36. The Picky Eating Spectrum with Danielle Zold, RD of @PickyEatingDietitian

May 20

On today’s episode, Brittyn welcomes Danielle Zold, the Picky Eating Dietitian and a personal friend on the podcast. She is a Registered Dietitian Nutritionist and a Certified Lactation Counselor with a focus on pediatric nutrition and a passion for helping kids eat. She helps parents support their children to grow to their best potential and create healthy relationships with food one bite at a time.

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IN THIS EPISODE

Resources to help you expand your child’s diet and creating an eating environment that is welcoming and encouraging for your little one
Why picky eating is less about the taste of the foods that your child is eating and more about the other senses they are experiencing
How developmental disorders such as autism and other neurodevelopment disorders are connected to picky eating

TRANSCRIPT

Welcome to the Nourishing Autism Podcast where you take a deep dive into the research on autism and dietary changes, nutrition supplements, and lifestyle modifications. Every week, we break down nutrition topics and an easy-to-understand way for you to feel less overwhelmed and feel confident on your nutrition journey with autism.

The Picky Eating Spectrum with Danielle Zold, RD of @PickyEatingDietitian

[00:00:00]

Hello everybody. And welcome to the Nourishing Autism Podcast. I'm your host, Brittyn Coleman, the Autism Dietitian. And today I had Danielle Zold, the Picky Eating Dietitian and a personal friend of mine on the podcast. It's so fun speaking with her because we have such a huge overlap in what we do and the clients we serve.

She specializes in picky, eating as a whole, where my expertise is more niched down into autism and neurodevelopmental disorders. We have very similar approaches we have so much to talk about always. Today, we talked about the picky eating spectrum and diagnoses like pediatric [00:01:00] feeding disorder. And ARFID we also discussed some easy ways and resources to help you get started with expanding your child's diet.

Danielle is a Registered Dietitian Nutritionist and a Certified Lactation counselor with a focus on pediatric nutrition and a passion for helping kids eat. She helps parents support their children to grow to their best potential and create healthy relationships with food one bite at a time. I hope you enjoy the episode

[00:01:25] Brittyn: Thank you so much for joining this episode of Nourishing Autism. Today, I have Danielle Zold, the Picky Eating dietitian. I'm so excited to have you here at Danielle.

[00:01:34] Danielle: I am so happy to be here. Thanks for having me Britain.

[00:01:37] Brittyn: Yeah, of course. I mean, it's been a long time coming. You and I have been connected for many years now. And finally we live in the same place, which is super fun and get to collaborate in different ways. I'm glad to have you here. And I know how awesome you are, but I would love for you to introduce yourself.

So everyone else knows how you serve your clients and what you do day-to-day.[00:02:00]

[00:02:00] Danielle: Yeah, absolutely. So I am a pediatric registered dietitian and I work virtually one-on-one with families of kids who are picky eaters and picky eating is really a huge spectrum. And it ranges from normal phases of development to really impacting nutrition in development. And so I help families, nurse their kids and fight.

Really creative ways to get those nutrients in knowing that they aren't routinely eating the foods that contain those nutrients in the first place the constipation, and some nutrient deficiencies can also lead to poor appetite. And so it ends up being the cycle and it can be a cause of picky eating.

So in my practice, I also run tests to make sure that we're optimizing kids' nutrition and targeting their deficient.

[00:02:48] Brittyn: I love it. And we have such a huge overlap of what we do and we just work with families in different ways. So I have been super excited to talk to you because I feel like we can just like, Go off on [00:03:00] the pig eating topic and you have so much spring from, I was just saying this, I really focus in on like the autism side, but you really cover like the whole span of picky eating within autism and outside.

So I feel like you bring a really great, big picture approach to all of it.

[00:03:16] Danielle: Yeah. Yeah, definitely. I almost wish that we recorded this podcast when we were at brunch a few weeks ago, because we were just talking all about these things. And so I think it's great that we're actually recording it now.

[00:03:28] Brittyn: I know, and maybe next time I just need to set up my voice

[00:03:30] Danielle: Yeah, bring it on the brunch table. Yeah.

[00:03:34] Brittyn: Perfect. Yeah. Well, so how did you decide to become the picky eating dietitian or even go into picky eating in the first place?

[00:03:42] Danielle: Yeah. So I honestly just fell into this area of nutrition. I started working in WIC so that is the zero to five population. And then I started working in early intervention, which is ages zero to three. And so many parents started coming to me for support, with [00:04:00] picky eating. It was like the chief complaint that they're coming to meet with.

And so I decided to open my practice at that time. To support even more families who are struggling with the same issues. And I also realized that there's a huge nutritional component to picky eating. Obviously these kids are eating or not eating specific food groups, you know, a lot of crunchy beige carbohydrates or eliminating veggies and meat.

That's what we see the most common. And so they're getting the same nutrients over and over again, and lack of specific nutrients over and over again.

[00:04:34] Brittyn: Which leads to a huge nutritional issue when you consistently don't get those nutrients in, or you're consistently eating the same nutrients over and over does really limits your variety of,

[00:04:47] Danielle: Absolutely.

[00:04:48] Brittyn: and limits you to how much you're getting of each thing.

So Danielle, we were talking about the term picky eating, and obviously your business name is picky eating dietitian. But tell me your thoughts on just [00:05:00] the phrase, picky eating in itself.

[00:05:02] Danielle: Yeah. So I, I really don't love the term picky eating, cause I think that has a negative connotation and I never want parents to call their kids picky eaters, because then that kind of becomes a self-fulfilling prophecy. The only reason that I use the term picky eating is because that is the chief complaint that parents come to me with. and that's what I can help support, but It's just the tip of iceberg. And there is so much more to picky eating and feeding in general than just kids not eating. There's so much more to it.

[00:05:36] Brittyn: It's so true. I think just the label, picky eating, we just put that stamp on top. And when we do that, it's just like, oh, this child is a picky eater, but no, in reality, they have an oral motor issue or they have a severe gastrointestinal issue and that better describes what's going on for them, not just the stamp of picky eating.

Is that what you're saying as well?

[00:05:56] Danielle: Exactly. Or sensory components to sensory [00:06:00] issues. Yeah. There a lot more to it. And my goal is to really figure out the root cause of.

[00:06:07] Brittyn: Exactly.

Do you find that there are any particular issues that stick out ? Like some of the most common reasons for picky eating.

[00:06:13] Danielle: I think you mentioned a few of them already. Definitely sensory issues, oral motor delays, but I think ultimately feeding is a really complex process. It's actually one of the most complex things that we do as humans. And so if any of these areas go awry, it can lead to selective eating.

We use our nervous system, our oral motor skills, like just the ability to chew and swallow can be impaired constipation or even diarrhea, really, anytime that we don't feel well, we don't want to eat. And so sometimes we have to address that. and then we also use a lot of our muscles. So the way I explain this to parents is if a child doesn't [00:07:00] have the motor skills, like the core strength to be able to sit up when they're eating, it's going to be really difficult for them to focus on food. So the way that I explain this- I ask parents to envision that they're going out on a fancy date night and they're going to the steak restaurant, right? Steak is a really difficult thing to chew already, but let's say they walk in, sit at the bar because the only seats available are at the bar, stay with me here.

And if you're short, like. My feet will kind of Dingle a little bit, right. So I have to use my core to keep my legs upright and keep myself upright so I can focus on my new that I'm eating. And so if I had a weak core or weak muscles, and it would be really difficult to focus on the meal that I'm eating.

So a strong core and strong muscles are also really important for eating. And I don't think that that's something that people think about very often.

[00:07:57] Brittyn: Totally. It's so funny. I give a [00:08:00] very similar example when I'm trying to get parents to understand the importance of all of that, because our number one thing that we're trying to do is keep our. Up in space to have like proper posture so we can breathe and feeding will get tossed out the window if we can't properly breathe or can't properly like support our head in space.

And I think it's so easy to forget that. And we have all of these like high chairs in different booster seats that. Just don't support that at all. And you're not thinking about that. Parents don't think about it because they're like, Hey, this high chair is here as five star reviews or whatever. Surely it's good for feeding.

Maybe it's fine for some kids, but for kids who have low muscle tone, which is I, what the research says is one in three kids on the autism spectrum have low muscle tone. And so if we have low muscle tone and we're already having a hard time chewing, well, then there's no way that we're going to have success.

If we have some, you know, a chair that's not supporting proper posture at Neal.[00:09:00]

[00:09:00] Danielle: Yeah, definitely. And some of those chairs are hundreds of dollars and it's sometimes worth it because they can grow with the child and you can adjust them as the child is growing and it'll give them really good postural stability. A lot of experts recommend 90, 90, 90, right? So hips at 90 degrees knees at 90 degrees and feet at 90 degrees.

So kids are really, really well-supported and that can help quite a lot, but not everyone has a hundreds of dollars to throw at a high chair. That's not always a priority. And so there are plenty of things that we can do at home to provide that structure, whether it's taking a diaper box and filling it with.

Rocks or bricks, and you can even wrap it in wrapping paper, if you want it to look nice at your table. But you can position your child's feet so that it's at 90 degrees with different size boxes or yoga blocks,

[00:09:52] Brittyn: I was about to say, I actually had a group call yesterday and we talked about making the most of a chair that someone had. They sent in a photo [00:10:00] and yoga block. We put at the back even like to put a little bit more support on their back. We'd like put a folded up washcloth just to like give them a little bit more support.

And then we had a little stool and then underneath the seat that, because she was like, I'm worried that it's going to slide around in the seat. No. Just put some shelf liner, right.

[00:10:17] Danielle: Perfect.

[00:10:19] Brittyn: it won't slide or the little scotch, I forget what they're called. Like the little bumpers that you can, and it makes it where it won't slide and you can easily upgrade your seat might not be like still this perfect, like trip trap or whatever, you know, but it can take your seat and elevate it and make it so much better.

If you are saving up for a better chair or if you just need one short term to.

[00:10:44] Danielle: Yeah.

[00:10:45] Brittyn: Danielle, we have so many of the same recommendations. I'm like my clients are going to listen to this and be like, oh my gosh, there's two of her, everything.

[00:10:55] Danielle: a compliment to me.

[00:10:56] Brittyn: Everything that you're saying. I'm like, I think I said a lot of [00:11:00] this on a group call yesterday. So it's just like, I love cause you and I oftentimes, like, we talk about picky eating, but we don't get to go deep into it like we do now.

So I love hearing all of that align I think that's so neat.

So before we hopped on the call, we talked a little bit about different feeding diagnoses. I would love for you to talk a little bit about this and I'll chime in too. Mostly pediatric feeding disorder and ARFID.

[00:11:25] Danielle: Yeah, definitely. So I think I mentioned this before, but picky eating really. Spectrum truly and picky eating is really common. It's a common part of development and many toddlers go through this. Especially at the age of one. I see it more often around the age of two, but we become more concerned with.

Prolonged. And of course, certainly even though it's a part of normal toddler development, there are still things that we can do that will prevent it from becoming prolonged picky eating. But the longer a child has been picky, the more [00:12:00] likely they are to need some additional support. And that's where some specific diagnoses can come in. So the first one is called ARFID - it stands for Avoidant Restrictive Food Intake Disorder And this is the diagnosis that the American Psychiatric Association created in 2013. So it's been around for a while and for a long time, it was the only option that we could label kids who had let's call it picky eating.

Right. So, APA the American Psychiatric Association uses the DSM-V. So this means that only mental health professionals can or should ethically diagnose this. and they actually say that only those who are comfortable giving a diagnosis of bulemia or anorexia are qualified to give the ARFID. diagnosis.

So it's essentially an eating disorder. The problem with this too, is that it has a very broad definition [00:13:00] and it doesn't include or address feeding skill, which are some of the things that we had just talked about, right? The sensory component, the oral motor, it's huge. When it comes to feeding.

[00:13:09] Brittyn: Exactly. And, you know, I find too, since it was the only diagnosis, , I could see it being overdiagnosed because it would be the only option, but then if only psychiatric professionals are able to diagnose this. Then I can also see it being underdiagnosed at the same time. So it just feels like it's just not even in the appropriate space to be able to be diagnosed appropriately and assess all of the feeding skills and development.

It's so much more than just a mental health behind.

[00:13:41] Danielle: Absolutely. And the way that we treat eating disorders. So different than how we would treat a child who has an oral motor delay, right? Like we would want to focus on strengthening their oral motor skills. And truthfully, I don't know that much about eating disorder treatments. I'm not an EDRD, [00:14:00] but I believe that It's a little bit more about reward and bribery and convincing.

Patients to take more bites and eat more. And so it's definitely more different when we're addressing skill deficits versus getting kids to eat.

[00:14:19] Brittyn: It's true. I mean, if you're skipping over skill development and just expecting a child to try a new food and you know, they're, they're quote unquote like scared of that food or have a negative connotation to the. But yet can't physically eat the food. You're not going to have success until you address those underlying issues.

And then you could, if there is fear behind that food or whatever it may be, then we can address it. But we have to address those underlying issues before we even go into starting to try to get them to just eat a new food for the first time when they're.

[00:14:52] Danielle: Right. And you and I both take a root cause approach. And so if there's a, a [00:15:00] psychiatrist who is looking at ARFID, they are not looking at oral motor skill, right. Like that is not in their realm either. And so. I think what pediatric feeding disorder, which is the second diagnosis, that's optional pediatric feeding disorder really focuses on four different domains and it really talks about how complex feeding is, right?

Cause we know it's incredibly complex. It is one of the most complex things that we do as humans. And so the four domains that pediatric feeding disorder defines our medical nutritional. Feeding skill and psychosocial dysfunction. So it is still including that psychological component, but it's also acknowledging that it is medical.

It is nutritional and it does include those skills.

[00:15:51] Brittyn: Exactly and pediatric feeding. Or is also fairly common. I was just reading some of the stats that in kids under [00:16:00] five, and this is a conservative guesstimate, but one in 37 kids would be diagnosed with pediatric feeding disorder.

[00:16:06] Danielle: That's a lot of kids and pediatric feeding disorder, just to note May is pediatric feeding disorder month. And it was created by Feeding Matters, which is. Awesome organization highly recommend checking them out. They also have a great visual depiction of ARFID versus pediatric feeding disorder.

And maybe you can link that in the notes.

[00:16:29] Brittyn: Yeah, I'll link that I love feeding matters. That's actually where I found that statistic. They had linked some research about PFD and the.

[00:16:38] Danielle: Yeah. And so one of their biggest goals as an organization was first to create this diagnosis. And so this is actually a pretty new diagnosis and it came out in October of 2020.

So for years, the only diagnosis that providers could use is ARFID. So we probably have a lot of kids who are diagnosed with ARFID because that was the.

Only [00:17:00] option that physicians had for a long time.

[00:17:03] Brittyn: Exactly. It's wild to me that it took that long to get such a common diagnosis. It just seems like it just seems crazy to me, especially if there's 1 in kids that are experiencing this on a, like a conservative scale that it would take that long to get this diagnosis approved.

[00:17:26] Danielle: Yeah, and you, and I see this on a daily basis, we know how prevalent it is. So I'm so grateful to feeding matters for creating this. And hopefully it'll get a lot more kids, the help that they need.

[00:17:38] Brittyn: Exactly. I completely agree. So would you say that between pediatric feeding disorder and ARFID what if people are wondering is one more serious than the other? What would you say to them?

[00:17:48] Danielle: So I wouldn't say that one is more serious than the other, but of course, the way that we would address it is very different. ARFID is mainly addressed by a mental health professional and. [00:18:00] Again, it's treated in the eating disorder, realm and pediatric feeding disorder. Since we are addressing the skill, the skill based deficit it's addressed usually by an OT and SLP and a dietitian, usually a team, because they're really emphasizing that it's interdisciplinary and it's complex.

[00:18:20] Brittyn: Exactly.

[00:18:21] Danielle: in my eyes, the things that they have in common though, is that there are very likely to be nutrient deficiencies and potential growth concerns.

[00:18:30] Brittyn: Definitely. And that's why having a dietitian on your team can be so helpful because I mean, you need everybody on your team. You need a speech therapist, you need an occupational therapist and. A lot of times I see dietitians get left off the feeding team, which surprises me.

Speech therapists, occupational therapists are miracle workers. They're like looking into oral motor dysfunction, all of these other pieces that us society patients don't, that's not what we're trained in, but we're the ones who. On [00:19:00] nutrient deficiencies on patterns in the diet, on all of these other nutritional issues that are oftentimes left out. And so I've worked with clients who have been working with a feeding team.

Who've been working on getting fruity pebbles into their diet for six months and I'm like, okay. What other nutrients are lacking in their diet. But what are some other ways that we can build another nutrients too? And the feeding team was like, oh, that's an interesting thought.

So everyone deserves a space on that team. And sometimes it's all in one place. Sometimes it's also kind of building your own team. If you don't have a clinic or a center that has all of those people all in one place. Sometimes it takes a little bit of creativity to bring all of those people to.

[00:19:43] Danielle: Yeah. And I actually partner with several feeding clinics throughout the us. And one tool that is in my toolbox is a micronutrient test. And so I'm able to send a kit to the family's house and we can send that back to the lab. [00:20:00] We'll find out what nutrient. This child is low in. And so let's say they're low in Vitamin A, I can go back to the occupational therapist or the SLP whoever's working in feeding.

And I can say this child is deficient in Vitamin A can we work on carrots? What are some ways that we can maybe incorporate it into a recipe that this child likes. If they like muffins, can we grate up carrots and put it in the muffin, like a carrot cake muffin? And so I think one of the many benefits of having a dietitian on the team is that we can come up with really creative ways to get these nutrients into these kids.

[00:20:43] Brittyn: Well paying attention to both the nutritional and then if there are sensory issues, which there commonly are. And at least the kids that I work with, you know, sensory issues are prevalent in up to 90% of kids on the autism spectrum. So that's a huge focus of mine.

[00:21:00] And I mean, sensory comes into eating, even for kids who are not on the spectrum, but I love combining both the sensory component and the nutritional component and finding out those foods that are going to be helpful to them in more than just one way. So that's always a fun like creative piece of what we do.

[00:21:17] Danielle: Yeah, the way I think about it is feeding therapists work on expanding the diet and we make sure that they're getting the nutrients and the calories that they need to grow and thrive really, because childhood is a really critical point of development. I think that's pretty obvious, right. But if it's going to take them a couple years to or longer, potentially to really start incorporating more foods into their diet, we want to make sure that they are getting the nutrients they need. Now we don't want to wait.

[00:21:49] Brittyn: That's exactly right.

So what resources and professionals would you recommend for families who are looking for more feeding support? If this diagnosis of PFD or [00:22:00] ARFID or just picky eating in general applies to them, what would you suggest?

[00:22:03] Danielle: Yeah, of course. I think Feeding Matters is a great starting place for sure. But I would also recommend seeking a professional or interdisciplinary feeding team. If you have one in your area that really has an understanding of the intricacies of picky eating. They understand that it's a spectrum and it really is So complex. And I think sometimes that is overlooked.

[00:22:26] Brittyn: So true.

So Danielle you work with families privately. You work in contract with many different clinics. How can people find you and work with you?

[00:22:36] Danielle: So there are two ways that families can reach me. The easiest is probably to send me a direct message on Instagram.

My Instagram is picky eating dietitian, or you could also schedule a free 15 minute phone call with me on my website. And that is pickyeatingdietitian.com.

[00:22:54] Brittyn: I love it. And we connected initially on Instagram. Well, that's where both of us primarily [00:23:00] are. So that is definitely a great way to get in contact with you. And I love all of your reels and your posts, and they're super informative. So even if people are looking for a free resource Instagram is just a great place to go for that.

[00:23:11] Danielle: It really is. Yeah. Thank you.

[00:23:13] Brittyn: And you are such a great referral to me because the way that I work is now an online courses and I don't take private clients. And so it's great for families who need a little bit more support need you know, that private piece to it. I mean, you are such a great resource. So I love referring people over to you who need a little bit more support.

[00:23:30] Danielle: Yeah, absolutely. And likewise,

[00:23:32] Brittyn: Thanks.

[00:23:33] Danielle: I send people, your Autism Nutrition Library all the time.

[00:23:37] Brittyn: Yeah.

[00:23:37] Danielle: such a wealth of information.

[00:23:40] Brittyn: Thank you. I think that it's a nice tool to use alongside feeding therapy to help you explore like different nutrients and different foods, because it can all be so overwhelming to do it all at once. So thank you. I appreciate that.

[00:23:53] Danielle: And I'm a member myself. I love the Autism Nutrition Library. I've been a member since the very beginning.

[00:23:58] Brittyn: I was going to say you were one of my [00:24:00] first numbers. I remember.

Well, thanks so much for being here, Danielle. And I will link all of your information in the show notes so people can find you, but definitely follow Danielle on Instagram at @PickyEatingDietitian and, get connected with her.

Cause she's an awesome resource. Thanks for being here.

[00:24:17] Danielle: Thank you so much for having me. This was really fun.

This podcast is brought to you by the Autism Nutrition Library, a one-stop hub and community for all things autism nutrition created to help you explore evidence-based nutrition approaches that have proved to be effective to help individuals with autism feel their best, do their best, and be their best.

Join now by clicking Autism Nutrition Library or by stopping by my Instagram @AutismDietitian. See you next week.

Transcribed by Descript

ABOUT Brittyn Coleman, MS, RDN/LD, CLT

I’m a Registered Dietitian, Autism Nutrition Expert, and the Creator of the Autism Nutrition Library.

I work with parents of children with autism to optimize their child’s diet, supplements, and lifestyle based on their unique needs. I help expand accepted foods for picky eaters, improve digestion and gut health, find the root causes of many symptoms, and ultimately help them feel their best so that they can do their best and be their best.

Not only do I relate to families on a professional level, but also on a personal level. I have been a part of the autism community for over 20 years, as my younger brother was diagnosed on the spectrum at a young age.

I look forward to working with you to uncover the root cause of your child’s symptoms and help your child be the best version of themselves!