Much ado about food
Eating fewer than 20 foods, constant gagging or a traumatic choking experience could point to a child who needs help to enjoy food, writes Serena Solomon.
A7-year-old who eats only five different foods plus chocolate and lollies. A mother who follows her 2-year-old around the house with food because it is the only way she can get him to eat.
A 6-year-old who brings his full lunch box home from school and struggles to eat dinner.
A child with Autism Spectrum Disorder who eats a limited variety of food because of the sensory overload of smells, textures and tastes at mealtime.
These are all real-life examples of children who needed intervention to sort out their eating. It is a wide variety of case studies with an array of causes – if a cause even materialises – demonstrating just how difficult it is for parents to determine whether their child is just fussier than most or if something more sinister is at work.
At about the age of 2, almost all children go through a period when they regress in what foods they will eat, according to Rebecca Barnard, an occupational therapist at the Christchurch-based Nourish Feeding Therapy.
One in 37 will kick it up a notch and experience Pediatric Feeding Disorder, a broad term that covers children up to the age of 17 whose eating isn’t age-appropriate, such as sticking to fewer than 20 foods or refusing anything that isn’t a puree long after the baby stage.
A pattern of limited eating that lasts for months could be triggered by an underlying medical issue, such as allergies and constipation, forging a connection between pain and eating. A child could lack the skills to chew and swallow food. Trauma could be lingering after a choking incident.
‘‘Rarely is there just one thing making food challenging. Multiple factors are at play,’’ wrote Barnard in an email to Stuff.
Some of the markers of a child who needs professional help is being underweight, malnourished, constantly tired, or regularly constipated, says Dr Sarah Leadley, a psychologist with All You Can Eat in Auckland. Being overly particular about food being cut a certain way can lead to them becoming hysterical when offered new food.
To help parents take stock of their child’s eating, Leadley has a checklist of eating behaviours that might indicate help is required.
A difficult eater can put pressure on parents and siblings.
‘‘If parents are feeling high levels of stress around mealtime, if they are dreading the next meal, that is a sign to reach out for help,’’ she says.
When children arrive at Go Glow in Palmerston North, their parents have likely tried everything suggested by Google and more to get their child to eat a typical diet.
They have also received plenty of unsolicited advice from family members or other parents, including comments such as: ‘‘If you let them get hungry enough they will eat, or you’re spoiling them or you let them get away with everything...’’ says Rachel Fletcher, an occupational therapist at Go Glow.
‘‘No amount of being hungry or behaviour interventions will overcome the fact that it hurts when [the child] eats or they have that negative association from the trauma of choking,’’ she says.
Aparent in The Catlins said she has been overloaded with misguided advice since her 7-year-old son’s eating changed drastically at age 2 after he had croup. Her son went from a typical eater to a diet grounded in dry, bland, crunchy food, such as crackers, plus sausages, chicken and yoghurt occasionally. He eats no fruit or vegetables.
‘‘The problem is the perception that he is fussy and if he was hungry he would eat,’’ she said, ‘‘but he would prefer to starve.’’
The mother took her son to 2Bites, a Dunedinbased service that is run by Siobhan Mckinlay, a speech and language therapist who specialises in feeding, and Sophie Nation, a registered dietitian.
With tricky eaters often gravitating towards crunchy foods, freeze-dried fruit can be a small step towards regular fruit, as are crackers with trace amounts of vegetables. ‘‘Pea-flavoured crackers or tomato- or pumpkin-flavoured ones have been helpful in transitioning to the whole food,’’ Nation says.
Mckinlay encourages parents to keep offering their children an array of different foods even if it lands in the bin after dinner.
Parents role-modelling a balanced diet is important, as is keeping a regular time for sit-down meals that involve at least one parent with the child eating at the table. This should be done without distractions, especially screens.
Parents can guide their picky eaters on an exploration of food by discussing its taste, smell, and texture. Making a big ol’ mess should be encouraged and not wiped off straight away.
‘‘Eating is a learned process,’’ says Mckinlay.
‘‘It takes time and it takes skill.’’
Parents role-modelling a balanced diet is important, as is keeping a regular time for sit-down meals that involve at least one parent with the child eating at the table.