Mary’s parents had every reason to be worried. Not only they were concerned over the limited number of foods she was eating: pizza, white bread, cheese sticks, blueberries and apples, this 6 year old also seemed genuinely disgusted by all other foods. After she gagged a few times and even vomited when trying spaghetti, the parents decided to look for professional help and learned that Mary was a resistant eater. After the thorough assessment by a team of health professional, including a doctor, speech therapist, occupational therapist and a dietitian, a treatment plan was developed and Mary’s parents learnt the strategies they could use when feeding her at home in between the visits to a feeding clinic.
There are many resistant eaters like Mary who need more help when learning to accept a wider variety of foods. In order to better understand how they can be helped, I interviewed an experienced pediatric occupational therapist Tania Hanson OTD, OTR/L, C/NDT, who is also the owner of Achievement Therapy Center and the co-author of Just Take a Bite: Easy, Effective Answers to Food Aversions and Eating Challenges!
Picky eater vs Resistant eater
Although there is no formal definition of picky eating, it is generally accepted that it is a developmentally appropriate phase in a child’s life which starts at around 1,5-2 years and lasts till the child is 5-7 years old. Division of responsibility in feeding helps successfully outgrow picky eating. Division of responsibility is the authoritative approach to feeding, when parents take the upper hand with meal structure and food choices while letting children decide what to eat.
But sometimes eating problems are more complicated. Just waiting for some children to be hungry enough to eat will not work because of the bigger emotional or physiological issues that make kids prefer to go hungry rather that eat something new. Eventually the list of their favorites gets shorter and shorter as parents become more and more anxious. Tania Hanson OTD, OTR/L, C/NDT who has been working in the medical and occupational therapy field for more than 20 years, explains that although there is no formal definition of resistant eating, we can identify it by certain characteristics that include:
1. Limited food selection. Resistant eaters often accept only 10-15 foods or fewer.
2. Limited food groups. Refusing one or more food groups is fairly common among resistant eaters.
3. Anxiety and/or tantrums when presented with new foods. Resistant eaters often gag or become ill when presented with new foods.
4. Experiencing “food jags”. Resistant eaters require one or more foods be present at every meal prepared in the same manner.
5. Resistant eaters are sometimes diagnosed with a developmental delay such as Autism, Asperger’s Syndrome or Pervasive Developmental Disorders- Not Otherwise Specified. Some of them may also have a diagnosis of mental retardation.
Improving feeding strategy is not enough
Switching to authoritative parenting style and using the division of responsibility is often not enough to help a resistant eater feed himself better. According to our expert, there may be contributing factors compromising the child’s ability to accept foods into his diet, such as:
- Inadequate oral-motor skills, when the child may not have enough jaw/tongue control to chew foods.
- Sensory processing skills, such as sensitivities to smell and taste that can influence food choices.
- Gastrointestinal factors can be a problem, when children refuse to eat the food that they associate with stomach discomfort or pain.
- Environmental controls. These may include parenting around food, such as allowing the child to graze throughout the day, so that he is not hungry for meals or tolerating inappropriate mealtime behavior.
- Medical issues such as food allergies or swollen tonsils/adenoid.
Parents need more help
Hanson says that multidisciplinary team approach should be able to help the parent look at all the factors that may be contributing to the child’s eating choices. Parents need to be supported, they need to understand that they are not alone. Having a team of professionals including school teachers and clinicians to refer to will help them develop a plan of action to meet the child’s needs.
What can be done at home?
Involving a child in food preparation has been helpful for children of all ages. Often kids are expected to eat a food which they know nothing about. Hanson often asks parents whether they would be willing to put in their mouths food that they know nothing about. Most parents say they wouldn’t. Hunson stresses that allowing their child to learn about the food outside mealtimes is very important. Incorporating fun, play-based interactions with food often reduces the child’s anxiety. Everyone learns better when they are not stressed. Just take a bite teaches parents how to introduce foods through the sensory stages of looking, smelling, touching, tasting and eating.
Besides, many parents are likely to introduce a food a few times and then give up when the child continues to refuse eating it, adds Hanson. Research proves that it takes 12-15 exposures to the food, and sometimes 12-15 exposures on every sensory stage such as viewing, smelling, touching and tasting the food, before the child accepts it into their diet. She recommends parents help their children keep a food journal. Children who cannot read yet can draw pictures of the food they are learning about.
When it comes to expanding food choices, Hanson recommends gradual changes to familiar food. Changing the food slightly by varying temperature, texture, shape or taste and involving the child in the process will serve as a stepping stone to accepting a wider variety foods.
Tell me, what are your biggest obstacles to getting your kids to eat well?