More Than Picky: Food Chaining with Cheri Fraker, CCC/SLP

Today I discuss my work with a seven year old child who was tube fed starting at age 4 months. He had years of therapy but did not make progress and even with tube feeds, weight gain was poor. I had to unravel his past, explore his prior diagnostics, win his trust and form a plan. In two years, we reached our goals with PreChaining and Food Chaining therapy, nutritional rehab and a comprehensive feeding team care plan. Want to know how we did it? Listen…

This one is all about how I do my therapy. I talk you through what you would see if you observed my sessions. I describe in detail how to triage feeding disorders, what to say and do as you start your treatment program, how to troubleshoot problems and avoid shut down. I describe what to say when as you start Chaining. I describe how to correctly design a Food Chain. Food education, surprise foods and anchor foods matter. Use the rating scales the right way. I also share with you all the how to's I have developed in my 37 years as a therapist. Food Chaining techniques work when implemented correctly. Learn how to support and lead a child through sensory exploration in your therapy sessions. Learn how to comfort and encourage them in creative ways that allow them to open up and put fear and aversion down. I talk about how to easily bring new foods to them. I also talk family care and I discuss trauma and fear and the wounds parents carry when their child struggles to eat.

Overcoming picky or problem eating or treating ARFID requires you to taste new foods. That is a tall order. It can be frightening just thinking about it. So how do you learn about a new food and try a bite and feel safe? How do you find new foods that you will actually enjoy? Food Chaining creates chains, the links from the foods you like to eat to new foods that are very similar. We stack the deck in your favor by having you learn to feel good while trying new foods in a new, systematic and safe way. New foods are selected that are very similar in taste, texture and temperature to the foods you eat every day. These modified foods are highly likely to be accepted because they are foods that you are highly likely to like. That is what this is all about, finding new foods you like over and over and over. This two part in one podcast is a detailed guide that is full of advice for the patient, the family and the therapy team. Try Food Chaining, form a plan, and change your eating gently and well. It will change your life.

(Note: Please do not do this if you have food allergies or swallowing problems) Part two helps therapist's set up an effective home program and additional instruction provided helps the patient try bites of new targeted foods at home. This self help program can supplement your therapy care plan for older kids, teens or adults with ARFID, extreme selective eating or years of picky/problem eating. What can you the patient also do to help yourself? How can you set up experiences at home to improve your sensory tolerance for new food? How can you feel good and safe when you learn about food with your senses? How can you put fear down? Improve your nutritional status? Can you see yourself successfully eating new food? I can! Find out how. Let's see how far you can go in therapy and at home. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This podcast is for YOU. The patient. The individual dealing with ARFID or extreme food selectivity. Picky has become a huge problem. Fear has climbed to a level that isn't healthy. Your nutritional status is a concern. Socially, it is hard to eat at a friend's house or restaurant, and holidays make you feel sick. There are a lot of problems, that is why this is so hard to overcome. Let me make it easier for you. Let me teach you the ONE skill you lack. Once you master that one skill, you too can change your life with Food Chaining. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

What do I DO in my therapy sessions? I find “the daily calm” and help the kids relax. I teach them how to learn about a food with their senses. I teach them how to crumb and achieve a test bite and then I teach them the varying motor plans when eating new foods. I teach them about the rating scales and developing advanced eating skills. We look at the few foods they may eat now and then, and we try to eat them more frequently, expanding the core. I help them learn to rate new food experiences in the real world. I respect those ratings. I respect their yes and no responses. We develop the skills in order to double the core diet over and over. It is fun, it is freeing and it works. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

Let's talk about Avoidant Restrictive Food Intake Disorder. There are several types of ARFID and Food Chaining can be a very effective tool for treating children, adolescents or any individual experiencing the challenges of ARFID. A customized Food Chaining program is a great way to change a life and open a child up to being able to enjoy new experiences with food. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

The feeding team evaluation and the oh so important first treatment sessions of the plan are discussed. This is the case history of a two-year-old born at 24 weeks. This child is a preemie grad with failure to thrive and aspiration of liquids. How do you start? Who needs to see the child? What does the home program look like? What other referrals do you need? Expand your team PreChaining therapy approach to meet the needs of the child and family. This episode is full of multidisciplinary ideas to add to your treatment program and I share ideas about how to expand the treatment program over time. Thanks for listening and Happy Chaining! --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

New without No! This podcast teaches the listener how to structure mealtimes, prepare the parents for their part following the home program and how to set the right tone at the table. This episode is full of tips to help you learn how to successfully offer new foods using a Food Chaining program. Sample Food Chains are discussed. I also discuss mastering the simple, elegant art of Food Chaining and expanding the diet with joy. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This episode discusses how to complete your evaluation and set up successful transitions to spoon and cup and stop gagging from occurring. You can let the child treat their own problem! Self directed oral motor is always the best plan! Let's talk about PreChaining! --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

Part 3 discusses advancing your Food Chaining program to more solid foods for the child who has no core diet. The 6 steps and principles of the Pre and Food Chaining programs are explained in detail. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This is a short episode and it is part 2 of our last episode about a three year old with only one food, applesauce pouches. This one is a discussion of how to start sessions and your home program and I discuss what foods to try. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This episode is about how to assess and treat a three year old child with only one food in the diet: applesauce pouches. How would a PreChaining/Food Chaining driven pediatric feeding team evaluate and treat this child and literally teach the child how to eat? Want to know what you should do in sessions? Find out! This podcast actually tells you what to DO. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This season will be all about cases. The Specifics on what to DO during a feeding evaluation and setting up child specific treatment plans. Diagnostic therapy helps a child be known. Then you can design the right plan, set the right tone and develop eyes that SEE. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

In this episode, I talk about the evaluation process, team care, building trust and developing eyes that SEE. I discuss what the parent needs to do at home and what the team should do. So how do you put the problem down to get things on track? --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

You want to try Food Chaining. But how do you get started? How do you set up a snack time in a therapy session? What do you do in the beginning? I have seen a lot of things online that are described as Food Chaining, but they are not using the program as we designed it. What fruits and vegetables can I try? How do I coach a child to learn the skill of trying a new food? This IS Food Chaining! The right way. The easy way. Check it out. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

Your evaluation forms matter! You will need a very detailed medical and nutritional history and the Individualized Eating Profile. The IEP consists of data from the growth chart, analysis of the three to five day food record, oral sensory motor age and patterns noted in the Food Chaining Intake Form. This information will help you fully know your patient and plan their customized and effective Chaining program. Take time to analyze the profile! It is vital to making good decisions in Food Chaining therapy. Write your reports using this important information. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

What are you doing to learn about Y-O-U. Who are you? You are the product. You are the resource that people are turning to and you need to understand how you learn, teach, counsel, guide and work with families or on interact on a team with other personalities. Do you communicate well with physicians? Expand your vision. The True Colors Assessment will be discussed. Are you green, orange, blue or gold? Let's find out! --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This episode addresses the issue of Nipple Confusion. Is it real? Or is it a preference? Or an oral motor problem showing itself in two distinct methods of feeding? Baby can't or won't take a bottle and mom has to return to work? This episode gives you ideas of how to help. Baby has taken a bottle but is now refusing breast? What do you DO? These are very treatable disorders. How can you build two great experiences? --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

NEC is a horrible and poorly understood disease. “The Why's “ behind it are hard for any medical professional to understand. We are still studying NEC and we need a lot more research. What is it? What happens? How can a therapist support a child and family? What does treatment look like? In NICU and at home? Learning about NEC made me a much better therapist and I have just scratched the surface of all there is to learn. We all have. The gut is a mystery and a vital core to our health. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

As Mary Massery would say, “if you cannot breathe, you cannot function” and she was right. Today's episode explains the respiratory conditions of prematurity and how they impact the lungs and breathing. Breathing is a foundation skill and is the priority of our early treatment. I also talk about some of the early feeding issues associated with RDS, BPD and MAS. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

How did Food Chaining start? What are the 6 steps of Food Chaining? How do you use the Food Chaining Intake form? Why are the rating scales so important? How do you start a diagnostic therapy program? I answer all of these questions. There are also many examples of Food Chains with many tips provided to get a child specific, customized Food Chaining therapy program going forward without stressing the child. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

Conditions of prematurity have lasting effects. If you work in pediatrics, with any child, anywhere, you are treating some preemies. Prematurity continues. What is IVH, an Intraventricular hemorrhage? Why does it happen? Prognosis? I give you information to understand what that means and the impact on the developing baby. I also talk about team based PreChaining therapy for children with PVL and hydrocephalus to give them a therapeutic life instead of a life full of therapy. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

What should you ask, how do you ask it, how do you interpret the information you receive, how do you communicate compassionately with the family, how do you give them bad news, what ARE the 911 issues, how do I recognize the red flags, when and how do you ask the doctor to address urgent feeding issues? Develop diagnostic therapy programs and gather information. Addressing medical and nutritional issues is key to your success in treatment. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

How can you as the CCC/SLP help the nursing mom, support the child and the family, work with the team and learn from the lactation consultant? Do you understand the benefits of feeding colostrum and breast milk and how that impacts development of the microbiome? What is the microbiome and why is it so important? How can you support the health of the microbiome? Do you understand the basics of breastfeeding and breast care? Do you want to pursue your CLC? How can you help the mom and baby have a successful breastfeeding experience? --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This episode teaches you how to do PreChaining therapy like an expert and fulfill your role well on a multidisciplinary feeding team. This is about the knowledge you gain only on the job, and only with experience. How do you do multidisciplinary PreChaining therapy and play Hot Potato well? How skilled are you? Do you understand the work the rest of the team is doing? Check and see! Let's look at how to DO this the right way. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This episode explains how to do a safe, informative feeding and swallowing evaluation and what to do when things do go “off the rails.” Product flow rate issues? Positioning issues? Pacing needed? Or is something much more significant going on? What is the root of many types of feeding aversion and how does it show itself in infancy? Aspiration fears? How do you comfort and educate the parents? What do you DO? --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

Sometimes a mistake can be your best learning opportunity. Cheri shares all she has learned from making mistakes and how having mentors around her helped her grow through those challenging times. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

Fear, dread, avoidance, nausea, pain, always choosing hunger over eating. Is your child caught in that trap? How do you get out? We have to take all thoughts into captivity and analyze them. We have to check our thinking. Are the fears realistic? I talk about treatment plans for extreme selectivity and ARFID. These are the kids that don't eat. Yet. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This episode focuses on the child who won't eat. How do you shape less than desirable behaviors into more positive behaviors? Is the child picky or truly selective? Is it even fair to call someone “picky?” What about negative, aggressive or dangerous behavior? Tantrums? Meltdowns? When do you need help? Ongoing refusal of food? It is more than picky. This episode is packed with suggestions to turn the tide, hear the SOS, help the child and the family and guide the child who won't eat. You can help that child become a child who will eat. With joy! --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

Some children can't eat, some won't eat and some just don't eat. Today, we talk about the children who can't, cannot physically eat, we discuss the anatomical reasons why they struggle, and how to develop team treatment plans to intervene. You must treat the child and support the family. It is possible to overcome these issues and get the child eating again. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

Help! The Holidays are here! This episode is full of tips to help you and your child have a great Thanksgiving. Travel tips, lodging suggestions, mealtime modifications, sensory breaks, calming breaks and other tips to help the day be as pleasant as possible. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

Did you realize that you actually treat the Suck/Swallow/Breathe sequence long term? With infants, kids, teens and adults? How do you develop POWER musculature for safe eating and drinking? How can you improve swallowing beyond just using thickening? What activities help build a respiratory system that supports oral feeding? This episode answers those questions and covers the first three months of treatment using team care and diagnostic therapy. Happy Chaining! --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This episode is about treating the child with special needs. Where do you start your treatment program for a child with special needs and the challenges of extreme selective eating? How do you make progress? Read cues? Tune in, and find out. Case histories are discussed in detail.   --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

It is estimated that 590 million people suffer from dysphagia. Dysphagia impacts infants, children, teens and adults. Acquired dysphagia will impact way too many people over the age of 60. Our Dysphagia Food Chaining therapy program is explained in detail. Multiple, specific food chaining ideas are shared, giving the listener foods to consider from all food groups. The complexity of advanced food chaining is evident. In regard to safety, the IDDSI and dysphagia chaining go hand in hand. Use of the IDDSI in treatment is explained. A case history discussed is about treating a patient with oral cancer and a hemiglossectomy. The patient went from only being able to eat three bland foods to enjoying high flavor, nutritious foods from all food groups. How did we do it? That is what this episode is all about. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This episode provides examples of clustered, brand specific food items to create initial food chains. In no way are these the only foods to accept. The American diet is addressed today. Specific, simple, easy to eat food chaining examples are provided because brand is very important to patients struggling to eat new foods. The goal is new without no, and new without fear. I also provide examples only, of some brand specific foods that are easier to eat from an oral sensory motor perspective. We need to find those first foods that the child is likely to accept. Examples of Food Chains for toddlers and children are described in detail. Quick chains are also discussed. I also provide tips for fun Food Chaining therapy sessions. Happy Chaining! --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

Cheri explains how to develop a Chaining program that is customized to each individual child, how to get started in treatment and how to have great, fun and effective Food Chaining therapy sessions. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This one is about working on the pediatric feeding team and your role as the SLP from your initial evaluation to the development of a very detailed treatment program. This is PreChaining 101 from birth to age one year. I also discuss how to see the big scary red flags and the all important signs of big anatomical TROUBLE. So jump in, let's learn about these extremely complex issues that lead to severe feeding problems and aversion. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This first therapy short podcast brings YOU in the therapy room with our team. You will hear what we do step by step in treatment. This podcast is set up to describe the session like you were observing treatment. All about the baby with dysphagia. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This episode addresses PreChaining therapy in the beginning phase and how to “script” children through those first bites of food. Treatment builds to help the child develop the complex oral sensory motor gymnastics of eating a wide variety of foods and drinking liquids. PreChaining is “Lather rinse repeat.” Patterned neuronal activity. Understanding how to eat based on the type of food presented. Tube feeding regimens, formulas, supplements and clean technique are discussed in addition to protecting the child from gastric aspiration risks. Resources for help with blended tube feeds are also addressed. *Be sure to contact your physician, Peds GI and pediatric dietitian for specific treatment suggestions tailored to your child. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This episode comes from the CDC website and covers information about cronobacter and risks for food poisoning. Detailed information is provided about how to safely express and store breast milk, how to mix and store infant formula, how to use, make and store baby food, how to safely clean baby feeding products and more tips for food safety for older children. This is part 1 with more on food borne illness next week! --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

Do you have the level of respect you need for the complexity of eating food? Do you understand why it is so hard and what to DO to help that baby struggling with bottle and gagging on a spoon? What is the child's feeding age? Is aversion rising? What should your first sessions look like. Help the baby see, smell, hear, feel and start to know how to eat. Safely and well. Respect this stage. Don't marry feeding to fear. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This episode reviews the PreChaining comprehensive infant feeding evaluation, discuses the volume of infant feedings, 0-6 month feeding skill development, suggests specific feeding products and talks about problems with gagging. Why does the baby have such difficulty transitioning to spoon feeding? There is a therapist's quiz at the end! Pop quiz! Oh happy day! --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

This episode discusses the beginning of aversive feeding patterns, starting in today's episode, with medically fragile infants. The feeding evaluation and instrumental swallowing assessment can be challenging. PreChaining therapy programs are also described. More on this topic later this week…. --- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message

--- Send in a voice message: https://podcasters.spotify.com/pod/show/cheri-fraker/message