62. When Picky Eating Is More Than Picky Eating with Sarah Almond-Bushell, @thechildrensnutritionist

Written By Brittyn Coleman, MS, RDN/LD

In this episode of The Nourishing Autism Podcast, Brittyn welcomes Sarah Almond-Bushell, a UK-based international award-winning registered dietitian with 25 years of experience in pediatric nutrition.

They discuss Sarah's approach to managing picky eating in children through play and sensory experiences, emphasizing that it's okay to play with food to encourage positive interactions. Sarah highlights red flags that might indicate when picky eating requires professional intervention and discusses the benefits of using learning plates over no thank you plates.

If you have a picky eater in your family, this episode is a MUST listen!

Podcast Resources:

 

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TRANSCRIPT

Hi, I'm Brittyn, a Registered Dietitian and autism sibling. I have a passion for helping parents of neurodivergent kids navigate nutrition and wellness for their child, one small step at a time. Here we'll explore practical nutrition tips, learn from top autism experts, break down the newest research, and share inspirational stories that will empower you to utilize nutrition to help your child feel their best and thrive.

Listen in while picking kids up from school, sitting in a therapy waiting room, taking a quick walk or wherever you find yourself, looking for some inspiration and a friend to guide you along this journey. This is Nourishing Autism.

Brittyn: Hello. Hello. I hope everyone's having a fantastic week. I'm really excited to share this amazing podcast episode that I recorded with a fellow dietitian who specializes in picky eating. For those of you who have kids with limited diets, this is a fantastic, fantastic conversation to listen to.

And I owe that to Sarah Almond Bushell, who is a UK based international award winning registered dietitian with 25 years of experience in pediatric nutrition. We had such a fun conversation. I even learned quite a bit of information from her sharing her experience with her clients.

And I've just got to tell you, if you're working on expanding your child's diet, we talk all about the sensory experience of food. We also talk about the developmental stages [00:02:00] of picky eating and how this can be a very developmentally appropriate stage to go through when your child limits their foods, but how to come out of it on the other side.

Sarah shares tons of information with us about how to do this and some tips that she has utilized with her clients. Sarah is also an author, speaker, health business coach, and an ex NHS consultant pediatric dietitian, is the founder of two businesses: The Children's Nutritionist and Sarah Almond-Bushell Coaching. Her aim with The Children's Nutritionist is to help parents resolve fussy eating by tapping into the psychology of feeding with the aim to reduce stress at the dinner table so families can enjoy happy meal times, which I absolutely love. So join me in welcoming Sarah Almond-Bushell.

Brittyn: Are you an educator looking to make a real impact in the lives of young autistic students? If so, I'd love you to join me at the Preschool Autism Summit.

I know how frustrating it can be when professional development rarely [00:03:00] applies to early childhood and overlooks relevant topics for autistic students.

And that's why I'm joining over 25 special educators, parents, psychologists, speech therapist, and OTs who advocate for neurodiversity affirming strategies at the preschool autism summit, July 15th through 17th. During the summit, you'll learn how to equip your support staff and paraprofessionals with the latest strategies, create compassionate and strength-based classroom environments and replace outdated methods with practical, current strategies. You'll gain actionable tools and insights to enhance your teaching practices, promote meaningful engagement and empower every child to thrive.

Grab your free ticket in the show notes or by visiting nourishingautism.co/summit and gain the knowledge and tools that you need to make a real difference in the lives of young autistic children. Again, that's nourishingautism.co/summit to grab your free ticket.

Brittyn: Hi, everyone. Thanks so much for joining us on another episode of Nourishing Autism.

I am sitting here with Sarah [00:04:00] Almond-Bushell, and I am so excited to have you here, Sarah. Thanks so much for being here.

Sarah: Thank you for having me. I'm really excited to get on with our conversation today.

Brittyn: Me too, and I'm so glad to connect. I'm in the U.S., you're in the U. K., and we originally connected from another dietitian named Erica Julson, and she doesn't even know that we connected through her, so shout out to Erica because she's amazing and does amazing things for our field of nutrition and helping us expand our businesses online.

She's really wonderful. I know you feel the same.

Sarah: Yeah, I've learned a lot from Erica over the years.

Brittyn: Yes, she's wonderful. So any dietitians listening, definitely check her out if you don't know her already. But Sarah, I want to talk more about you and your business because we overlap so much. So tell me who you are, what you do, and who you help.

Sarah: Yeah, absolutely. So yeah, I'm Sarah Almond-Bushell. I'm a registered dietitian over in the UK. I've been qualified for 25 years this year, so I'm very old. And [00:05:00] I help parents manage fussy eating or picky eating as you guys call it in the US, don't you? And really anything from that sort of typical toddler food refusal stage right through to extreme fussy eating, children with ARFID or suspected ARFID.

 Really just to help parents do whatever they can to help children eat a wider range of food, more volume of food if they need to, but also to reduce the stress and the drama that happens at mealtimes. Because for me, it's all about parents and children and families having this lovely, happy relationship with food and making memories around the dinner table that will last a lifetime.

Brittyn: That's what drew me to you because I share the same approach in that the most important thing is to be able to have a positive connection with food,

and that's what's going to help kids move forward in a sustainable way as well, and then just [00:06:00] make it so much more about just the nutrition of the food. We have so much more...

Sarah: Oh, totally.

Brittyn: And so I love that. And that was why I was like, okay, we need to get on because we're going to have a great conversation. And then I also realized that you are certified in SOS feeding therapy. And I didn't know that. I found that out when I was preparing for our episode and so am I, which I think is one of the greatest things when it comes to eating

for kids with sensory needs. So I want to talk about that a little bit. Would you mind sharing a little bit about why you got certified and how you use the certification?

Sarah: Yeah, absolutely. So it really goes back to my own children. So I had, I've got two children. And one of them, my second child had real extreme fussy eating.

And we discovered when she was about eight months old that she had an undiagnosed egg allergy. And essentially she grew up just learning that food caused pain so she didn't bother eating. And I [00:07:00] struggled over the years, not really knowing what to do to help her. And I worked in a children's hospital and none of my colleagues could help.

 And then I was doing a research degree, a master's and I got stuck into some research that was written by a lady called Dr. Kay Toomey, who is the founder of SOS. And, oh my goodness, I just learned so much, and I found it fascinating. And her background is in psychology, so it was all around the psychology side of eating, and the sensory side, and how the two things come together.

So, I ended up getting in touch with Kay and she became my mentor for a few years. And then I did an SOS conference when they came to the UK, I think that was in 2017. And then I did her advanced courses, you know, as time went on, and everything I learned, I tested it out on my daughter and the effects that it had were just, you know, absolutely earth shattering.

It was, it was profound, the difference that it made. And it really made me [00:08:00] realize that, you know, all these years as a dietitian and, you know, all the training that we do at university, the whole thing about firstly eating and feeding children, it's not just about the food. It's so much wider than that.

And I think that's hugely missing from our dietetic education. And so now, you know, all of the families that I worked with, whether it was in the NHS back in the day or in my private practice now, all of the families get a combination of this stuff I learned from SOS,

the stuff I've picked up from being a dietitian, the stuff I've picked up from being a mum, and I've combined all of that together, and it really does have remarkable results.

Brittyn: It really does. I tell everybody that four day conference that I went to was the best thing that I've ever done as a dietitian. And now I actually, I live in Colorado and they're in Centennial. So it's really only like an hour away from me. And so, I've always wanted to connect with them, but it is for kids who have sensory needs.

I think it is hands [00:09:00] down the best approach for eating and even for kids maybe who don't have sensory processing disorder or autism or ARFID, I think it's beneficial for anybody because it just makes sense. So for anyone listening who doesn't know what SOS therapy is, it's an approach to feeding that also, it's very multidisciplinary.

So it takes into account speech therapist, occupational therapist, psychology, dietitians and then it takes this gradual approach to feeding and that it's very manageable for a child who does have sensory processing disorder. So you start from just seeing a food for the first time and 30 steps later going into actually eating that food and I think that you can break it down a hundred steps later.

There's so many little tiny steps you can take and you take this approach of really following the child where they are and also monitoring for other pieces that might be going on in the background. Are there issues with oral motor issues? Are there, you know, medical issues that might be getting in the [00:10:00] way of them eating appropriately?

It's like bringing in pediatric feeding disorder and ARFID and all of these different pieces. And I just thought that it was so well rounded and I did the training as well in 2018 in Seattle, and it just completely changed my practice because I think you're spot on. We're not taught picky eating in school.

And if we are, I mean, I took nutrition of the lifespan. I don't know what it was called for you, but that's basically like going from infants to, you know, the elderly. So it's like, you touch on kids, this tiny, tiny bit in this one hour class. And all they say is just put new foods out, basically. Expose that new thing.

And so that was all I knew. And we know that that's not enough. And there's so much variety in how people are going to choose to expose their kids to food, so there's no [00:11:00] consistency. But I just wanted to explain that because it makes so much sense for my population with autism. And I know, Sarah, you said you see kids, all kids as well.

 So have you, it sounds like you've noticed that it's been really helpful for all the kids that you support.

Sarah: Yeah, absolutely. So it got to the point in our business where we decided that actually we weren't going to miss this out because it had such a huge impact and what we found,

we surveyed our clients over the last two years and what we found was within six weeks of implementing this stuff, whether they had sensory differences or not.

96 percent of our families had their child eating new foods at six weeks.

Brittyn: Oh my gosh, it's insane!

Sarah: It is, isn't it? It's, you know, it was just so profound the impact that these techniques have that we couldn't not do it. It would be doing a disservice to avoid that and stick to you know, the general stuff.

So now everybody, [00:12:00] irrespective of what they come to us with, they all get a little bit of SOS.

Brittyn: I think it's great. And again, it just takes into account everybody's sensory needs and really follows the individual which I think really needs to happen. It's a shame when it doesn't. And we just stick to this one size fits all picky eating approach.

So it sounds like you see kids, you said from toddlerhood up into the teenage years. Is that correct?

Sarah: About 10. So we have had a couple who were a bit older, but we've really decided just to focus the business on up to about 10

because as you know, as children go through different developmental stages, different things apply, doesn't it?

So one of the things that we've tried to do is we've created a program which is very much brilliant for sort of those younger children and that sort of middle age. But once they get to, I say between nine and 11, which is why I've put 10 there, they change again. So, you know, we're trying to keep to the younger age groups because they're the ones that we've [00:13:00] had the success with. The older kids,

we do get success with but it just takes a lot longer.

Brittyn: I've noticed that too. I want to point out in that space for a second talking about developmental stages in eating. So I mean, there's a huge developmental stage where kids often become picky eaters.

Sarah: Yeah.

Brittyn: Tell us about that. Like what age range do you typically see that happens?

And yeah, let's start there.

Sarah: Yeah, so the most common age is that sort of 18 months to three, when they move away from the baby phase and into that toddler phase and the independence kicks in and that's actually a brain development. It's a cognitive shift that these children go through and that's when it typically, you know, typical toddler fussy eating, picky eating, that's when it sets in.

But we also see it again a bit later at the age of sort of five to seven and then again a bit later between nine and eleven. So often what I say to families is, you know, if you've had a toddler [00:14:00] who's been a picky eater and you haven't managed to sort it out, they'll get a lot worse in that five to seven age.

And if you haven't managed to sort it then they're going to get a lot worse in that sort of preteen stage as well. So it's really important to be able to pick up on these stages when they happen. And even if it's just a typical food refusing toddler, knowing what to say, knowing how to parent around food at that stage is actually crucial so that they can move on and it doesn't get any worse.

Brittyn: Absolutely. And so you're saying all of those stages are developmental shifts.

Sarah: Yeah.

Brittyn: Okay. I'm curious because, I mean, I have completely seen that too, but I'm learning from you as a dietitian right now. That developmental shift from, you said like five to seven and then nine to 11. Would you be able to share a little bit more about like what actually might happen during those times?

Sarah: Yeah, [00:15:00] absolutely. So it's actually a physical change in the brain. So that's when we talk about it, it's a cognitive shift. So it's a developmental change in the brain. And because all children are different, there's a range. So that's why it's between five and seven because each one will get there at a different time.

And it really affects the way they see the world, how, you know, they interpret information and make sense of that information in their minds. But what happens with eating is they will interpret the way food is differently at that time as well. So something that may have been perfectly acceptable can suddenly be absolutely disgusting.

 They can be influenced. So for example, with the older children, they can suddenly be influenced by a friend. So if a friend has had an anaphylactic reaction to peanuts or something, and they've witnessed it, they can then decide that they're not going to eat peanuts anymore. And, what it is, is it's not that anything different has happened compared to if they'd witnessed that anaphylactic shock at the [00:16:00] age of three.

 It's the way that their brain has interpreted it.

Brittyn: That makes a lot of sense. Ooh, wow. Where did I miss this in my training? Because I see it. I see it all the time. And it makes so much sense. And I think I just learned we have that huge developmental change in between 18 months and three years. But it makes total sense that we would continue to see that, and I do, all the time.

 I say to my friends sometimes, they're like, well, you're a picky eating dietitian, so your son's gonna eat all of these things. And I'm like, no, no, no. I can't stop it. It is a developmental shift that we see. And no matter how great of a dietitian I am, we're still gonna see a shift there. Now, I know how to manage it.

I know how to move forward, and that's what makes the difference as well. Now, I have a 15 month old who has already started limiting his diet. My husband was an incredibly selective eater. He ate five foods, like, as a toddler. Oh, [00:17:00] wow. So I've been like, okay, prepare for impact because we know that some pieces of picky eating are also genetic.

And so we've been prepared that this may happen, and you never know, of course. But I think that it's an important thing that for parents, oftentimes we put the blame so much on ourselves of, I must have done something wrong. But it is I mean, it's physiological that they're experiencing these shifts, which I think is a really important thing for parents to understand.

Sarah: Yes, it is. Absolutely. And you mentioned there about, you know, things like your husband being a picky eater and how that can run in families. And it can be the same with, we were talking about the sensory side of things. You know, the way that children perceive taste can be very different to the way that we perceive taste.

And actually, if dad perceived taste in a different way and didn't like something, that can be passed on to children as well. So it's just so multifactorial, there's so many different component parts to this which is, I [00:18:00] think, why, you know, having that SOS training and that background can really just help you pull it all together and support families in the best way that we can.

Brittyn: Absolutely. So let's hang out in this like 18 months to three because that's where a lot of people come to me. They're getting their autism diagnosis around this time as well. And then their child's diet is also becoming especially limited. So I think a question a lot of people have is, what is considered I hate the word typical, but we're going to just use it just to explain what we're talking about.

Do you see that it's pretty typical for kids to head out of picky eating around three? At what point do parents need to be considering, hey, this may be, this may need additional support, and this is not just the typical picky eating developmental stage.

Sarah: Yeah, absolutely. So the sort of things that I would look out for are when the number of foods that the child will eat, I [00:19:00] hate the word safe foods, but that's what parents use, the number of safe foods that a child will eat starts reducing and gets smaller.

 So 20 is kind of my cutoff for, right, okay, we need to do something about this here. But like you mentioned earlier, I have had children who've turned up with five foods and that's a real, real struggle. They really need some help quite quickly. So that's one of the things that I would say is a bit of a red flag, a bit of a difference between your typical fussy eating.

The other thing as well is when mealtimes are just really unpleasant, so they're filled with drama, there's a lot of stress. The child might have high levels of anxiety at the table and parents haven't noticed that that's necessarily anxiety. They might just think that they're a typical toddler having a tantrum or refusing to sit at the table, but it can be, you know, even things like, a child might need to watch a certain video over and over and over on mum's iPhone in order to eat.

That can be a sign of anxiety. So, [00:20:00] children who chatter incessantly throughout the meal, that can be a sign of anxiety. And often, you know, these signs that we see are what children are doing to try and escape the situation or deflect attention away from the situation. So, if mealtimes are not a happy vibe, if there's something else going on there, that would be another red flag for me to kind of look into what exactly is going on here and does this family need a bit of additional support.

Brittyn: I think those are really great red flags for families to help understand because sometimes it's easy for things to start out and things are just a little limited and mealtime is okay, and then gradually turn into this huge struggle

where the child is also eating a few foods and everyone is just not wanting to come to mealtime and I think it's easy to kind of like, realize, oh no, we're here, and it kind of gradually started.

So I think that that's a [00:21:00] really good realization for parents, I also think they need to realize it's okay to get help and that's what we're here to do. And again, it's something that, you know, it does happen to most families, this developmental stage of picky eating. That's not in our control, but what is in our control is how we handle it and move forward with it.

And that's what professionals like you and I are there to help them get and transition out of that as well. So I wanted to also bring up this topic that I've been talking about a lot with my clients recently, and I thought since you were in SOS as well, and I saw you post about this, that it would be an interesting conversation.

So I use the approach of learning plates when children are learning a food or don't feel comfortable with it on their plate quite yet. And I prefer this approach over the no thank you plate and from what I've seen, you're kind of in the same camp. Now the learning plate for me comes from the [00:22:00] SOS training.

That's where I learned this kind of approach, but I would like to talk about the difference between the learning plate and the no thank you plate and if you see that the learning plate is more successful for kids.

Sarah: Yeah, absolutely. So, as I mentioned earlier, I'm very old, and so the learning plate used to be called a tasting plate in my very early training, and now I can just see how wrong that was, but the idea is the same.

So, foods that your child is happy to have on their main plate, they can put on their main plate, brilliant. Everything else that they're not yet familiar with or happy to have on their own dinner plate goes on a side plate and that's the learning plate.

Now what I see where most people go wrong is that plate becomes the ignoring plate, so they've put it there and they just leave it and ignore it,

but actually what we need the child to do is to explore the food on that plate.

So, [00:23:00] for your listeners who don't know much about SOS, one of the concepts is that there's 32 different sensory steps that a child has to progress through for every single food before it's accepted. And the idea is, is the food that goes on the learning plate, they are working on whichever step they're on.

So, chances are, if it's in front of them, they're visually okay with that. So they're probably, you know, step seven or above on those 32 steps, but they might not yet be at a stage where they can interact with the food. So what they need to do with that food is learn to be able to interact with it. And initially that might be poking it with the back of a spoon, or with your fork or something like that.

So they don't actually have to physically touch it with their hands. But we want children to be able to really explore that food. And one of the things that I like to get my families to do is to meet the child where they're at developmentally and do that through play. So it might be [00:24:00] driving a toy car

through the sauce that's on the learning plate or it might be giving them a straw and getting them to blow bubbles or something just so that they can turn it into a fun activity and learn about the food. So it's totally okay to play with your food.

I see that the most progress happens when we get silly and just drop anything that's gonna make us

I say like get out of our adult brain and try and meet a child where they are. And I see the most success happen in that place, for sure.

Yes, absolutely.

And you know, table manners. Park them, wait until your child's eating well, and then you can focus on table manners. A lot of the families that we work with are very fixed on table manners, with very young children who are not eating.

So that's something that I absolutely say, you know, you can sort that out when they're 20. You can, at the moment, let them just learn about the food. And if they have to learn by being messy and playing and blowing bubbles [00:25:00] and driving cars, that's an absolutely fine way to do it.

Brittyn: Totally, I agree. Another reason I like that learning plate, I think it opens up just even the language that we use around a learning plate versus a no thank you plate.

I really feel like the learning plate just leaves things open for opportunity, whereas the no thank you plate, it just kind of closes the conversation. And there's not much that you can do because we have to respect children as well. If they are saying no, it's no. Period. And so I don't feel comfortable after the point that they've done that to then be like, well, can you smell it?

Can we, you know, all these different types, like, let's drive our car through it. The experience and the vibe is gone. Now it's negative. And so I find, especially too, when kids start with the food on their plate and they're not ready for it to be there, we're already in this, or for a lot of kids, in this fight or flight [00:26:00] state.

Sarah: Yeah.

Brittyn: And that starts off mealtime not so great and can affect their appetite as well. And so when kids feel overstimulated, we go flight or fight. And so I see when we start it in that learning plate first, we're already in this like sensory positive experience. And if they choose to move it to their plate, that is their choice.

But we help them facilitate that over time by helping them through those stages. And so, especially for autism, I just find that the no thank you plate, we start from a place of overstimulation and then the whole mealtime goes downhill. And so I know it's a really popular approach, but I see, especially for the kids I work with, it just completely changes the mealtime experience.

And again, just ends the conversation before it's even started, is what it feels like.

Sarah: Yeah, you're absolutely right, because, you know, once children are in that fight flight mode, their adrenaline [00:27:00] levels are up, they're not going to eat, they're not going to eat now, they're not going to eat later, it's, you know, game over, isn't it?

And the last thing we want to do is stop our children from eating.

Brittyn: Yes. Exactly. And kind of like you said, the experience at mealtime makes such a difference. And so the language that you use around mealtime, even your body language, it can just make such a difference in the child's experience with food and sitting down at the dinner table or being around the dinner table.

So even those small things really can make a difference. I truly believe it totally shifts the experience. I don't know if you've ever heard, Stephanie Meyers is another dietitian who actually is on another episode of the podcast, but she is Table Talk Coach and we had a whole episode talking about just meal time language around food.

It was very fascinating, I wish we would have had you in on the conversation because I feel like you could have contributed so much to that but, it truly does make such a difference.

Sarah: Yeah, [00:28:00] absolutely.

Brittyn: So, I think we could talk for so much longer, but I do want to know, where can people find you?

How do you currently support families? And where could people connect with you?

Sarah: Yeah, absolutely. So I've got a website with loads of blogs and recipes and free resources, and that's childrensnutrition.co.uk. I'm on Instagram @thechildrensnutritionist. And how do I support families? I have got a brand new program that we've just launched this month called Fussy Eating Fixed, and it's really for

those children who are, parents describe them as strong willed, stubborn fussy eaters, or children who parents think they may have ARFID, but they haven't necessarily got a diagnosis. It's really hard to get that diagnosis over here. Because irrespective of whether they've got the diagnosis or not, this is how we can help you.

So that's what we are currently doing at the moment with our clients.

Brittyn: Is it online or is it in person?

Sarah: It's kind of a bit of a [00:29:00] hybrid really. So what I found was we used to do it one to one with clients. And what we found was actually if we record a little video for them and got them to watch stuff in between, they had a much greater success rate and much more quickly.

So now we've got like a library of information for them to watch and it's all assessed. So they have to go through it in the right order. But then they get some personalization as well with myself or my team. And that's over a six week period so that they can get their questions answered and move forward throughout the program.

Brittyn: That's amazing. And can you share where in the UK you're located? I have a lot of UK followers and listeners as well that are always looking for resources.

Sarah: Yeah, absolutely. So I'm right on the very bottom on the South Coast in a tiny little town just outside of Eastbourne.

Brittyn: Okay, amazing. But if they didn't live there, they can still participate in the program.

Sarah: Of course, yes, yes, yes. Yeah, I very rarely see people in real life anymore because my clients are from everywhere.

Brittyn: That's awesome. It's so great to be able to have that virtual [00:30:00] component because I don't see anybody in person either and it's so neat to be able to help everybody. I mean, wherever they are, wherever they are.

Exactly. Well, thank you so much for joining us. I learned so much from our session. I'm like, where did some of this education drop off for me? So I think I need to go to Children's Nutritionist's School and learn from you. So thank you so much for sharing with us. And I will post all of your information in the show notes as well.

So people can connect with you and learn more about your program as well.

Sarah: Amazing. Thank you so much for having me.

Brittyn: Thank you for being here.

Transcribed by Descript

About Brittyn Coleman, MS, RDN/LD

Brittyn Coleman, MS, RDN/LD, is a distinguished Registered Dietitian and Autism Nutrition Expert, known for her innovative, sensory-friendly feeding approach to nutrition for children on the autism spectrum. As the founder of the Nourishing Autism Collective, and as an autism sibling herself, Brittyn brings both professional expertise and personal understanding to her work. She empowers families with her expert guidance, helping children receive essential nutrients for optimal health and development. Her strategies are tailored to the unique dietary needs and sensory preferences of each child.

Brittyn's influence extends beyond her membership site through her active social media presence and her popular podcast, 'Nourishing Autism'. Her educational content on Instagram, YouTube, and other platforms has established her as a leading voice in autism nutrition, providing valuable resources, practical advice, and a supportive community for parents and professionals. 

Brittyn Coleman, MS, RDN/LD https://www.autismdietitian.com
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