. He also attempted to bang his elbows on the table. We blocked this behavior as well. Soon, Nathan decided that he should put the food to his lip and we praised him and gave him access to his iPad book. After a few trials, Nathan decided that the new food was not so scary and he ate it. Soon, Nathan was willing to try (and eat) all of the foods we presented to him. He continued to show his distaste for the new foods by screaming and crying. He also gagged a few times. However, it did not take long for him to realize that these new foods actually tasted good.

Generalization (Transferring the Behavior to New Situations)

Nathan’s challenging behaviors subsided and it was time to transfer therapy to Nathan’s parents. Nathan’s mom started therapy on the 3rd day of services. As we often see when the parents take over, Nathan attempted to scream, cry, and hit his head. His mom knew how to block the behaviors and she held strong. By the end of lunch on the 3rd day, Nathan ate willingly with his mother so Nathan’s dad joined Nathan and his mom for dinner. For the first time, Nathan and his family shared a meal with all family members eating the same foods!

On the last day of therapy, Nathan and his parents celebrated by going out to eat. The family enjoyed a healthy meal free from challenging behaviors. The following week, we accompanied Nathan to school to show his teachers how to support him during lunch and snacks. Sadly, Nathan’s classmate brought in pizza for lunch. Poor Nathan! He could no longer eat his favorite food. He cried briefly but his teacher showed him the wonderful new foods in his lunch box and ate his meal. Over time, Nathan began enjoying healthy foods. In fact, we recently posted a picture of a meal Nathan ate when we dropped by for a visit 7 months after feeding therapy. Nathan ate grilled chicken, Texas Caviar, raspberries, blackberries, and grilled vegetables with no challenging behaviors. In fact, he is now learning to eat slowly without stuffing and he is learning table manners such as wiping his mouth and putting his silverware down between bites.

Way to go Nathan! You worked hard to learn to eat such healthy foods! Giving up milk was not easy for you. Give your mom and dad a huge hug for their support through this difficult phase! It was not easy for them either.

Side Note

We often see children in our clinic who have food sensitivities, allergies, and gastrointestinal issues. As such, we require the support and consultation of appropriately trained professionals prior to the commencement of feeding therapy. We see observable changes in behavior when milk or other allergens are removed from the diets of some (but not all) children. If you are interested in reading more about the Devil in the Milk, we found the book to be informative.

 

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Well, we are most certain that the topic of today’s post is probably not the most appetizing to many of our readers. However, given one of the headline stories on yahoo, we felt compelled to chime in. We should first clarify that we are not nutritionists, nor are we pretending to be. (On a completely unrelated note, we can recommend some good nutritionists if you are looking: Kelly Barnhill, Vicki Kobliner, and Dr. Liz Lipski to name a few).

While we are not nutritionists, we routinely see children who are having feeding difficulties. We also routinely see children who have a number of food allergies and/or intolerances including issues with cow’s milk. Because of this, we now have extensive experience with children who follow a dairy-free, lactose-free, or casein-free diet. We have seen children experiencing detox symptoms when they stopped consuming casein. We have seen children start sleeping through the night when they stopped consuming milk. We have seen children stop having seizures when they stopped drinking milk. In summary, milk must be the devil. Well, at least that was a thought until we realized that someone else had already taken claim to that statement (i.e., Devil in the Milk is actually a published book!).

We are not here to bash milk. We are here to simply say that if you (or your child) is not going to consume milk and milk products, that you should seek some assistance from an appropriately trained person before quitting. In addition to having some help, you should also know your milks. Multiple milk varietals are now available in many places. For example, if you are lucky enough to get your cup o’ joe at Whole Foods, you will be overwhelmed with your choices for a latte. You may choose from soy, almond, rice, hemp, or coconut (as well as 2%, skim, half and half, and whole). “WHAT? Can you repeat that? I can actually have a choice of dairy-free, lactose-free, casein-free milk substitutes?” The answer is “yes, you may.”

Again, we are not here to explain to you the pros and cons of each of your milk varietals. That is what your trained professional is available to do. We can, however, give you some pointers so you don’t make the same mistakes we have made. So, in famous Dave Letterman fashion, we are going to give you the top 10 reasons you need a trained professional to help you quit your (milk) habit.

10. Drinking hemp milk will not have the same effect on you as the more popularized hemp product.

9. Soy milk curdles just like cow’s milk.

8. Coconut milk is sweet, so you do not need to add a sweetener in your latte.

7. The only difference between rice milk and water is…well…..water is clear.

6. Almond milk is now available in a yogurt (if that is what you want to call congealed white stuff in a cup).

5. Milk substitutes are often available on the shelf and only need refrigeration before consumption (now doesn’t THAT sound tasty?).

4. Milk substitutes also come in ice cream form! Mmmm thoughts of peanut butter zig zag is making my mouth water.

3. Milk substitutes work well in smoothies, puddings, desserts, and cereals.

2. Almond breeze is now available in bulk at Costco.

And the number one reason you should not quit your milk habit without professional help:

1. Coconut milk with live cultures is NOT the same as regular coconut milk.

Sadly, we learned the hard way when one our clients ate buttermilk-style coconut milk on his cereal. Poor fella. And he still ate the cereal without putting up a fight! We TOLD you we could get your child to eat ANYTHING.

Happy detoxing! (but only with the support of an appropriately trained professional)

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Hi and welcome to “What Works Wednesdays” where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be.

Today we would like to introduce you to a cute little fellow named Mikey. Mikey was 33 months old when we started intervention. Mikey was a typically developing toddler in every way except for his eating. Mikey preferred to drink his milk and he drank lots of it. His mother reported going through a gallon of milk in just one weekend. Mikey had some sensory processing issues which led to oral motor therapy from a speech and language pathologist (SLP). During oral motor therapy, he learned to tolerate having a toothbrush in his mouth and he learned to eat a few new foods.

Before we started intervention, Mikey occasionally ate cream cheese and jelly sandwiches on white bread. He also occasionally ate cheese sandwiches on white bread. His mother reported to us that she was very interested in Mikey becoming toilet trained.

We sent Mikey’s mom some written instructions on how to toilet train her child. We suggested that she start toilet training the weekend before we started feeding therapy. We have found, in our clinical practice, that children respond well when multiple areas of growth are targeted simultaneously. For Mikey, we could say that he was becoming a “big boy”. Big boys learn to pee on the potty and they learn to eat big boy food!

Mikey’s mom was a champion. She followed the toileting protocol that we provided and by the time we arrived for feeding therapy, Mikey was already urinating regularly on the toilet. He was also accurately reporting if he had to urinate when asked! His daytime diapers were gone and he was wearing big boy underpants.

The other curve ball we threw Mikey was that he was no longer allowed to drink from a sippy cup. He was starting preschool and big boys drink out of regular cups. We told Mikey that he could only have his sippy cup if he needed to drink while riding in the car to keep from spilling.

Prior to therapy, we encouraged Mikey’s mom to work with a nutritionist to determine if Mikey had any food sensitivities. Unbeknownst to her, Mikey was reactive to a number of common foods such as avocado. Additionally, Mikey suffered from a zinc deficiency. So, prior to therapy, Mikey’s mom started him on a few nutritional supplements. We believe that well-rounded nutrition is one of the best mechanisms to ensure success in our therapy sessions.

For Mikey, we provided all services in his home and his mother was present for every session. Mikey’s father attended one session to ensure that he knew how to support Mikey when therapy was finished. In addition to having well-rounded nutrition, we have found (along with other researchers) that hunger inducement is one of the best strategies for feeding intervention. When children are hungry, they are more likely to want to eat. For Mikey, this meant that multiple cups of milk were eliminated each day. Unfortunately, Mikey’s mom had to deal with Mikey’s unhappiness about this change in the early morning hours before the first session. As we said previously, she is a champ and she handled this challenge like a true fighter. Mikey was definitely hungry at mealtime and he soon learned to get along without all that milk.

Mikey received services over the course of 4 days. On the first and second day he received services at breakfast, lunch, and dinner. Mikey’s mom took over the meals starting at dinner on the second day. On the third day, Mikey received services for lunch and dinner. On the final day, he received services for breakfast. So in just 9 one-hour sessions, Mikey learned to eat new foods when asked.

We had several pleasant surprises when working with this client. First, Mikey had never eaten protein in solid form. We were all pleased that protein was becoming a fast favorite for Mikey. Additionally, Mikey loved fruits. We couldn’t find a fruit that he disliked. Despite the great progress that Mikey made in such a short period of time, Mikey will still need to work on chewing his new foods. As his mouth becomes accustomed to all the textures and flavors, he will become desensitized and more willing to use all of his mouth when eating. Additionally, as he learns to use his mouth to chew all of these foods, his overall motor function should improve.

Mikey, congrats on your progress. And to Mikey’s mom—he could not have done it without you. Now go get yourself that manicure, pedicure, or date night that you deserve. Tell your husband “it’s the doctor’s orders!”

Happy Eating!

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