Let's Talk Childhood Feeding Issues: Interview with Cara Kantrowitz

Meet Cara Kantrowitz, an Occupational Therapist for the DOE who specializes in childhood feeding issues and happens to be a patient of SSP.  Surely this is someone we’d all like to learn from, and we are so very excited that South Slope Pediatrics will be holding a seminar with her on April 29th!  As parents I think we have ALL been there, dealing with different variations of picky eaters. This might actually be the most popular topic of discussion between parents of small children.  Why does my child suddenly hate the food they once loved? Why is he always “grazing” verses having a full meal? Why can’t she sit down at the dinner table for more than 3 minutes? The questions and concerns are endless. Not only is Cara a licensed therapist, she is also a mother of a 1 YO and 4.5 YO - so she inevitably has experience first hand!

SSP: We are so lucky to be interviewing a beloved member of the SSP community, who happens to be a renown Occupational Therapist!  Can you please tell us about Occupational Therapy, and what it means?

April is OT month so it’s a great time for me to share a little about what Occupational Therapy is!  A lot of people hear “occupation” and assume we do some kind of job training or return to work therapy.  Occupational Therapy refers to “occupation” in the broader sense though, as in the meaningful things you do to fill your time.  OTs work in many practice areas across the life span; pediatrics through geriatrics. Some areas of specialization and focus include: home modifications, rehabilitation for orthopedic or neurological conditions,  developmental delays and disabilities, mental health, and ergonomics.

I’m a Pediatric  Occupational Therapist so I use the occupations of childhood, especially play, to help children improve their skills for participation in their Activities of Daily Living at school, at home, or in the community.  These ADLs include fine motor and handwriting skills, social interaction skills, sensory processing and self-care such as dressing, & feeding.

SSP: I understand you specialize in Childhood Feeding Issues.  Can you please expand on that, and what it is specifically that you do?

Sure! As an OT my favorite practice area is working with children with feeding issues.  I work hands-on providing therapy to children with limited diets to increase tolerance of a wider variety of nutritious foods.  For many children this means working to increase the repertoire of sensory experiences they can tolerating relating to food such as flavor, temperature, texture, smell and visual presentation.  Feeding therapy also addresses the developmental motor skills needed for safe eating and self-feeding. The goal of feeding therapy is to promote a safe, balanced and healthful diet and enjoyable mealtime experiences to support growth, nutrition and learning.  I use a variety of strategies including food play activities, modeling and desensitization to decrease stress around eating and increase joyful mealtime participation.

Since 2013 I have been the OT for the NYC Department  of Education Citywide Feeding Team. I give workshops (together with a physical therapist and speech therapist) to OTs, PTs, SLPs, teachers, paraprofessionals, families and others on how to address limited diets related to medical, sensory, motor, and behavioral issues.  I also consult with schools and therapist to identify and assess individual student's feeding issues and design appropriate intervention plans.


SSP: How did you find your passion in this field?

When I was still a brand new OT I attended a workshop on assessing and addressing feeding concerns and I loved it! So I attended another and another and began implementing strategies into my own treatment sessions.  I saw such positive results, after that I was hooked!

SSP: How has being a mother of 2 affected how you assess and treat children?

Being a parent has, I hope, made me more sensitive to the wide variety of stressors and prioritization that all families must deal with on a daily basis.  Raising small humans to be the best people they can be is not easy, and patience and sensitivity for children and their families is key. Being a parent constantly reinforces for me that therapy can't be entirely deficit focused because it impedes your ability to see the whole child, which is such an important tenet of my field.  Being a parent has also exposed to me so many on-line and in person parent communities. Interacting with other parents in these communities I have come to realize how much conflicting, or inaccurate information is out there for families struggling with "picky eating", and true feeding issues.

SSP: How do you define “picky eating” and what are the more common reasons behind this behavior?

First off let’s just say that some amount of “picky eating” is totally normal, especially in toddlers. That’s part of why it’s such a problematic term. There are kids who are “picky” and it’s a phase, and it’s normal, and we just want to support them and encourage food exploration.  There are lots of fun and simple strategies we can use to address this type of picky eating. Then there are kids who are extremely selective eaters and their diets are not varied enough to support their growth or their nutritional and developmental needs. Extremely selective eaters frequently have multi-factorial feeding issues.  There is often an underlying medical factor such as reflux, allergies or frequent illnesses. Many of these kids have underlying motor or sensory processing deficits that affect feeding as well. Finally, layered on top of that, may be maladaptive habits, that can't even be addressed until the underlying issues are remedied. These kids often need therapeutic intervention to address their feeding concerns.  


SSP: As a mother of 2, one being a 2.5 YO, I am experiencing this first hand on a daily basis, and it is a little stressful.  Snacking all day seems to be the norm, and sitting for a full meal seems close to impossible (meaning both parts of this statement - the actual sitting, and eating a full meal)!  Is this normal and do you have any advice?

Yes, its common,  and yes, I have some advice.  
1.  Try not to stress, your stress level around mealtime and feeding can have a pretty major effect on your kids feelings about eating and mealtime.  Take a deep breath, smile, count to 10. Do whatever you need to do to help yourself feel calm, it will help your kids too!
2.  Remember that kids' tummies are small (about the size of their fist) so the actual amount they need in a given meal isn't nearly as much as you or I.  
3.  If the SITTING part of sitting for a meal is problematic in your household be sure to start off with proper supportive seating for mealtime.   For many kids, if they are sitting in a grown up size chair with their feet dangling, they are using all their energy to stay upright in that chair and reach and they just don't have anything left for actually eating.  This can be especially true at dinner time (or just before a nap) when kids are already tired from their day. Be sure to position kids in an appropriate size chair or use a foot rest so that their feet can be firmly and securely planted during meals with hips, knees and ankles at approximately 90 degrees.  
4.  All day snacking can be a really hard habit to break.  I'm a big fan of carrying water bottle for those times when kids need "something", but aren't actually hungry. 3 meals and 2-3 snacks a day should really be enough.  One way to work on this is by separating mealtime and play time. This way during mealtime the focus is on eating and not on TV, iPad or toys etc. I don't let me kids walk around the house with snacks; if they are eating its at the table.  Feeling hunger is NOT the end of the world. If your kiddos are healthy, and growing along their growth curve its ok for them to be hungry sometimes, and to hear, "Ok, but dinner is in 30 minutes so we are not going to have a right snack now".  Getting hunger and satiety cycles back on track will help with having more successful mealtimes as well.

SSP: Are there certain goals we should shoot for every day or week?  How do we measure “success” in regards to feeding our children?

To me success means that your family is able to enjoy happy stress-free mealtimes full of nutritious foods.  It means raising kids who are willing to try new foods, even if they don't like them all. Above all, it means having kids who's food intake supports their growth, nutrition and development so they are as prepared as possible  for learning and engaging with the world around them.

SSP: What is your number one piece of advice for mothers who are worried about their children’s eating habits?

Try not to stress!  That doesn't help anyone, and for many kids, this too shall pass.   That and ask for help. If you are concerned, seek out advice from knowledgeable professionals.  Also, know that not all medical professionals have a strong knowledge base regarding feeding, so if you don't feel like you got the help you needed don't be afraid to keep looking for the supports you need.   

​