Guest post: "Food refusal in children isn't anyone's fault"

[MumsnetGuestPosts]

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.

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.

[roosterroo]

Great post, makes you realise that it's not anything that you have done. My youngest is my fussy child - Dh is training as a hypnotist! Looking forward to seeing positive results. Apparently the lower age for hypnotherapy is around 5 years.

I have stopped fighting with ds2 about food a while back, I think he is one of the people who would starve rather than eat something that they don't want. I don't want his childhood memories of me to be about food!

[AdoraBell]

I was lucky in as much as my attitude to other people kept me sane.

DD2 had reflux, only breast fed for more than a few minutes the day we moved house and I had no formula. Then she was fussy about textures when weaning, also cried if her hands were dirty. Every time MIL someone told me where I was going wrong I said oh yes, okay I'll try that, but I thought ah fuck off she's my DD not a fucking clone of your's

Interestingly, the other family member who had reflux and trouble feeding as a young baby has just been diagnosed, as an adult, with ADD.

There are still things DD2 can't eat if she gets to texture, like mushrooms and beans. If she has cream on fruit there can't be any juice/syrup mixing with the cream and if it can't be done she will forgo the cream. She usually asks for seperate bowls.

I didn't see it as an issue, it's just DD2. But it wasn't nearly as bad as some DCs.

And just like DH she can't wear anything on her waist, skirts and trousers must sit on her hips and jeans are just out, she literally cannot bare the feel of them.

[MummyMatters]

This is my 8yo DD to a 't' and is such a stress on our lives. It took 2-3 days to get her to breastfeed initially and then she would vomit most of the feed, EVERY feed. When I tried to wean her as her Annabel Karmel cookbooks I thought I must have gone wrong as she would scream, gag, vomit and throw a hissy fit. At around 10 mths she began to accept a couple of the jars of Stg 1 food, nothing that I prepared myself. Each 'flavour' would last around 2mths before she would refuse it and then we would have to find a new flavour and oh so many yoghurts (petit filous only).

Mealtimes were always a battle, to the point that some friends didn't want to meet us for lunch because they found it too distressing, yay me! For a long time I managed to get her to eat fruit by having the Ella's kitchen fruit pouches but now she won't touch them.

Her list of accepted meals includes: fishcake and chips, plain pizza, garlic bread, pancakes with chocolate sauce, chocolate spread sandwiches, plain crisps, cake, dry cream crackers, fromage frais, chocolate milkshake and the occasional banana.

We are currently trying to work with school because she has only been eating 1 cream cracker for her lunch!!!

I have two younger sons (5 and 3) who used to eat well but are now copying their big sister, triple the stress. I tried taking her to a hypnotherapist last year but I don't think she was the right one. I am really tempted to try Felix at Great Ormond Street so would love to know if anyone else has tried him?

[tilder]

I have been talking to my mum about this. I was a fussy eater as a child (not so fussy as ds2) and have memories of sitting at the table when everyone else has finished. Trying to swallow but physically heaving.

Some food still turns my stomach. Apparently I ate vast quantities of rice crispies with milk. I don't really remember.

My diet is normal now. I like a wide variety of food, just normal. Although I don't really eat fruit (I find it quite acidic) and would still go for processed carbs. I also find that sort of food works best for my migraines.

I hadn't really thought before this thread. Maybe ds2 is a slightly more extreme version of me.

Another one with for the op and for mn.

The relief of knowing it's not just us. That I haven't failed my child. Will hold onto that next time mil is here!

[Dancergirl]

How old are your dc dodo? My dd is 13 and now at the stage where SHE is really fed up with her limited eating.

We saw a dietician recently who said her diet isn't TOO bad in the scheme of things, lacking in fruit and veg but otherwise fairly balanced. She discussed with dd some fruit and veg that she might be prepared to try. Dd was enthusiastic but 2 months on we've only had some success with red pepper (and a very small bit at that). But at least that's a bit of progress. But what's the point of her being able to eat a small bite of pepper when she wouldn't entertain the idea of pepper being part of a meal?

It's just such hard work and emotionally draining. Some days I just want to put my head in the sand, do absolutely nothing and hope it gets better with time.

[TheGreatSnafu]

That's really great to hear, dodobookends

[dodobookends]

My teenage dc has had something of an epiphany after reading this thread. A complete jaw-dropping OMFG moment, and a realisation that this is what they have been struggling with since babyhood.

Thank you Dr Gillian Harris.

[InTheTeapot]

I'm so glad there has been an alternative post on fussy eaters. Thank you MN.
My experience is similar to many. My eldest and youngest both were slow to breastfeed, fussed at the breast and had some sort of reflux issue. It was never diagnosed, in fact I was told with the youngest that it couldn't be reflux because she threw up more than a few minutes after finishing a feed. They both seemed to have problems keeping food down and would choke when they threw up which was incredibly scary.
Both then became very fussy at around 2 having previously eaten a wide range of foods. They have improved over the years partly through having school dinners- oh how I second the thrill it is when your child comes home and asks for bolognaise or a chicken wrap with sweet chilli sauce! like they had at school.
Middle child was so easy to breastfeed and eats a wide range of food, is adventurous and likes to try new things.
It has been so soul destroying sometimes to have food refused, to try everything to get them to eat and to be criticised by partner, relatives and Internet strangers. Reading the OP and the experiences of others makes me feel weepy with relief that it isn't me failing.

[whatevva]

The dinner ladies used to give DS mashed potato with grated cheese on top on a bad day. He liked fish and chips so Fridays were ok, and he liked things in custard, after trying it at school.

He did get better - we minimised junk and kept trying different ways of outwitting him, without making an issue of anything (must admit, we take the piss out of him at times). He is adult now and eats well but still cuts the brown bits off the edges of meat, and will drift towards high refined carb junk if left alone.

His refusal to do things has gone all the way through school with various things, so he does have problems elsewhere that this was part of (dropped out of uni and unemployed atm). He was also late talking, without any cause being found.

[Pocketrocket31]

Reading this thread brings it all back, I remember years of dry special k, dried cranberries and cows milk only.

[Dancergirl]

Thank you adorabell you are spot on. I know it's not my fault but it's so bloody frustrating at times. Dd takes forever to eat a meal and has to psyche herself up to eat a tiny piece of red pepper. We've all long finished eating. Sounds horrible of me but sometimes I can't bear to watch her eat

[Dancergirl]

Does anyone have any personal experience of the Birmingham service?

[blobbityblob]

Personally I found school dinners good. Mine is much more likely to try something because her friends are eating it and she's hungry.

She would come home some days having picked the sweetcorn off a pizza and eaten little else. But she'd generally eat something for pudding - maybe yoghurt or custard so she wasn't completely starving.

I did worry though looking at the menu. I thought she's not going to eat any of that. Several years later - she eats fishfingers (at school but not at home), spaghetti bolognaise (at school but not at home), jacket potato and beans. It sounds really bizarre but we went to a cafe when she was 9 and she asked for a cheese sandwich. Never before had she eaten a cheese sandwich. We felt normal that day. It nearly made me fall off her chair but she came home recently saying how nice her Chicken Korma had been that day.

It's just been a massively long haul for us. She's complained tonight that we've given her one of her three meals we sort of can rely on, AGAIN! I had that on Sunday.

[RaspberrySwitchblade]

DD is almost 9, she lives on squashy yoghurt in plastic tubs (can't bear to eat it from a spoon), cheese strings, sausage rolls, jacket potato, boiled pasta, butter and one brand of cheese that has to be grated.

if she's having a good day she'll eat chips and chicken nuggets, maybe an apple (if the texture is spot on)

i've been that mum at a dietary clinic who's papped off with the 'let her help you cook', but trying to explain that since she was a baby she bursts into tears at the smell of onions, hates the noise of stirring in a pan

she has dx of ASD, and we've been working with Outreach trying to get her to try to expand her range of foods.

Thank you for posting this

[tilder]

It does help to think it's not my fault. My other two eat normally, or normal for their age with some fussiness but nothing excessive and it's easy to deal with.

I keep hoping he will grow out of it. Maybe hunger when he starts school.

I was thinking about school dinners. We can choose each day from a meat option, veggie option or packed lunch from home. Helped my normally fussy child by expanding the range of food she eats. Not sure about ds2 though.

You're not waffling snafu. It's good to hear success stories.

[TheGreatSnafu]

Thanks, Geneva. I agree with what Polter said re the advice - most of the advice is things most desperate parents will have already tried and are sort of common sense type of things and come across as patronising when offered as advice. As you say, it's an emotive topic and it's easy to feel blamed when someone says if you just do XYZ then things will be better and many of us fall over with frustration because we've all tried XYZ about twenty million times. I'd rather not have advice given and I'm glad it wasn't offered here.

Also I think that just because the author posits that it is a medical condition that doesn't mean that children aren't going to get better or wouldn't respond to support and/or therapy. I didn't take it that way anyway.

And yes, Polter - you are right, it was probably serendipity more than anything else as to why we actually got help - I hope that my suggestion did not come across as "I got help because I tried hard to get help"- lots of parents try desperately to get help and never get any sadly. I really don't know why we did get help.

Also, the process that helped my son was 2 years long and in hindsight it was as much the fact that I had a team of folks supporting me as it was any specific therapy that they did for him, if that makes sense. They were really happy with teeney tiny progress whereas I would despair at lack of progress.

Gah, I do waffle.

Anyway, please, to anyone with a food refuser/picky eater, let go of all the blame and just do what you can to support your child, it's not your fault!!!!

[whatevva]

DS, who was difficult, never went through the phase where they put things in their mouth at about 10months. Whilst all the others were picking up unsuitable bits off dodgy carpets and putting them in their mouths, he was fiddling with the knobs on the audio equipment. He would not use his own spoon or tilt his own cup. Only happy being spoon fed bland sludge (and this took a while). He used to enjoy dropping food over the edge of his high chair table, and anything new would go flying. At 1 he was on only milk and breadsticks. At two, bread, milk, orange juice, bananas and fromage frais.

At 7, he said he would eat green beans when he was 8. When he was nearly nine, I remembered this and pointed it out to him. He remembered, and to give him credit, he did eat one, but gagged on it and nearly threw up. There was obviously a lot more going on with texture of food than you can tell from the outside.

DTDs were very different - used to take the food off your plate, and I remember desperately clearing up after a friends DCs birthday picnic, as they crawled around picking up all the dogends of half eaten food. (no use trying to pick up two determined 1 year olds)

[zen1]

Polter, I can absolutely empathise with the cafe thing. Ironically, DS likes nothing better than to go to a restaurant/cafe for food, but that is only because he knows we will take a good supply of rice-cakes, crisps and museli bars for him to nibble at. He only partakes of the food on the menu if a) they serve toast and marmite b) it is McDonalds and he can eat fries out of a bag. I would give anything for him to eat a fishfinger.

I truly believe that this is the way our kids are wired and there is nothing we could have done to to prevent it. DS had obvious sensory issues from a tiny baby, like phobias of water and lifts, when he was far too young to understand anything other than how they made him feel and he would react to them with terror. I have written before on the SEN children board that he never put his hands in water for the first couple of years of his life as the feeling of it was over whelming for him.

[AdoraBell]

I'll bet the reason you didn't offer "enough" variety was because it was better that she ate something without the stress on both of you than having battles resulting in her not eating.

There's a world of difference between a child who can't cope with food and a child whose parents CBA.

Hopefully now you can let go of that self judgement

[Dancergirl]

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

God yes. But I am also quite judgmental of myself. I sometimes feel terribly guilty that maybe it IS my fault and didn't offer enough variety as a baby.

[Ineedmorepatience]

Ginga66 The Birmingham food refusal service have a website! I know you can access the service privately but dont know if GP's can refer, you could ring and ask though

Another lady who works there came to talk to our Autism support group, it was brilliant to know that we are not to blame and that its ok to not traumatise our kids around food issues.

[Dancergirl]

What a relief to read this.

I've struggled for years with my now 13 year old dd with food. She breastfed well, no problems there at all, but she just didn't like food from day 1. She has been diagnosed with mild dyspraxia and associated sensory issues. She hated loud noises as a younger child which has got better but she hates hearing people eat. The sound and touch of polystyrene is also an issue but I imagine that's quite common.

She's now at the stage where she hates not being able to eat more and is embarrassed eating at restaurants with friends. We've seen a dietician who said her diet wasn't too bad in the scheme of things, she's seen a lot worse.

Do children grow out of this if no intervention is put in place?

[AdoraBell]

Gina maybe you should show your DH this thread. My MIL, who I now has reason to believe is either on the spectrum or has something similar gets so angry at children who "won't eat" that it used to put off my DD who eats anything in most situations, other than if Granny is around. Even now both of them are reluctant to eat when we see the ILs regardless of the venue.

Obviously try to get some professional help for DS too.