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

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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.

After reading some of the posts above, I've noticed some similarities.

DD wouldn't or couldn't breast feed, but loved her bottles of milk. She refused to move on from a bottle to a spout or cup until she was about two. If we offered her milk in anything other than her normal bottle, she would have a huge tantrum, and rarely had tantrums otherwise. She would be so upset that she would scream for an hour and then refuse her normal bottle as she was exhausted.

She had reflux as a baby and suffered with projectile vomiting. She screamed most of the time, and seemed to be in a lot of pain if we ever put her down flat.

I planned to make all her food when I weaned her, but she wouldn't eat it. The only thing that she would eat even a few spoonfuls of was powdered baby food that came free in my bounty pack. When she was about one she would eat smooth baby food from jars, but only three specific flavours. At two, she would still only eat baby food from jars for six month olds, nothing with lumps.

As she got older, the problem seemed to be more with texture rather than taste.

She was actually a very well behaved lovely child, who was very eager to please us. She wanted to eat like other people, but just couldn't. I never pressured her about food, but I did encourage her to try new things if she could.

When her little sister came along, it was wonderful to feed a baby who really enjoyed whatever I gave her. I couldn't get the spoon in fast enough for her!

Oh yes, DD doesn't like different foods to be mixed on her plate, she'd rather them even not touch each other. We joke that she should have a plate with sections like a baby, and she loved the idea!

Thanks pocketrocket31. We live in a rural area but there appear to be a surprising amount of hypnotherapists nearby from a quick google! I will ring round and see whether there is anyone with experience in this. It would be game- changing for all of us if we could help her. She's been difficult with feeding since 8 weeks old...

This post struck such a bell regarding my 8 year old.

I once changed the butter we used and for 8 months he then refused bread/toast. I immediately bought the usual butter when he said he didn't like the new one but it made no difference. He just couldn't eat it anymore, or didn't trust that it really was the 'nice' butter.

Never made that mistake again!

It seems to be a texture thing for him with most foods. He can like the taste but the texture has him retching. It's horrible and frustrating in equal measure.

His school lunch every day is a plain roll (he doesn't like the school butter or cheese!) and milk. And pudding if it's something he likes.

He did live on bread and yoghurt for a couple of years but we've managed to improve his diet a tiny bit. Each new food feels like a HUGE achievement.

Dunno what the point of my post is, but it's nice to write it down, and read that it's not just my DC. I knew it wasn't just him of course, but it's nice to have company iykwim.

His big brother is a different kettle of fish and will give anything a try so I know it's not a parenting thing - convincing others if that is the hard part!

Describes my almost 7yo DD to a tee. I have been certain all along it was sensory related because she also has issues with noises, smells, clothes feeling strange etc.

Hope this information gets filtered through to all health professionals asap, basically every health professions we have seen about DD (bar one or two), couldn't have given two shits about the fact that she was limiting her diet.

This bit totally, absolutely sums it up for me: "such a restricted diet that their nutritional needs might not be met, although they might be consuming enough calories to meet their growth needs." I was repeatedly told well she must be fine, she's not lost any weight...despite the fact she didn't gain any weight for 15 months. Yeah she consumed enough calories to meet her growth needs because I calculated how to get what she needed, out of the few foods she was willing to eat. Fortunately she mainly enjoys good health now after a few years of being ill nearly.constantly. I just hope the lack of nutrition won't have affected her brain development or bones in the future.

Dare I go and read the other thread linked to above, or will I end up frothing?

And it wasn't until I had a third child, that I became 100% sure none of it was my fault. Third one eats most things, just like my first child did. Although she has a few dislikes, just like every living being! Went through the tricky phase as described above around 2yo with any new foods, over it now and she has a decent appetite. Worlds apart from middle one. Goodness knows what I'd be like if the third had been the same as the middle one...

Rings a bell for my youngest. Reflux, lots of crying, fussing when BFing, several medications, poor weight gain. Doesn't sleep (now 3) and has an unhealthy love affair with a bottle teat.

Food wise I cannot complain at the range of foods (she likes chicken, avocado, banana, strawberries, crackers, cheese, Yorkshire pudding, broccoli, carrots, hummus, apples, ham, chips, etc etc so a large enough range) it is the amounts and the way they have to be presented in order for her to consider them. We get into situations where she complains of hunger, requests a specific food, I say no problem, give it to her in the desired way, and she will look at it, and say she doesn't want it and run away and hide. I leave it on the side with no pressure and she still doesn't go for it. She eats best if chop it all up into tiny bits and then hand her one bit at a time or place the tiny pieces one at a time on the table in front of her. I cannot get her to sit at the dinner table even if I accept she won't eat. When she does its the one or two fingernail sized pieces of food which constitutes a meal. No sauces, no mixed up foods, no mingling, nothing she says is 'dirty' or 'mushy' (I blame Bing for the last one)

I don't pressure her, I don't talk about eating in front of her, we cook together, we try to eat as a family. I have an older child who loves nothing more than trying new foods in new restaurants or wandering round the World foods aisle finding new things to try. So I know it isn't me!!

More worried by the sleeping than the eating.

Thanks so much for the sensible, balanced post that will hopefully go some way to de-stigmatising children (and their families who really suffer)

My DS was a severe case of food refusal - couldn't even swallow solid food without vomiting and gagging until he was nearly 5 years old. I was so desperate to get him help and was repeated blamed by my GP amongst others. Of course he would drink milk, one type, one temperature, one container, one setting, so he was growing.

When I finally got appropriate help for him, it was like night and day and I was set free from all the angst that I'd experienced.

Now he's older, he has a big(ish) repertoire of hard won foods but it's take a lot of time and me having perfected the rhino skin to not give a toss about the harsh judgemental smug twats who like to blame me.

When he started reception he expressed interest in eating a few items from the school dinner menu, of course, I was absolutely elated but I was told categorically from the school that they would not be flexible on their "either school dinner or packed lunch" policy! So since there was no way he could eat a sufficient amount from a school dinner, I had to stop him from eating foods that he wanted. Because of course, he "would have to learn" and exceptions could not be made just because he was "picky" because there were other picky children, blah blah. AAGGGGHHH.

I have not heard the evolutionary theory - it all makes sense as there are children, like mine, who would rather starve to death than eat - it's like that protective instinct against poisonous foods has gone totally haywire.

I hide most threads on MN that are about food refusal and picky eaters because, as always, there are folks who categorically blame the parents and cannot hear that a child can be born as a food refuser or very picky.

My son (5) has a very limited diet. He eats pancakes, bread, cheese, breakfast cereal and some fruit, plus unhealthy things like cake, crisps, biscuits, ice cream and ketchup when given the chance. He won't eat pasta, rice, pulses, eggs, meat or fish. The only vegetables he will eat are fresh peas from the garden or the little beans inside French bean pods. In contrast, his younger sister will eat or at least try most foods. I will read the link with interest. DH is of the opinion that he would eat whatever he was given if he was hungry enough.

A great post. DD is at the fussy end of normal but is also very sensitive to other sorts of stimulation.

I don't know. I think what is being described here is a medically diagnosed condition which has to be managed in a specific way, and is "one per school".
That is something different to picky eating which is what the previous poster was talking about.
There is a spectrum surely? I think picky eating can be solved by parents but severe issues are probably a lot more difficult to manage.

I think my DD os somewhere in the middle with this. She has reflux and milk intolerance (still age 8).

She is hypersensitive to smell and will stop eating if you have eaten something she does not like and she can smell it.

She will eat any amount of sweet food but only bread, eggs, soya yoghurt, plain pasta, crisps, cheddar and some meat. She absolutely will not eat veg or anything that touches veg.

Some days she might eat pizza or a pasta with a tomato based sauced but then will often refuse the next time. The same with meats - one day she eats pork then she doesn't.

She used to eat oranges, bananas and grapes but now will only eat the occasional orange and a recently acquired taste for tinned pineapple.

She is painfully thin. And she absolutely will refuse to eat if she doesn't want to.

But I still cannot tell if some of it is just that she has decided she does not eat vegetables. If I blend them into food she will eat them if she does not know. some of it is she just cannot be bothered to stay still to eat.

I thought 8 was the magic age they grew out of this but she just gets more stubborn and more angry by the day.

PP who have actually accessed help for their DC, how have you managed it? I have constantly been told the usual things, "it's a phase", "she'll grow out of it", "a healthy child will never starve themselves" basically fobbed off. Any advice?

GenevaMaybe What do you not know?

The previous writer's theory was that picky eating/food refusal was learned behaviour or socially conditioned, i.e the parent's fault.

This writer says that there is a biological imperative to refuse food, especially around a certain age, i.e. that it's nature and not the parent's fault.

There is a spectrum of food refusers, of course, the "one per school" is the severe end of the spectrum. (Such as my child).

However the parent whose toddler self-restricts to 10 or 11 foods is still a parent who is living a nightmare and who is desperate for help, not blame.

As to getting help - it was 9 years ago, please god that Health Care providers are more knowledgeable now and less blaming (but from posters here, it seems not)

Here's what I did:
I documented everything. Videoed feeding, videoed food refusals, videoed him vomiting and wretching, I made a list of all the books I read, I listed all the professionals that I had consulted, I listed all the foods that I exposed him to and how I exposed him to them. I listed all the methods that I tried and I eventually refused to believe that I had somehow "done" this to my child when my other DC were adventurous eaters. I was really desperate and scared for my DS.

I finally got a referral and a team of professionals to help. We didn't get a diagnosis per se but with their help he learned to eat food.

PS - for those looking for help - I found the team that I wanted to be referred to (via recommendation from another parent), took my "evidence" to the GP who passed my evidence on to the team and they accepted the referral. So it was through the GP.

I also included a summary of son's history of eating and also video showing him eating in one setting but refusing in other settings.

Snafu, sorry if I was a bit vague. I meant I don't know if this post is helpful. First we had a (truly repugnant) post saying it's all parents' faults if children don't eat everything they are given. Now we have this post saying, don't worry it's not anybody's fault but a medical issue. Completely polar opposite and extreme views.

What might have been helpful is to have had a post somewhere in the middle, from an expert in more everyday eating issues giving useful tips and advice. It doesn't really matter whose fault it is, we should all assume it's not parents' fault but it is a real and emotive issue, and we could do with some guidance and advice.

I am saying this as the mother of a 16-month old who was very difficult to wean on to solids leading to many a tearful mealtime. She is much better now but still avoids lots of things and my floor is better fed than her on many an occasion.

I was lucky in that the OT I used to assess DS for SENDisT told me about a behavioural feeding clinic at one of the London Hospitals. I then had a job trying to persuade my GP to refer him, but in the end she agreed. It was the feeding clinic that diagnosed him with ARFID, but tbh, although I had high hopes, they haven't suggested anything that I haven't thought to try myself. They basically told me any improvements would be very small and not to have high hopes of him ever eating 'normally'.

When people say that new foods added to their childs diet have been hard won, can I ask the process followed to get the new foods added? I would like to add new foods but no joy.

He quite happily refuses food. All food if he doesnt want it.

Has a reasonable sized breakfast (dry breakfast cereal or at the weekend pancakes, waffles, crossiant or other product but no jam, milk etc).

Lunch is a wrap or sandwich. Either butter or marmite. Will eat yogurt.

Then tea. Is offered what his siblings get but separated eg pasta separate to sauce with grated cheese again separate. Am lucky if 1 piece of pasta gets eaten.

Then milk at bedtime (warm, has to be warm (.

So he fills up on carbs and then feels no urge to eat anything else.

With my DS, his diet has broadened a very little over the past couple of years, but any success I have had in introducing new foods has been as a result of different factors at different times. He enjoys eating packet foods, so introducing a new food in a packet (ie so there is something he is familiar with in the way the food is presented) has often meant he is more willing to try it. He would not contemplate taking a bite out of an apple, but did express an interest when he observed his siblings eating cut up apple out of of those little snack bags you get from supermarkets for packed lunches. As a result, he agreed to try apple and will now occasionally eat a bag even though he is not keen on the texture.

He used to eat completely dry toast and has still never had butter on it, but after he tried and liked marmite rice cakes, he was persuaded to try a scraping of actual marmite on toast (because the Marmite logo was familiar to him) and actually loved it and ate 4 slices in one go. I was overjoyed at that!

As he has got older, he is easier to 'bribe', so will often agree to try something for a small reward, even if he then says he doesn't like what he's tasted. He has never eaten any item of protein though without it being blended with vegetables, so a long, long way to go still.

Thankz zen. I have had some limited success with products that look similar as well. Mainly processed foods eg he ate a bit of a crumpet over christmas, which he viewed as bread. Will see if we get any luck with fruit in packets (he currently eats no fruit or veg but eats fruit flake things in packets).

Interesting to see bribery starts to work as well. At the moment there's no bribery and he wouldnt eat the pudding anyway.

At least we aren't the only ones!

I know, what is with the marmite? It's quite a strong flavour plus mega salt (although good on b vitamins). Ds loves marmite.

Only on bread, wraps or toast though. A friend recommended trying on pasta (licked it off and ate none of the pasta) on twiglets (big no) and general flavouring eg in hummus (puzzled looks all round).

My DH is still affected by this. Unfortunately when he was a child the "treatment" ranged from force feeding to physical punishment, meaning his issues were never properly tackled. He had hypnotherapy 18 months ago which took away the fear of trying new foods, but I beleive he is on the autistic spectrum and the thought of trying anything other than a small range of vegetables to add to his dry, carbon heavy diet is a real issue for him. It's definitely in part a sensory thing as he has issues touching things (like when the DC were little he couldn't do playdo or mix bread with his hands)
It is debilitating to a certain extent, we could never go to a dinner dance for example as we wouldn't know what the food was, fortunately things such as weddings our friends are very accommodating.

I do beleive that most children would grow out of it with the right treatment though.

Similar to Jasper my DD, and DH, has other sensory issues and even though as a baby/toddler she would reject many things she is much better now in her teens.

It's good to have this information now, hopefully it will filter through and help parents of food refusing DCs.