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.

[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!