Guest post: "Food refusal in children isn't anyone's fault"
Birmingham Food Refusal Services
Posted on: Mon 01-Feb-16 16:03:10
(76 comments )
Hannah was lucky with her second child, Emily. She fed well, slept well and rarely cried. She would make a face, of course, when offered strong, bitter or sour flavours, but she would happily try them a second time and quickly grew to like a wide range of tastes. However, Hannah's first child, Molly, was entirely different. It wasn't anything that Hannah did or didn't do - Molly was just born with a different way of reacting to the world.
Molly was difficult to feed from the beginning. She fussed at the breast, wouldn't sleep, and cried all the time. Any tastes of foods were spat out. She learned to turn her head away when the spoon approached. Mealtimes became a source of terror and stress for Hannah. She struggled on, relying on one flavour of fromage frais, dry crackers and grapes. This pattern continued for some years, until Hannah came to see me.
The problem was made even worse because when Molly was at nursery school, she would eat the small sausage that they often provided for lunch. She would not eat this at home, even when Hannah begged the school for some of their sausages to take home to cook. Home was home, and school was a totally different context. Hannah was blamed by both relatives and nursery staff for her poor management of Molly's eating behaviour. But it wasn't just her eating that was the problem. The noise of the vacuum cleaner terrified Molly, she screamed if her hands were dirty, refused to get into the shower and had to be bathed in a bowl in the bathroom. Hair washing was almost out of the question.
Molly would now be diagnosed with the new Avoidant/Restrictive Food Intake Disorder (ARFID). This describes children, and adults, who have such a restricted diet that their nutritional needs might not be met, although they might be consuming enough calories to meet their growth needs. These children might rely on as few as five foods to make up their entire dietary range.
All children go through a fussier stage as well: the neophobic stage, starting around age two. In some ways ARFID is a continuation of the neophobic response; no new foods are eaten and anything that looks slightly different is rejected on sight.
This very restricted dietary acceptance is strongly related to sensory problems. These children have not been able to dampen down their response to incoming sensory information. Everything they taste, touch, hear and smell leads to sensory overload; sitting in the dining hall at school can be unbearable. This acceptance disorder can usually be seen from the very start of feeding, but more often it really begins to show when the infant is first given textured solids. These are foods that might have to be moved around to the side of the mouth as they are eaten. The sides of the mouth are very sensitive to touch and food moved there will feel quite uncomfortable. Because of this, many children who are oversensitive to touch will only happily accept smooth foods (such as yoghurt), or foods that quickly melt in the mouth (such as chocolate buttons).
The disorder in its extreme form is most frequently seen in children on the autistic spectrum, as they are more likely to be hypersensitive to incoming stimuli. Because we do not yet have a good way of assessing this disorder, we do not really know how many children are affected. My rough guestimate is usually 'one child in every school'.
There are of course many children who are mildly fussy, but not so much that they would be given a diagnosis of ARFID. Some people are sensitive to bitter tastes; others are prone to dislike beetroot or coriander. Some children are mildly hypersensitive and will be happier with foods that are not 'lumpy', or just with finger foods. There are innate differences in the extent to which children will accept foods of certain textures.
All children go through a fussier stage as well: the neophobic stage, which starts around age two. During this stage children will refuse food on sight without having tasted it, which is thought to be of evolutionary benefit to avoid poisoning. They will also refuse food that they might have eaten before if it looks slightly different. Most children gradually grow out of this stage, and by age five are quite happy to try new things. In some ways the eating disorder ARFID is a continuation of the neophobic response; no new foods are eaten and anything that looks slightly different is rejected on sight. Even toast of the wrong colour will be turned down.
Some children are easy and responsive to food cues and not oversensitive to sensory information. Others are reluctant to try new things, restricted in what they eat, and have a real fear response to new foods. Although it is a good idea to offer as many different tastes and textures as early as possible, this just does not always work well with sensory sensitive children. It is not the parents' fault; it is not the child's fault: it is just down to genetic diversity.
Dr Gillian Harris has spent the past 30 years working as a consultant clinical psychologist running a clinic for extreme food refusal and carrying out research into food acceptance and rejection in childhood at the University of Birmingham.
By Dr Gillian Harris
My first DD was just like this with food, and my second DD ate everything!
DD does not have autism or Asperger's, but she was always very sensitive to fabrics, especially with elastic or labels.
At 18 she is still very fussy with food. I blamed myself when she was little, but couldn't understand why my second child ate normally when I had treated them the same.
Thank you Gillian, I have a child like this and it took me years to work out it wasn't my fault.
Thank you for your post Dr Gillian Harris
My ds is a 'food refuser' and somehow manages to thrive on a very restricted diet. I can remember the angst and all the things I tried to broaden his diet as he slowly refused more and more things. It was after seeing you on TV that I felt a bit vindicated, and started stressing less! He's alert, growing and learning. We have an occasional success with a new food and I try to find creative ways to introduce new foods, tastes and textures. It remains a very poorly understood topic though and there doesn't seem to be much direct practical help.
A brilliant post, and my guess is that some children fall somewhere between 'normal' and this. My son wasn't / isn't as extreme but I recognise a lot in what you've written.
My sister and I were similar too. My sister became a veggi at an early age and is still one (who eats everything) and I now eat everything (pretty much) - but probably not until I was in my late 20s.
Stop the pressure and guilt tripping please celebrity baby food chefs. My husband has found it very hard not to worry endlessly (as he ate everything from the word go).
Great post - thank you. I recognise a lot in what you describe. Ds (age 4) is a food refuser and does seem to have sensory issues (have to cut all labels off clothes) while dd (age 2) eats or at least tries everything and is very relaxed in general.
Hoping ds will grow out of it...
Tokulau, your DD sounds exactly like my 10 yr old. She had reflux as a baby & has eczema too - I believe the reflux (very sensitive with her gag reflex & could vomit v easily) impacted her food range as she wouldn't tolerate textures when we started on solids. She went on to become hyper sensitive with clothing too - labels especially cause issues & everything 'itches', again because of her eczema (and for the most part we have that under good control).
My DD has a v limited diet & its shrinking all the time. The few things she will eat, she's going off v quickly if she eats a meal that has something that 'offends' i.e. too hard/too soft/wrong colour/wrong texture etc.
I tried getting her into cooking classes to help her try new things but the class folded v quickly & there's very little else out there that caters for what I think we need.
I'm dreading her teens tbh, I foresee eating disorders if this keeps up, or some kind of health issues (obesity or being unhealthily underweight, or diabetes are my main fears).
I just wish there was easily accessible help/advice/guidance that goes beyond the 'keep offering new foods' advice.
I found the book "my child won't eat" very helpful and reassuring (and my mum!)
That was very interesting to read. My 7 yr old DS was diagnosed with ARFID last year. He also has ASD. He has made some progress recently (started eating toast for the first time, but has still never eaten untoasted bread), but has many sensory problems in regard to touch, taste, smell and hearing. In fact he has many similarities to Molly. Anything not of a crunchy texture has to be blended and spoon fed to him. Often people don't understand and think there is something else I could 'do' to encourage him. They haven't got a clue.
My third child has an incredibly restricted diet. No problems with milk (still his favourite ) but has been reluctant to eat food from the start. Showed no interest in solids until a good 7 months and then no spoons or feeding by me. Just refused. So blw by default.
He is now 4 and growing well. Looks healthy is active, engaged and very sociable.
Just has an incredibly limited and very unhealthy diet. On a maintenance dose of movicol but independent for toileting.
I have tried introducing new food and feed him with his siblings. He also eats in a group at childcare. No joy re new foods at all for over a year (unless it's a new brand of biscuit ). He is just not a hungry child and will quite happily and regularly eat nothing at mealtimes.
Longterm it does worry me. His nutrition must be terrible. Is he likely to grow out of it?
I'm pretty sure my DS1 had this. He refused to breastfeed, weaning was a nightmare, ate a very restricted diet for a long time. But at age 13 he's a lot better. It has been a long process and there are still foods he can't eat but he has learned that if he tries new foods then sometimes he likes them. I was so proud of him when he ordered pineapple fritters from a Chinese restaurant. He didn't eat them of course, but he was willing to try them. A far cry from the boy that only ate beige carbs of the correct brand.
I have one who wouldn't eat. Cried what seemed like all the time for the first six months, fought sleep, loud noises were a problem (hand dryers, hairdryers), won't wear anything but t shirts and leggings. The number of people though who do judge - you didn't offer enough variety, you didn't persist, you don't cook from scratch, you've spoilt them.
Mine too would eat things at school/nursery/childminders but not at home. We spent ages trying to emulate the school spaghetti bolognaise (which I think consisted of a square slab of fried mince with no sauce).
Still quite limited aged 10 but not too bad (eats meat/fish/cheese and vegetables/salad - just nothing with sauce). Never finishes a meal and still exasperates people when she goes round for tea. Some think they can "cure" her. I will get her eating this they say. Then get all arsey when she doesn't. She won't drink milk at all now, having been force fed room temperature milk by both a nursery worker and a TA who deemed her fussy.
I have to hide the threads on MN about fussy eaters generally, they wind me up so much. Very refreshing to see this actually, thank you. I used to be in tears over it on a daily basis.
The thing is when you have a dc who won't stop crying, won't sleep, won't eat - you really do start to question your parenting abilities. Why isn't this information more widely available?
"The thing is when you have a dc who won't stop crying, won't sleep, won't eat - you really do start to question your parenting abilities. Why isn't this information more widely available?"
Hooray! At long last, someone who understands.
<goes off to send link to SIL who always blamed me>
Thank you for explaining this so comprehensively, Gillian
My boys' diets are fairly limited, but thankfully not at the extreme end - they both have ASD. They also both suffer from migraines with cheese and chocolate as triggers, which rules out a lot of previously loved foods. They have very few accepted foods in common and DS1 is so disgusted by some of the foods that DS2 loves that mealtimes are rarely without drama. We have to give DS2 foods like peanut butter, yoghurt or rice pudding when DS1 isn't around, because just knowing they're in the room will send DS1 into meltdown.
I have a child with very restricted tastes (ASD). This post has really cheered me up after reading the other guest post a few weeks ago, the "fussy eaters are made not born" one, which was deeply upsetting. I too regularly have to hide fussy eating threads on MN because I am so tired of people saying "if they're hungry they'll eat" or "Mine always just ate what we ate". Well, if only it was that simple.
I so wish that I had read this when my DD, now 17, was little. Although she has never been diagnosed with anything she was a complete nightmare with food from weaning onwards, wouldn't sleep, wouldn't nap, cried for a whole year. I thought I would go mad, especially when everyone else's DC were so compliant. She still has food issues, but we just accommodate tem.
This is a really interesting and helpful post. While I'd made links to his reflux and severe croup, I'd never put together DS's food issues with his sensitivity to noise - he really struggles deal with loud noise, like at the cinema or at the theatre - so this explanation resonates a lot with me.
We are starting to see real improvement now, at age 4. I'm sure most of my friends still have him down as a terrible eater, but his repertoire is so much expanded, and he is now occasionally willing to try new things. There is hope.
Just like my boy. At 8 would puke in dinner hall at school if any1 even attempted to sit next to him with a pie/gravy/tomato type food (basically wet)
Lived of crunchie veg sticks, crackers, pasta, chips, crisps, tuna steak & chicken
He went to hypnotised last year for sensory issues/fear
After the 2nd visit he eat a steak bake!!!
Still not a fan of tomato anything but can sit next to, smell or touch any food. Will eat cooked veg and some fruit. Pasta with sauce. Sandwiches. Loads & loads now
Pocket, I can only imagine the relief you must be feeling!
Honestly. I cried & cried. He had sweetcorn that touched gravy on Sunday & I cried again!
I never thought I'd see the day, after 7 loooong, stressful, upsetting & extremely worrying years
I'd advise any1 to give it a go
A rugby playing iron man challenge 6 ft 6 colleague described only eating about 4 foods, mainly chicken nuggets, till he was 20 and went abroad and was forced to do so. Lovely chap, now a teacher.
And yes I read that post recently about children being made fussy. Bloody awful. Of course you can widen the experiences etc but just like taking a horse to water, you can't make them drink. Same applies for sleep too I'm afraid. Some just don't / can't/ won't till they're ready and that's normal and healthy and fine,
(Incidentally, researchers, mainly Helen Ball, at Durham have spent a lot of time looking into this. This is their now unfortunately named website https://www.isisonline.org.uk)
Pocketrocket31 I'm really interested to hear more about your experience with the hypnotherapist. Did you stay in the room for the sessions? What did they do? How did you find the right hypnotherapist?
My DD is exactly how you describe. Very fearful of food, has to be reassured about things she's eaten before but look slightly different/in a different context. Eg she will only have smoothies out of a pouch not a carton with straw or cup. And only certain flavours. Fruit not eaten otherwise. Increasingly restricted range of food choices. Very anxious about mealtimes and finds them very stressful even at home. Food at other people's houses very challenging.
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