From the minute our children are born there is a huge emphasis on supporting their feeding. Parents are faced with the decision to bottle or breast feed. Mums may encounter difficulties with breastfeeding and change the mode of feeding with mixed emotions. Babies are regularly weighed to check development. Understandably, parents can start to feel an urgency to get food into their growing baby with a panicked sense of needing to keep them alive! Research has shown that when asked, 50% of mothers claim that at least one of their children eats poorly. Whilst nutritional intake is an important issue in infancy and early childhood because these periods are regarded as key to optimal physical and brain development, the anxiety caused from feeding difficulties can be tricky to manage. Mealtimes can become battlegrounds and parents can worry about the social impact of their children eating a limited diet.
Feeding difficulties are distinct from Eating Disorders which tend to develop and become more evident at a later age. Eating Disorders such as Anorexia Nervosa or Bulimia Nervosa tend to be characterised by ‘body dysmorphia’ (being preoccupied with a perceived flaw in appearance that is not apparent to others or a strong belief that there is a physical defect causing an ugly or deformed appearance) and related behaviours such as negative body talk, body-checking using mirrors or frequent weighing. These thoughts and behaviours are not associated with feeding disorders. Whilst feeding and eating disorders can co-occur and there is a lack of research regarding the relationship between the two.
Between 20 – 30% of infants and toddlers in the general population have feeding related problems. Feeding disorders encompass all spectrums of feeding problems ranging from a mild form of fussy eating to a severe form of food refusal which may be observed in children with Autistic Spectrum Disorders. Childhood feeding disorders can include food refusal, disruptive mealtime behaviour, rigid food preferences, parental concerns regarding growth and a struggle to learn self-feeding skills. Feeding disorders are most commonly seen in the first few years of life between 1-3 years. Recently, there has been a re-classification of early childhood feeding disorders under the umbrella term of ‘Avoidant Restrictive Food Intake Disorder’ (ARFID). Feeding difficulties were recognised as lasting beyond early childhood (6 years) though not falling into the classification of an Eating Disorder. Sensory Food Aversion is a Feeding Disorder whereby a child might refuse specific foods with specific tastes, textures, smells or appearances. The onset of sensory food aversion is often with the introduction of different types of foods and children continue to eat preferred foods. Children with Sensory Food Aversion tend to be very ‘picky eaters’. Fear of feeding can occur following a one off traumatic incident such as choking. This is more common in the earlier stages of weaning. Feeding disorders can be associated with medical conditions that compromise a child’s ability to swallow, self-feed or make feeding painful.
When children are poor feeders as babies or children, feeding and mealtimes can become an anxious time for both parents and children. It is very common for parents and children to become locked into unhelpful patterns of communication during mealtimes due to the anxiety caused by the eating difficulties.
Whilst it is easy to recognise severe ‘Feeding Disorders’ and ‘Eating Disorders’ what about the plain ‘picky eaters’. This might include children who are continuing to grow and develop well and are fairly happy at mealtimes but just show an above average level of ‘pickiness’. There are some strategies that parents can put in place to support their ‘picky eater’ at mealtimes.
- Involve children in meal time preparation. This may involve washing vegetables and where appropriate helping to chop up food. Research shows that involving children can influence their food preferences, attitudes and behaviour towards food. If you have a place where you can grow vegetables (even in pots) this can be a great inspiration for children to try their own grown vegetables. When they develop more of an interest in food they tend to be more willing to try new foods.
- Making sure that children have an appetite when they come to the table is important. This can be achieved by having a regular mealtime schedule with three healthy snacks in between meals (roughly every two to three hours). Children who ‘graze’ during the day even on milk, juice or a few crackers will be less hungry.
- Remember to turn off all screens both child and adult! It can be tempting to allow viewing at mealtimes or to check adult phones. However, this will pose a distraction to eating. Connecting as a family over a shared meal is associated with many positive gains. Research shows that it is associated with a healthy diet and improved overall well-being for children and teens. It promotes a positive eating environment for children. It also allows for family communication about the day. Try to eat together at mealtimes, however, if plans don’t allow for this try to eat a little something with them even if it is not a whole meal.
- Let your child set the pace. It can be tempting to try to get children to eat everything on their plate or ‘bribe’ them with a dessert in exchange for eating more of their meal. Children have a natural ability to self-regulate their eating response to internal hunger cues. This natural ability can be easily overridden by emotional cues or demands from parents which can lead to difficulties. Try to get into the habit of providing a healthy meal and allowing your child to decide how much they eat.
- Encourage independent feeding. Feeding in the earlier years may be a messy affair! This is okay, allow for food spillage and age appropriate mess which sometimes looks like playing with food. This will help your child to build a positive relationship with food.
- As much as is possible, try to all eat the same family meal which can be tailored to your child’s needs (i.e. they can have it all on their plate with a spare plate beside them to place unwanted foods). Children are naturally food neophobic (fearful of new foods) and this is an evolutionary trait to keep them safe. Children can require a new food to be presented to them up to 15 times before they will accept the new food. If parents get into a habit of only providing what is liked it can prevent a child from learning to like new foods.
- Try to remain calm. Whilst over dramatic praise is not always helpful at the table, make sure to pay attention to and praise the behaviour that you would like to see more frequently. When feeding difficulties are causing high anxiety, it is easy to move into a directive position as a parent. This can take the joy out of the mealtime and negatively impact on your child’s relationship with food.
- When children feel pressured to eat they do not eat well. If your child refuses a meal or doesn’t eat anything for 15 to 20 minutes, calmly remove the food and withdraw attention from the non-eating behaviour.
- Systematically introduce new foods. Provide some of your child’s favourite foods alongside one new food. If your child refuses a new food, offer just one bite of the new food without tricking, hiding or bribing or forcing. If your child continues to refuse after three attempts, do not pressure your child any further. You can attempt to reintroduce that particular new food in a few days or weeks. Remember it can take up to 15 times of introducing a new food before a child will accept the new food. Children’s food preferences also change over time.
Thankfully, most children labelled as ‘picky eaters’ have healthy growth and development. However, if you have concerns about your child’s eating pattern, including slow growth, weight loss and/or distress around eating, it may be helpful to get support from a professional. Managed early, feeding difficulties resolve more quickly; don’t be afraid to ask for help.
Dr Elise Kearney, consultant child and family psychologist runs a regular weekly clinic from The Fold Therapy Centre. Contact Elise for a free 15 minute telephone consultation. (Find Elise’s details here)
You can also find the article on The Families Magazine website