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Juice Isn’t “Bad” and May Be Good For Children With Feeding Challenges

Juice Isn’t “Bad” and May Be Good For Children With Feeding Challenges

by Katja Rowell, MD | Nutrition Notes

Nutrition Note Series: Katja Rowell MD, Grace Wong RD, Jo Cormack PhD, Jennifer Berry OT Different foods or liquids can prove helpful for a child on their feeding journey. But a caregiver or clinician’s fear that foods are “unhealthy” or even “dangerous” can...
Nutrition Note: How Much Protein for Kids

Nutrition Note: How Much Protein for Kids

by Katja Rowell, MD | Nutrition Notes

Protein seems to be a common nutrition concern in pediatric feeding. Parents commonly worry that their child doesn’t get enough. Most parents greatly overestimate how much protein a child needs. One mother offered a perfect example. After a workshop, she...

Recent Posts

  • “Help! My preschooler is obsessed with food!” Food Preoccupation in Pediatric Feeding
  • Juice Isn’t “Bad” and May Be Good For Children With Feeding Challenges
  • Amy and the Magic Carpet: Assumptions in Pediatric Feeding Mean Missed Opportunities
  • Answering Your Questions: on “overfeeding”
  • Spotlight on: RFPro’s Jo Cormack PhD, MA MBACP

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  • Avoidant Eating
  • Discussion point
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  • Nutrition Notes
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responsivefeedingpro

Do you use this question (or a version of it) in y Do you use this question (or a version of it) in your assessment? Have the answers surprised you? 
Often it has little to do with food prep, playful utensils, or sensory adjustments and more to do with felt safety. 
From the original caption: 
Staying with this example of low appetite and children who “can’t” sense hunger, here are just a few examples I’ve heard of a child eating happily and beyond a few nibbles:
🧡 At a park after swim practice
🧡 At a special buffet restaurant
🧡 From a particular take-out place (this family served foods from the takeout container and it seemed to signal something positive for the child who enjoyed meals more that way)
🧡 A foster child who hardly ate until food was given to them in a paper bag from a coffee shop
🧡 At a friend’s house trying a new candy that was out after Halloween
🧡 At the buffet after a religious service
Often it comes down to felt safety. And that is signaled in different ways to different children. The paper bag was familiar, the child at the park was enjoying the novelty of a new place, or their body was relaxed after swimming, the child at the fund raiser was with friends and maybe the skewers were easier for him to manage...
And sometimes the answer is as much in what WASN’T happening as what was. 
❗️Realizing that the last time children did well with eating is almost never at the table with conflict and tears over a bite of non-preferred food or after kissing a food… that’s critical information towards a healing food environment.
#responsivefeedingtherapy #responsivefeeding #feedingdisorder #feedingtherapy #pediatricslp #pediatricdietitian #pediatricot #arfid
As I try to figure out how to work smarter and not As I try to figure out how to work smarter and not harder, I’m considering sharing reels that I (@katjarowellmd) make for parents here and adapting for the feeding and nutrition professional audience. 
How do you assess parent worry? How do you help reassure parents where you can? Where are you experiencing the most resistance? 
#responsivefeeding#responsivefeedingtherapy #arfid #pediatricfeedingdisorder #feedingdisorder #pediatricslp #pediatricdietitian #pediatricot
Hope this is a helpful resource. Reviews from firs Hope this is a helpful resource. Reviews from first edition available under the first edition. Rollout to some countries on Amazon takes time. This can also be requested at public libraries. 
#lovemefeedme #feedingtherapy #responsivefeeding #responsivefeedingtherepy #feedingtherapist #foodpreoccupation #intuitiveeating #nondiet #haes
How have you been able to flexibly meet the needs How have you been able to flexibly meet the needs of the parents and families you work with? Or wish you could!? 
#responsivefeedingtherapy #feedingtherapy #feedingtherapist #pediatricfeedingdisorder #arfid #pediatricspeechtherapy #pediatricot #pediatricdietitian
#Repost @laurathomasnutrition with @use.repost Mu #Repost @laurathomasnutrition with @use.repost
Must read for feeding and nutrition pros working with kids… my commentary on mast slide. 
・・・
My latest piece for my newsletter - Can I Have Another Snack? - is a trip down memory lane to *peak* clean eating, and although we don’t use the language of ‘clean eating’ any more, all the hallmarks are still there. And the influencers who popularised the concept? 
Well, they’re parents now. And they’re presenting a super distorted picture of what good nutrition looks like for kids and families, and making other parents feel anxious and guilty in the process.
In this piece I’m looking at the dark side of what happens when clean eating comes for kids, and how we get from fairy innocuous to really extreme in just a few clicks. And, well, it’s really fucking terrifying. 
Click the link in my bio to read the article - or go to laurathomas.substack.com 
#feedingtherapy #responsivefeedingtherapy #antidiet #feedingtherapist #pediatricslp #pediatricdietitian
“It’s not working” can feel challenging to h “It’s not working” can feel challenging to hear as helping professionals. ⁣
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🧡 Viewing it as an invitation to learn more, to get curious, to use that WHOLE CHILD LENS to learn about all the influences on a child’s eating opens up opportunities for healing and connection.⁣
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Do you hear “It’s not working?” ⁣
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🧡 Stay tuned for some examples of when a block or frustration led to further discoveries that helped children do their best with eating. ⁣
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Grace Wong RD has a great webinar on demand: Discovering the Mealtime Story. link to webinars in bio.⁣
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#responsivefeeding #responsivefeedingtherapy #RFT #RFPro #feedingtherapy #feedingdisorder #pediatricSLP #pediatricOT #pediatricdietitian
Tracking growth is important! Child Growth is an a Tracking growth is important! Child Growth is an app I recommend for feeding and nutrition professionals. ⁣
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✅ I like how it calculates Z-scores, and offers so much more information than the last app I used. Country-specific data and a user-friendly interface.⁣
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🧡 For more on growth and Z-scores and what they mean, check out my webinar What You Need To Know About Growth, and how many common misperceptions can harm children at responsivefeedingpro.com linkinbio⁣
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#arfid #pediatricfeedingdisorder #responsivefeedingtherapy #RFT #failuretothrive #weightneutral #pediatricdietitian #pediatricSLP #pediatricOT #feedingtherapy #feedingtherapist
“Healthy” is contextual when it comes to food “Healthy” is contextual when it comes to food and kids with feeding challenges. Does your marketing and social media imagery reflect this?⁣
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Is your content inadvertently contributing to shame parents feel around feeding and food? ⁣
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🧡 If the concept is new to you, check out our blog post, “Juice isn’t ‘bad,’ and may be good for your child with feeding challenges.”⁣
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#responsivefeeding #responsivefeedingtherapy #RFT #feedingtherapist #pediatricSLP #pediatricot #pediatricdietitian
Borrowing a reel I made for parents. How we frame Borrowing a reel I made for parents. How we frame  eating opportunities and think about food matters!  Helping caregivers let go of “shoulds” can open doors of healing.
#pediatricfeedingdisorder #arfid #feedingdisorder #extremepickyeating #avoidanteating #pediatricslp #pediatricOT #feedingtherapist #pediatricdietitian
Anytime we can reduce anxiety (appropriately, afte Anytime we can reduce anxiety (appropriately, after a thorough evaluation), families and children do better.  @allergykidsdoc  is a great resource. 
This reel shares their free webinar on decreasing anxiety around food allergies and anaphylaxis. 🧡 
#foodallergy #anaphylaxis #responsivefeeding #responsivefeedingtherapy
This wouldn’t have crossed my mind until I exper This wouldn’t have crossed my mind until I experienced it myself as a parent, and until several clients told me how terms like “little peanut” reinforced their fear and sense that they were failing. 
Something to consider. 
#responsivefeedingtherapy #responsivefeeding #RFT #pediatricfeedingdisorders #pediatricfeedingdisorder #feedingtherapy #pediatricslp #pediatricOT #responsivefeedingpro
Thanks for being part of the RFPro community! 🧡 Thanks for being part of the RFPro community! 🧡⁣
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To help us connect and to learn from each other, we are offering an opportunity for anyone who has ever registered for an RFPro webinar or been part of Jo’s EAF programme.⁣
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𝗪𝗵𝗮𝘁 𝗶𝘁 𝗶𝘀: ⁣
Jo and Katja will host a live, free Zoom chat. We hope to offer monthly sessions, with guests down the road. Each session will have a loose theme, and no “lecture.” The floor will be open for Q&A and discussion among participants. To foster discussion, sessions won’t be recorded.⁣
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𝗪𝗵𝗼 𝗶𝘁’𝘀 𝗳𝗼𝗿: ⁣
Anyone who has attended a webinar or been part of an EAF programme will receive a separate email invitation to sign up.⁣
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𝗙𝗶𝗿𝘀𝘁 𝘀𝗲𝘀𝘀𝗶𝗼𝗻: January 16, 2023, at 3 pm ET (New York); 8 pm London time; and 07:00 am Sydney time (this is January 17!)⁣
Theme: Autonomy⁣
Duration: 1 hour⁣
Price: Free⁣
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✅ And… if you’d like to attend but haven’t signed up for a webinar yet, use the code 𝗔𝗟𝗟𝟭𝟬 through 12/12/22 at checkout for any of our 10 on-demand webinars! Link in bio and at responsivefeedingpro.com⁣
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#responsivefeeding #responsivefeedingtherapy #RFT #pediatricfeedingdisorder #PFD #ARFID #pickyeating #selectiveeating #avoidanteating #pediatricSLP #pediatricRD #pediatricOT #feedingtherapy
In November’s AOTA magazine 𝘖𝘛 𝘗𝘳𝘢𝘤𝘵𝘪𝘤𝘦, RFPro team member, Heidi Liefer-Moreland SLP, coauthored, “Responsive Feeding Intervention: Impacts on Mealtime Engagement and Skill Development.” ⁣
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The article (co-authored by Alyse Biscan, OTD and Lauren Foster, OTD) describes the responsive tube wean program @thrivewithspectrum pediatrics through the case of Baby G. ⁣
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G is a 9-month-old with a complex medical history, who had “failed” previous attempts to transition to oral eating from enteral (G-tube) feeds.⁣
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🧡 Baby G is a contented oral eater three months into the Responsive Treatment Program. ⁣
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Graphs are presented with meaningful outcomes in terms of skill and engagement:⁣
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 “Oral motor skills are not the target of intervention. Instead, as children feel more comfortable eating, their oral skills progress at a rate that is appropriate for their level of development... Therapists collect data on oral and self-feeding skills as well as other behaviors, such as initiating eating and enjoying mealtimes. The goal is for mealtime to be not only positive for the child but also a joyful time for the entire family. After the 10-day intensive period concludes, therapists provide in-depth support and coaching with the families on an on-going basis during the span of 6 months, or until discharge is determined appropriate.” ⁣
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🧡 This article is a great step along the path to collecting data and publishing cases using Responsive Feeding Therapy.⁣
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It also addresses those who wonder if RFT is only appropriate for “mild” feeding challenges, or contend that RFT doesn’t pay enough attention to eating skills or volume and weight.⁣
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“Outcomes not only support the use of responsive feeding therapy among children with feeding challenges, but also fortify the argument for occupational therapy practitioners to approach feeding difficulties with a responsive lens.”⁣
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Thanks and congratulations to Heidi and her team @thrivewithspectrum pediatrics⁣
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#RFT #responsivefeedingtherapy #responsivefeeding #tubeweaning #pediatricOT #PFD #ARFID #pediatricfeedingdisorder #pediataricSLP⁣
Today’s study, “Three More Bites” is an obse Today’s study, “Three More Bites” is an observational study. Observational studies are methodologically valuable because they’re more neutral than studies relying on parent report (how data is collected in most feeding research). ⁣
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This study of parental socialization of children’s eating had a relatively large sample for this type of project: 142 families of children of kindergarten age. The sample was also socio-economically diverse, giving us a broad snapshot of feeding practices. ⁣
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The study reported:⁣
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‼️ Eighty-five percent of parents tried to get children to eat more than they naturally wanted. ⁣
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Given what we know about the negative impact of pressure to eat on children’s relationship with food (and their ability to regulate energy intake) this underscores how some SOCIALLY TYPICAL feeding practices are fundamentally MALADAPTIVE. ⁣
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What can we take from this? Here are some ideas. We’d love to hear yours in the comments.⁣
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✅ Assume that pressureful practices are almost certainly being used, even if parents don’t view them that way.⁣
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✅ Assume that parents’ almost always see it as their job to ‘get the food down the child.’⁣
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✅ Recognise that pressuring children to eat is socially acceptable, and what most parents are doing. It is wrong to judge parents for this.⁣
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🧡 It can help to share this stat with parents, to help us walk that fragile line between addressing unhelpful practices, and what may be perceived as blame (and shame): ⁣
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“It’s totally understandable that you tried different ways to get Lucy to eat a few more bites. Research tells us that 85% of parents do the same. And while it may have helped get a few bites in here and there, over time research tells us it backfires. It sounds like that is what you’re describing.” ⁣
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Orrell-Valente, J. K., Hill, L. G., Brechwald, W. A., Dodge, K. A., Pettit, G. S., & Bates, J. E. (2007). “Just three more bites”: an observational analysis of parents’ socialization of children’s eating at mealtime. Appetite, 48(1), 37-45.⁣
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#responsivefeedingtherapy #RFT #pediatricfeedingdisorder #PFD #pediatricOT #pediatricSLP #pediatricRD #pediatricdietitian #responsiveparenting #responsivefeeding
Commonly with food preoccupation, a worry that a c Commonly with food preoccupation, a worry that a child is or will become too big, that they eat too much, or the wrong kinds of foods, leads to non-responsive feeding in the form of restriction. ⁣
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🛑 Research is clear that trying to get kids to eat less or different foods is likely to backfire.⁣
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Addressing our own weight bias, and helping parents address theirs, is key to helping parents resist non-responsive practices/restriction and feed children in a responsive way.⁣
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And most of us working in the fields of pediatric nutrition and feeding have only been exposed to a weight-centric model of care, and steeped in our fat-phobic cultures. ⁣
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🧡 Be kind with yourself if these are new ideas. ⁣
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🧡 Follow your dissonance into new areas of listening and learning. ⁣
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I know that it took me a few years of listening, reading, and challenging my upbringing and training to conclude that a weight-neutral, responsive approach was 1) more effective at promoting health and wellness 2) more loving and compassionate 3) felt better as a practitioner (versus judgment, blaming, and shaming parents).⁣
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If you missed the food preoccupation webinar, you can purchase a recording on-demand (links to edited recording go out this week).⁣
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#haes #weightneutral #antidiet #responsivefeeding #responsivefeedingtherapy
“When caregivers misinterpret their child’s re “When caregivers misinterpret their child’s refusal to accept food as a sign of poor appetite, rather than a signal for autonomy, the mealtime may become stressful, potentially leading to the child’s feelings of frustration, inattention to internal cues, and lack of interest in communicating those cues to the caregiver.”⁣
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Black MM, Aboud FE. Responsive feeding is embedded in a theoretical framework of responsive parenting. J Nutr. 2011 Mar;141(3):490-4⁣
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This reel reviews some of the many reasons why children may appear to have a “low appetite” and why autonomy and a response to pressure should be considered when exploring why a child may refuse to eat.⁣
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#pediatricefeedingdisorder #PFD #pediatricSLP #pediatricOT #pediatricRD #responsivefeedingtherapy #RFT #responsivefeeding #ARFID
Food preoccupation is more common in children who Food preoccupation is more common in children who have experienced adversity. It is particularly common with a history of food insecurity and neglect. 
And food preoccupation is not uncommon in children being raised by their birth parents. There may be different factors at play, but underlying is a child’s anxiety and focus around getting fed enough, and regularly.
🧡 Early intervention specialists have a unique opportunity to help. 
🧡 Pediatric feeding and nutrition specialists are also poised to help adults help children heal their relationship with food.
At a minimum, those working with children should know how to not exacerbate food anxieties or make matters worse.
Food preoccupation webinar available November 14 live and after that on demand.
#responsivefeeding #fostercare #earlyintervention  #earlyinterventionspeech #pediatricdietitian #SLP #pediot
Don’t miss early bird pricing for the live webin Don’t miss early bird pricing for the live webinar with Katja Rowell MD on food preoccupation. For pediatric feeding and nutrition professionals. 
More info on webinars, link in bio.
If you’re unfamiliar, check out the blog post, link in bio and stories.
#pedifeeding #pediatricdietitian #haes #intuitiveating #responsivefeeding #responsivefeedingtherapy
This quote from Max’s mom could hold true regard This quote from Max’s mom could hold true regardless of the child’s eating differences or challenges; whether there is avoidant eating, or food preoccupation. ⁣
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Children are exquisitely sensitive to attention and comments around their eating.⁣
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Well-meaning comments and questions around intake such as:⁣
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“Check in with your tummy.”⁣
“What is your body telling you?”⁣
“Are you sure you need another pork chop?”⁣
“Just one tiny taste. You liked it last week.”⁣
“Carrots make you see better!”⁣
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... are likely to increase anxiety at eating times and provoke resistance. ⁣
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⚠️Instead of helping children tune in to their internal motivations of hunger, curiosity, or feeling full, attention to a child’s eating can further separate children from their bodies. ⁣
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They may try to guess what you want them to say or do (and really those comments and suggestions are almost always made to try to get the child to eat less, more, or different foods), or they may resist and push back.⁣
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🧡 Helping parents to identify this kind of “gentle” pressure or “encouragement” can go a long way to supporting the child’s autonomy, sense of capability, and internal drive to eat. And with less said, there is less to argue and push back against which can also bring parents and children closer. ⁣
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If children bring up the topic of tummies or what a food might do for their body, parents don’t need to shut down that discussion, but can explore with genuine curiosity. ⁣
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#pediatricfeedingdisorder #PFD #respoinsivefeedingtherapy #responsivefeeding #RFPro #responsivefeedingpro #intuitiveeating #haes #ARFID #pickyeating #foodpreoccupation
Responsive Feeding Therapy may be a very different Responsive Feeding Therapy may be a very different approach from what feeding and nutrition professionals trained in. (It was for RFPRo team members!) ⁣
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We are so grateful to help shape and share the transformative power of the RFT values in practice!⁣
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RFPro offers:⁣
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🧡 on-demand and live webinars⁣
🧡 blog posts, from reassuring around common nutrition worries to topics such as “instrumental no-pressure”⁣
🧡 ongoing small-group training with Jo Cormack PhD⁣
🧡 live speakers for your organization⁣
🧡 growing library of handouts for parents and even art for your waiting room!⁣
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We aim to offer training and tools that positively impact your work with the families and children you care about so deeply.⁣
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Anything we’re missing?⁣
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Webinar and blog links in bio.⁣
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#RFT #responsivefeedingpro #responsivefeedingtherapy #responsivefeeding #intuitiveeating #pediatricfeedingdisorder #pediSLP #pediOT #feedingtherapy⁣
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