Food therapy helps picky eater

Kate Schonwald, 12, center, and her dad journalist Josh Schonwald try peanut butter during Kate's second session with occupational therapist Karen Dilfer, left, who specializes in food, in the Schonwald's Evanston, Ill. home on Monday, Dec. 2, 2019. (Camille Fine/Chicago Tribune/TNS)
Kate Schonwald, 12, center, and her dad journalist Josh Schonwald try peanut butter during Kate's second session with occupational therapist Karen Dilfer, left, who specializes in food, in the Schonwald's Evanston, Ill. home on Monday, Dec. 2, 2019. (Camille Fine/Chicago Tribune/TNS)

CHICAGO - The breakthrough bite took place about 30 minutes into treatment. My daughter Kate bravely raised a cracker to her mouth and, with little hesitation, took a bite. That cracker had cinnamon in it, a spice she hadn't tried in years.

Most parents have struggled with picky eating children. But Kate, my funny, ordinarily easygoing 12-year-old daughter, is an extremely picky eater.

She has never met a fruit she likes. She won't sit next to someone eating bananas, blueberries or yogurt. And she's so choosy about breakfast and lunch foods that for the past four years, she's been drinking Ensure, a nutritional supplement, for those meals.

That's what led us to seek the aid of Karen Dilfer, a Chicago-based occupational therapist who specializes in food therapy. There are many pediatric food therapists in the area who cover a wide range of issues - from infants struggling to swallow food, to preschoolers with sensory processing challenges, to teens with food-related anxieties - but Dilfer was one of a smaller subgroup of therapists who worked with kids similar to Kate: 7 to 18, often bright, well-adjusted, with no other special needs or medical issues.

Also, Dilfer comes directly to your home. Jennifer Dean, a Northbrook mom of an extremely selective eater, told me therapy with Dilfer has been transformative. Her son, Quinn, started with only 10 foods on his list, now has 20, and recently had a breakthrough. "He ate a ham and cheese sandwich at Subway," she said. "I was like, thank you, Lord."

I, too, longed to hear Kate call me from Subway rapturous about trying a new sub. Last month, we tried food therapy: an evaluation and in-home treatment.

Kate isn't eating mango quinoa salads just yet, but food therapy, even two sessions, was a great step for our family - and for reasons we never expected. Here are our most valuable takeaways:

Instead of focusing on what Kate didn't eat, Dilfer sought to understand why Kate has certain taste preferences, and then go from there. It was a glass-half-full view of picky eating.

Dilfer started with lots of questions - about goals, challenges, Kate's likes, dislikes, former likes, turning points, hardships, even our family food history. Another Chicago food therapist, Lindsey Lieberman, described this part of her role as "food detective."

Dilfer's questioning helped develop her treatment strategy, but it also gave us more insight into Kate's pickiness. After sharing some details from Kate's history with fruit, Dilfer observed that she likely has a hypersensitive sense of smell, which could be a reason for some of her aversions. Her dislike of fruits is also consistent with her taste profile: She favors "savory over sweet."

Dilfer demonstrated a method she called "redefine try it" on one of Kate's biggest needs: breakfast foods. The method looked, at first, like a lab examination of a cracker. Dilfer guided Kate through several steps - she looked, touched, smelled and listened to the sound of the cracker. After each step, Kate was asked to describe what she thought the cracker would taste like.

It wasn't until going through the pretasting process, gaining comfort and confidence at each step, that Kate actually tasted a cracker crumb. Although tasting just a crumb struck Kate as comical, that method has extraordinary success in palate changing, according to research.

After the crumb, Kate took a "mousebite," and decided she didn't like the cinnamon cracker. "If she says no to a food," Dilfer said, "that's fine. That's her right. That cannot be the end of the story. You have to say, it's OK, and keep presenting her with new options. That's the art."

The therapist recommends trying a combination method too. It's pairing a new food with a liked, familiar flavor, using dips and spreads. When Kate found a chocolate cracker that she was just OK with, Dilfer encouraged her to try spreads. Hazelnut? Butter? Peanut butter? She kept saying "no." Dilfer kept brainstorming. Finally, they stumbled on an approved option: chocolate and peanut butter on saltine crackers.

Her diet won't completely change overnight, but Dilfer's visit affected us more than expected. Learning more about Kate's perspective, and thinking differently about our role in feeding her has already made us more thoughtful, creative and relaxed about food.

Upcoming Events