Tube to Table Podcast: Episode 28: Doctor Dilemma

January 30, 2020

Posted in: Feeding, Feeding Tube Weaning, Tube To Table Podcast

On this week’s episode of the Tube to Table podcast, we are talking about the difficulties families face while communicating with their medical team during their tube weaning journey. Jennifer and Heidi sat down with Dr. Katja Rowell, the co-author of Helping Your Child with Extreme Picky Eating as well as a wonderful responsive feeding resource. Katja shares her experience working in a family practice and how she became so interested in the development of feeding as well as the importance of a positive feeding relationship for children. Dr. Rowell dives into what her role is now, how she is continuing to help families, and the importance of working with your medical team. They will discuss how to measure “success” while looking at the whole child and the importance of advocating for your child at the doctor’s office. She will share evidence-based information on where the focus should be when bringing your child to the doctor, as well as what questions to ask to effectively communicate with your team. 

You can download this episode from ItunesStitcher, Spotify, Google Play, or listen to it below:

Where did it all start? 

Dr. Katja Rowell initially worked in her family practice where she was seeing families who were often asking about feeding. Many physicians get into the field to help make an impact on children, but there is not a lot in their training about responsive feeding and feeding development across the lifespan, and how that impacts kids and families. 1 in 3 doctor visits are about feeding and growth concerns, but yet many physicians are unaware of the feeding struggles that are happening, or what that should look like. After learning more from her own parental experience and talking to a pediatric dietician, she found the Division of Responsibility and started to learn more about responsive feeding strategies. A lot of her information came from families and other responsive feeding professionals, but she notes that it is a huge problem that medical training does not review pediatric feeding difficulties.  

Why the panic? 

When the focus tends to be on the growth charts, there is a panic around the weight, which can lead a lot of physicians to focus on ONE parameter of the child’s wellness. When there is worry about where a child is on the growth chart, or concern with movement on the curve, physicians are often recommending non-responsive strategies and parents feel that they must “do whatever they can” to get them to gain weight. This can include restricting, pressuring, negotiating, etc. When there is a concern, the physician may not have the responsive strategies and therefore focuses on what they know. This leads to a medical and adult-directed approach, that could hurt a child’s relationship with food. Dr. Rowell references a study that looked at over a thousand of healthy children, and found that in the first 6 months, 2 out of 3 children made significant shifts on the growth charts both up and down. It is possible to see children cross percentiles that are perfectly healthy, and that’s where the focus needs to shift to the whole-child. It is crucial to look at their developmental milestones, sleep, energy, mood, eating, diapers, etc. This may be important  

What should you look at to measure “success”? 

It is important to have a conversation with your physician about how to assess health without looking at the weight only. As a physician, Katja shares what she encourages people to look at the whole child when assessing if a child is healthy. A few factors to look at include overall energy levels, happiness, how a child is functioning throughout their day, and their developmental milestones. It is important to look for changes in the child and if there is a sudden change in their energy or any signs of concern, talk about it with your doctor. It is also important that although physicians can listen to parents and reassure them when it’s appropriate, it is hard to reassure parents when they do not have the appropriate resources. Without the proper education, they may not be able to share all of the helpful information out there, especially with the lack of resources.  

How can we help? 

At Thrive, we work with a child’s physician and include them as a part of their tube weaning team. We encourage physicians to focus on other factors. Developmental progress is something that many doctors can look over when focusing solely on the weight. If a child is making significant gains and continuing to develop on a steady pace, it is a good indicator that they are doing well from a health standpoint. It is also important to look at the research regarding self-regulation. The literature suggests that a child’s ability to learn how to self-regulate at an early age is necessary for long-term development, and without that ability to learn it, their body does not understand what it needs to grow and develop. At Thrive, we do want to look at weight, and always include it as one of our wellness parameters, but we want to make sure physicians are looking at weight within the context of health including sleep, attention, mental state, etc. Weight is a piece of that puzzle, rather than the key to the entire progression. The answer is not to throw out everything we know about learning to eat, it is about focusing on what we know about typical feeding progression and applying it to the children who need it the most.  

A few tips to help you feel supported: 

Slow and steady: There is often an avalanche of strategies that can come along when there is a perceived or real problem. This can feel overwhelming for the parents, as well as the child involved. It is okay to take it slow and ask your physician questions along the way such as the possibility of waiting to try a new strategy or asking for the evidence behind a recommendation. 

-Be prepared: It is helpful to go into appointments with a list of questions you want to ask, or the points that you want to make sure you can make. Most physicians are willing to have this conversation with you, but making the time and coming prepared with questions can help facilitate that conversation. 

-Share your worries: It is okay to discuss your concerns or worries with the physicians, even if they don’t share those same concerns. Asking questions about why they are not concerned, or what the evidence is behind their growing concern. It may be helpful to ask for a longer visit so you are able to have a full conversation and feel that you have been able to share all your concerns.  

-Start a team dialogue: Rather than going in with the mindset that it is you vs. the medical team, focus on collaborating together and building a team to help your child succeed. 

Where can you find Dr. Katja Rowell’s resources? 

She is the co-author of the book Helping Your Child with Extreme Picky Eating as well as Conquer Picky Eating for Teens and Adults . You can also find more resources on their blog at as well as on Facebook and Instagram at: Extreme Picky Eating!