40. Debunking the "Starve It Out" Method with Melanie Potock, CCC-SLP

Oct 7

In today’s episode, Brittyn interviews Melanie Potock, CCC-SLP to discuss how to support children and families as part of an interdisciplinary care feeding team for children on the autism spectrum. Kids with ASD are more likely to be picky eaters and are less likely to emerge out of the “picky eating stage” as young children. Together we explore the most common reasons why children on the spectrum are picky eaters and why the “Starve It Out” Method can cause more harm than good.

SUBSCRIBE ↓

subscribe on spotify

subscribe on apple podcasts

subscribe on google podcast

IN THIS EPISODE

The importance of having a cohesive, interdisciplinary care team for children with feeding difficulties
Identifying the most important members in a care team: the child and the parent.
The issues with the term “picky eating” and how this presents challenges around getting support with feeding issues
Why children on the autism spectrum are less likely to emerge out of the “picky eating stage” as young children.
Why the “Starve It Out Method” may not be worth the risk for children on the autism spectrum
What are the three blocks of the “Stacking Model” that impact picky eating for children and why they may be experiencing feeding difficulties
The impact of Sensory Processing Disorder in picky eating and how this can affect hunger cues and food preferences
The importance of considering the whole child instead of just the growth chart

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.

40. Debunking the "Starve It Out" Method with Melanie Potock, CCC-SLP

Brittyn: [00:00:00] Hello everybody. And welcome to the Nourishing Autism Podcast. I'm Brittyn Coleman, your host, the Autism Dietitian. And I'm so excited to share my interview today with Melanie Potock. She is a Speech Language Pathologist. We connected on Instagram and it's highly likely that you know who she is.

Melanie is an international speaker and an award winning author and has put out so many incredible resources to support families and their children and expanding their diet and feeling their best.

Melanie's advice has been shared on a variety of television and print media, including the New York Times, The Wall Street Journal, Washington Post, CNN.com and Parents Magazine.

In this episode, we explore why kids on the autism spectrum are less likely to emerge out of the picky eating stage as young children. Why this "Starve It Out" Method may not be worth the risk for children on the spectrum. And more about how to support your [00:01:00] child and build an interdisciplinary feeding team.

So I hope you enjoy this episode. It may be one of my favorite episodes to date.

Thank you so much, Melanie, for joining me. I'm so excited to have you here and have you on the Nourishing Autism Podcast. It's been a really long time coming that we finally connect.

Melanie: I'm really happy that we're connecting too. Can we tell everybody that we live like 20 minutes away from each other? This is the first time we've met.

Brittyn: No, it's wild. And we've been connected on social media. I mean, at least a year now, probably multiple years

Melanie: Oh, yeah. We've been Instagram friends for the longest time. And then you move to Colorado and I was so excited and then like life took over and this is so silly. We're connecting on a podcast and literally I could hop in the car and come over and hug you in 20 minutes,

Brittyn: It's so true.

Melanie: but we will get to meet each other in live person very soon.

Brittyn: Absolutely. I know it is so funny that we're so close and on a zoom [00:02:00] call. well I know how amazing you are, and I want you to share a little bit about yourself with the listeners, how you serve your clients and families, online, social media, all of that. I would love for you to share a little bit about yourself.

Melanie: Well, thanks. I just like kids and food and I have been I have been specializing in pediatric feeding and pediatric feeding difficulties, but also just, you know, how you start solids and how to have a joyful family meal time and all the things that we need to know as parents in general that have to do with the joy of food.

And I've been doing that for 29 years now. Majority of my early clients were. Kids with autism, with autistic individuals and they have taught me so, so much. So I think that's how you and I originally connected is we have that in common as well [00:03:00] as just the fact that we both truly believe that.

Family meal times are a really special time. And that the most important thing to focus on is family and not so much about the food. The food's great. We can help everybody with that too, but it really is about connecting around the family table. So that's what I love to do. And that's what all my books are about as well as my teaching and just.

Oh, two or three things more about me is just that I'm an international speaker. I speak in a variety of different places around the world, and I coach parents all over the world as well. And I also treat children with pediatric feeding difficulties here in Colorado.

Brittyn: That's incredible. And all the information that you share on your Instagram is just so you provide so much. Information for free. And I'm always so impressed with just all of the, the wealth of information that you do share on Instagram. And then I actually, I bought my niece, your oh, what's it called?

You are not an Otter,

Melanie: Oh, [00:04:00] my children's book.

Brittyn: yes, I have that and it's actually on my baby registry as well.

Melanie: oh my gosh. That's fantastic.

Brittyn: I just think you're amazing. And all of the things that you put out, all of the knowledge and support that you provide for families, I think is incredible.

Melanie: Thank you.

Brittyn: Course. Well, both of us work in feeding. I mean, we both fill different areas of feeding.

You're more in the, of course speech language side, and I'm in the nutrition side, but we really overlap in what we do now. I used to work on a feeding team and I'm assuming you were as well, but now we're both in private practice and that looks a lot different for both of. I'd love to talk about the differences in how you support families and what your role is in feeding.

And then I can also share mine because really what we do meshes so well together. But I would love for you to describe from the speech side, what role do you provide for families and how do you support them?

Melanie: Right. It absolutely. [00:05:00] So because everyone listening can't see us. I want them to imagine the Olympic rings, you know, how all the rings overlap on the Olympic logo. Right. One of those rings is going to be you. It's gonna be the RDN. And one of the rings that's gonna be me and S L P there. Other rings might be OT pediatrician, but definitely one ring is going to be the child.

And the other ring is going to be the caregiver. It might be the parent cetera. So everybody. A role on this team because these kids need a team that they can count on. The rings overlap and just like magician ring. We can move them all about and they interlock with each other. So at some point I might be interlocking with the parent more and other times you are interlocking with the parent more.

It depends on the individual needs of each family, each child, and the team [00:06:00] itself because where you and I were on a feeding team in more of a hospital setting before each our individual teams for years. Now we're in private practice. So that pediatrician might be in a totally different county. They're not down the hall in the hospital.

And so because of that, Each one of us takes turns leading the team depending on that child's need at that week. So the most important thing in short is, and let me know what you think about this, but when you have so many professionals on a team and occasionally the leadership is going to shift a little bit, keeping in mind that the child and the parent are number one.

It's, it's one of those things where. I think we really have to set our egos aside and learn to approach this from a transdisciplinary model and understand that sometimes we are gonna overlap. I have to know the basics of nutrition, so [00:07:00] I don't get myself in trouble, but you are the team leader when it comes to nutrition and you have to know the basics of oral motor skills and sensory processing that, you know, Ooh, I see enough here.

I need to refer. So that's how we all overlap and that's how we all work together, but it will shift. It's very fluid.

Brittyn: I completely agree with you. And I think that's the perfect way to describe it. Those Olympic rings. I never thought of it that way. And it is so important to make sure that all of us on a team know that the parent and the child are number one, because a lot of times, and. Working in clinical, they got left out of the equation and that was always a huge issue for me.

But you're exactly right. I've had to learn a lot about oral motor, a lot about all these areas that I never learned in school. But if I don't understand the basics to all of these pieces, my clients miss out, because there could be an area where I could say, Hey, this is For example, I have kids who maybe aren't meat, eating meat, or really [00:08:00] hard to chew textures.

Well, I could say, oh, they just don't like meat from a, a taste perspective or maybe it's the texture. But what if this is more than that? What if there's actually an oral motor issue? And we'll start talking about some of those like structural issues too, but referring out to a speech occupational therapist, because there's something there that maybe.

I might not have recognized from my early training. So I completely agree with you. It's so important for everyone on the team to know the basics of everybody. Else's because you can serve your clients so much better.

Melanie: Absolutely. You can be a better team,

Brittyn: Exactly. Even though it is my main role to help identify nutritional gaps, figure out creative ways to help fill those and make sure that kids are getting the nutrients that they need.

Cuz they don't a lot of times when they're limited and the foods they'll eat and then they don't feel good. And then there's all these other things. So that's my main role, but you are so right that we have to overlap in what we. [00:09:00] So that's wonderful. Well, so you worked in kids on the autism spectrum.

Do you notice that there is more picky eating in autism than children who are not on the spectrum?

Melanie: For sure. And just like autism is a spectrum. Picky eating is a spectrum as well, but we do know that it's reported that 50 to 80% of children on the autism spectrum are very selective eaters. And of course the term picky eater is. It it's so thrown about we could have our garden variety pick eaters where the, you know, children is supposed to have a typical phase from about 18 months to roughly about age three, four, where they're just not that excited about food, but we can provide some strategies to help them emerge out of that natural phase.

What's challenging when we have a child who is on the autism spectrum is. Sameness [00:10:00] is really important to them. That's what helps them feel safe. And so if they're gonna move through a natural phase, Garden variety, picky eating. It's harder for them in my experience to emerge outta that without some very careful guidance and to help them learn, to be more flexible and learn to accept new things, they can have their favorites, but not be so in so much distress should something new and unfamiliar come their way and it's going.

Because they're only three or four years old, right. And new and unfamiliar things come our way every single day, even as adults. So working together closely with someone, with like you, with your expertise to make sure that not only they're learning about new foods, but they're also able to gain a wide range of nutritional benefits is essential.

And it's yet another reason why we need to work together.

Brittyn: That's exactly right. And I think [00:11:00] understanding that same. That that provides a lot of comfort for kids on the spectrum. You're right. I mean, it does start changing and getting out of that original or that typical picky eating area. I mean, you described it perfectly. I think that understanding where kids are coming from, why they're having a hard time with expanding their diet and.

I encourage this with a lot of the parents that I work with because it's frustrating. And I understand that, but coming from a place of also empathy of what are they going through when they're expanding their diet from a sensory perspective, what is getting in the way of them expanding and how can we support them there and work with them in their sensory needs instead of working against them, by trying to force them to eat or using the star without method.

And we're gonna, which is the perfect lead in to what I wanna talk to you about. But I agree that picky eating will just use that term with autism. I mean, a lot of times they do go hand in hand. And so I love talking about that because I think a lot [00:12:00] of professionals, well, nutrition professionals don't really go into autism.

Now your realm autism is I would say a lot more common to go into, but it's really not a huge conversation among dieticians, which is really unfortunate.

Melanie: I'm so glad that you're doing what you do, cuz I've learned so much from you, you know? I know we're about to talk a little bit about, as you mentioned, just the sort of star it out method and all that. Just let 'em get hungry enough and all of that. But what contributes to any child? Who's a selective eater is the anxiety that goes around with trying new things.

And anxiety is a really very special interest of mine. It's I teach a lot of courses on it about avoidant, restrictive food intake disorder, and more of the anxious eater. And we know for sure. Children who are on the autism spectrum have very high levels of anxiety and rightly so, rightly so. So we do have to consider that whole child for sure.

Brittyn: That's [00:13:00] absolutely right. I think, yeah, I think you said it perfectly, so easy to talk to you put all of my thoughts into such eloquent words.

Melanie: we're the same person. That's why we think alike. We really do.

Brittyn: Exactly. So let's move into the starving out method and like the no kid will starve mentality is how you portray it in a lot of your posts too. And why this really might not be worth the risk of trying this approach. Would you like to weigh in on that a little.

Melanie: Sure. Sure. Well, you know, it's, it's very common advice and that's because they're talking about a typical kid who doesn't have a pediatric feeding difficulty and that's because typically we pay attention to our hunger cues and we, when we're hungry, Or we eat because we are responding to something yummy.

Like I had chocolate cake last night. Was I full after dinner? I was, but I wanted some chocolate cake, you know, and that's okay. That's okay. Now it's very [00:14:00] different. When you have an extreme picky eater or a selective eater, especially a child who's on the spectrum, but let's just look at it more in general.

The way I explain it to all the parents that I work with is I want you to think about three blocks stacked on top of each other. I call this my stacking model. The first block, the foundation is physiology, and that can be sensory processing, anxiety, cognitive challenges. We could list 50 different things, but it has to do with the way our body functions.

That's physiology. The second stack. Kind of the two by four on the building are motor skills, gross and fine motor skills. And finally, the third stack, the roof on the building would be learned behaviors, why kids behave the way they do around food. And we're also gonna consider why parents behave the way they do, why a therapist behaves the way they does any, anything [00:15:00] that's gonna influence the child's behavior.

The reason why we tend to focus on behavior and that's okay around feeding is because it's what we can see and observe and identify, but we still have to consider the whole child. We still have to assess for sensory processing difficulties. That's in the physiology. We still have to assess for motor challenges, not chewing in an age appropriate way, not being able to move your tongue in a certain way, because maybe you have tethered oral tissues.

Maybe you have large tonsils, large adenoids. I could list a hundred different things, but if we take a look at it from more of. A de like we're a food detective then taking this attitude that no kid will starve is actually. A very unfortunate way to approach it because a child can easily starve. In fact, [00:16:00] Britain, one out of four, typically developing children will develop a pediatric feeding disorder.

So if one out of four, typically developing children is gonna need feeding therapy because something in one of those stacks went awry. Are we really gonna risk? Just waiting it out, waiting till they lose enough weight before we refer them. No, we're not. So we'll break it down just a smidge more. And I know you wanna contribute to this.

I'm sorry. I'm the speech therapist. So I get to talk more

Brittyn: What you're saying is too golden. I can't interrupt yet.

Melanie: okay. Okay, good. Good. I'm sorry. I'm just, just, I'm on a roll here, but it's, if we break it down, let's just come up with a couple different reasons here. It might be that your child's favorite foods. And the ones that they really just, they stick to the McDonald's chicken nuggets, the French fries, the apple sauce and the pouch, et cetera, that they do that because it's just [00:17:00] easier to chew and they can't manage new textures because they don't have a skill.

Maybe it don't feel safe. So that falls into that motor stack. What about if they're avoiding new food experiences due to anxiety? That's part of physiology and maybe there is something there in the family dynamic. It's not the parent's fault, but they're, they're trying so hard to get the kid to try new food and it creates so much anxiety in the family as it.

That repairing some of that dynamic and getting back to a responsive feeding model is really gonna help everyone enjoy meal times better. That falls into the learned behaviors, that roof on the building. What if they have undiagnosed sensory processing difficulties and. Definitely children on the autism spectrum have more challenges around sensory processing and that in turn creates anxiety.

So now we're back to that physiology and that, that lower stack we could go on and on and on. But a lot of these things are [00:18:00] not picked up easily unless the child has an assessment through a feeding team or an individual like yourself or me. And that's why we can't wait to refer. Wouldn't it be better?

To refer then to wait for them to lose the weight and just say I guess you never really to get hungry enough. Maybe we better look into an evaluation. We need to flip that. And first.

Brittyn: It's so true. And what I love that you're talking about that physiology piece and sensory processing disorder looking into how children detect hunger as well, because we see a lot of children on the spectrum who are out. Touch with their hunger cues or out of touch with those internal body signals, like you're in interception sense.

So do I need to go to the bathroom? Am I hungry? Am I anxious? These internal cues that they're just not recognizing and that may be hunger. So if a child is. Is maybe eating for some sensory input or maybe they are not eating out of [00:19:00] sensory avoidance. And they're not in touch with those hunger cues because of interception or sensory processing disorder.

That's where we also have a major issue too. And that, like you said, comes down to the physiological piece, but I love talking about those internal cues and how that can be off for children on the spectrum or with sensory processing

Melanie: Definitely me too. I teach a four hour masterclass all on appetite and really exploring hedonic appetite. And. Static appetite. And one of the interesting things is that when parents are professionals take that class, they'll often report to me. Oh, you know, my child loves popcorn. He eats a big bowl of popcorn every day at three o'clock after school.

Cause he doesn't eat well at school. So he is really starving. And then when I ask, how long has that been going on? Oh, he's been eating a bowl of popcorn every day at three o'clock for the past two years. My response is I suspect your kid doesn't really enjoy popcorn. He's just so hungry at that point.

And he's only got three or four options of what he's [00:20:00] capable of eating that. Now, all he cares about is zoning out in front of the TV. He's not really enjoying the popcorn and he's just getting food in his belly. And we have all been there when we're really, really hungry. Like just gimme something to eat, but.

He's limited because of all the other challenges we mentioned earlier to three or four foods. So you don't really enjoy popcorn. It's not really your favorite food. It's just the go to food. When you finally can feel enough hunger to eat it. And also it gets back to our earlier conversation about saying this, this is what I do at three o'clock.

Every single day. And I find comfort in that. So helping that child expand from there is what really requires an expert like yourself, us working together, et cetera, etcetera. It's really, it's so fascinating. The topic of appetite.

Brittyn: It truly is. There's so much that you said that I, I feel like I could learn from you. I need to go by all. [00:21:00] Courses. Word from you. But I love what you're saying and talking about all of the, the physi physiological piece is so important for us to fully understand how we can support our clients. So I love that you dig into those building blocks, those three different pieces.

I think that's so important and hugely needed. And. Hopefully more practitioners can take after that. And I share the same sentiment that it's really frustrating that a lot of times kids don't get the referrals that they need until they have lost the weight. Or I have people who come to me on their own because they say my doctor won't make the referral because my child's plotting on his growth curve.

And, but I know that there's a big issue. There's so much more to the. Numbers and growth curves then pick eating, cause you can have a nutrient deficiency and still, or multiple nutrient deficiencies and still be in the 50th percentile.

Melanie: And you can be an extreme picky eater and be significantly overweight as [00:22:00] well because you're just eating more. Of the same limited foods. Then my, the kids on my caseload who are underweight or even failure to thrive. So a growth curve is fantastic, but it's just a snapshot. There's so much more to consider.

We really have to consider the whole child and the stress that the family's going through over this

Brittyn: It's so true. I love it. Well, I feel like we could talk for another. But for the sake of everybody listening to, I, I wanna make sure that they have all the information on where to find you Instagram. I want you to tell us about your Instagram, your books, your website, all the ways that people can learn from you.

Melanie: Oh, thank you so much. So the easiest thing to do is just go to the homepage of my website and my website is melaniepotock.com. I'm sure we'll put it in the show notes or mymunchbug.com. It's the same thing. I, for years I've called my littlest clients, my little munch bugs. And that's where that name came from.

That's where you'll find all six of my books, including my latest: responsive Feeding and the award winning, Raising a [00:23:00] Healthy, Happy Eater written with pediatrician Dr. Yu and you'll also find all of my on demand courses. My bottle weaning course, my pacifier weaning my feeding development. I have so many And you'll find all of my social media icons, but I have to say my favorite is Instagram.

And of course that's where I met you. So I hope everyone will follow me there on Instagram and feel free to DM me. If you have questions about your kid. And I am just so grateful that we finally got together, this is awesome. And you're right. We could talk forever. So I'm gonna be quiet now.

Brittyn: Well, I'll put all your information in the show notes so everyone can uh, get to you and then I'll share on Instagram as well, so that people can, can link back to you because you're such a great resource. Like I said, so many free resources and I even saw you have a free toolkit on your website. Where you can go and download all of these amazing free resources.

So just saying that I'm grateful for that. And I know my clients are too, cause I talk about you all the time.

Melanie: Aw, thanks so much. This is so fun to get together and I'm so [00:24:00] excited to be referring clients to you now that you're here in Colorado. It's awesome.

Brittyn: yes. Thanks so much, Melanie, for being here.

Melanie: Thank you. Bye Brittyn.

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!