How do I know if my child is just being picky or has a food disorder?
Children who are simply picky eaters will be “choosy” about their food – they will like one thing one day – then not like it the next but may go back to it from time to time. A picky eater can be cajoled, bribed, encouraged to eat a food – an SED child can’t! A child with SED would go for days or weeks and not eat no matter what you offered him – a trip to Disney? NO way! – he would rather starve! THAT’S the difference. If your child is eating less than 15 foods and nothing you can do will make him try new ones, then there is a very good chance he is struggling with a selective eating disorder.
What causes Selective Eating Disorder?
There could be many reasons! It may be that the child wasn’t exposed to many different types of foods between the age of 4 months and 2 years (this is the development stage when toddlers will try most foods and either decide they like or dislike a food but experts say that children have to be exposed to a food item at least 15 times before the child has subconsciously decided if they like it.
Another reason may be trauma – perhaps the child choked on something at an early age and the fear of choking on food (any food) has stayed with him! He then develops a phobia of trying ANY new food – Neophobia.
Perhaps the parents are picky eaters and the child has picked up their habits.
One of the most common reasons though is Sensory Processing Issues. When a child has heightened sensory feelings such as noise (doesn’t like loud noises) or visual problems ( bright light) itchy clothes on the skin etc….it could be that their taste is also affected – everything they put in their mouth may taste 100 times stronger than you or I would taste!
It could be textures as well – the “feel” of breadcrumbs in OUR mouths feels ok – normal – but to a child with Sensory Processing Disorder it could feel like he has several mountains in his mouth!
But I can’t understand why my child doesn’t enjoy food like I do?
No – of course you can’t understand because YOU are not the one suffering from the disorder! Imagine if someone put a plate of live maggots or worms on the table in front of you and told you to stop being stupid and eat it? What would you do? I suspect you would gag, possibly vomit and then get very upset when you were told you had to eat it or sit there until you do and if you don’t you would be given it for breakfast. Correct? That’s EXACTLY how an SED child feels!
Then on top of those horrific feelings – the child has to cope with the anxiety of not being “normal” – not being able to eat at parties etc. Worried about being ridiculed or not believed by certain people. The anxiety must be enormous!
Safe Foods: Children have their safe foods and they are usually the white or “beige” foods like Pasta, fries, bread, breaded chicken, biscuits, cakes and of course chocolate and sweets! Not a vegetable or piece of fruit in sight!
Some people think their children will survive ok on these things but what happens when they start dropping their “safe” foods?
That’s when things get serious.
Between 25-35 percent of typically developing children have feeding disorders, and up to 40 to 70 percent with chronic medical problems are struggling with issues related to feeding and nutrition. Health Professionals working in private practice, community and clinical settings have to learn to evaluate and treat or refer paediatric patients with extremely picky eating, often referred to as selective eating disorder (SED).
SED is a condition present since earliest childhood where a child whose linear growth is normal eats only a very narrow range of foods and refuses all others. Although a whole medical and eating history needs to be taken into account before diagnosing such children, some of the signs of selective eating include accepting 15 foods or fewer, omitting whole food groups, persistent gagging, tantrums at mealtime. Over a period of years, children with SED may develop an avoidance-reinforced anxiety associated with new foods. There may be anticipatory nausea (with sight or smell triggers), fear of vomiting (textures) or a fear of choking.
In 2013, SED was officially added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and renamed Avoidant/Restrictive Food Intake Disorder (ARFID).
Does selective eating exist in adults?
While little data on SED or ARFID has been published, it appears that it usually presents in infancy or childhood, but it can also persist into adulthood. In children and adults, ARFID may be associated with impaired social functioning and affect family functioning, especially if there is great stress surrounding mealtimes.
Is selective eating related to how parents feed their children?
Internationally recognized feeding expert Ellyn Satter states that the parent-child feeding relationship plays a great factor in the precipitation of food disorders, including ARFID. According to Satter, “severe feeding problems must be considered in the context of feeding strategies as well as in the context of the child’s medical and developmental history. Even when children contribute to ‘food intake disorders’ by being irritable, having medical and/or oral-motor problems, developing atypically, or showing extreme food regulation patterns (e.g. don’t eat much or eat a great deal), the parent-child feeding relationship is paramount.”
How we can help selective eaters?
1. Understand the signs of underlying issues such as GI disorders, food allergies, sensory sensitivities, oral-motor delays and refer to specialists as needed in order to provide more comprehensive support. For example, Melanie Potock, MA, lists the following signs that may signal a need to work with a behavioural therapist who specializes in eating disorders – Child Psychologists, Clinical Hypnotherapists, Occupational Therapists.
- strong dislike of messy hands or face
- gagging on specific textures on a daily basis
- preference for “squish and swallow” foods
- unable to keep food or liquid in mouth
- extreme fussiness at mealtimes
2. Minimize counterproductive feeding strategies such as forcing food and catering to demands, and work with parents to reduce stress at mealtimes. Help establish structure in meals and snacks and incorporate at least one food a child can eat in each meal and snack.
3. Encourage parents to trust the child to eat the amount and types of food he or she needs within the structure and choices provided.
4. Educate parents about food chaining— an individualized, non-threatening, home-based feeding program designed to expand food repertoire by emphasizing similar features between accepted and targeted food items
What happens if things get worse?
If a child has selective eating disorder and is eating just a few foods its very likely that at some stage he may get poorly (ill) and when children get ill they normally go right off their food. Most children will go back to their normal diet once they feel better but of course with children with SED there is always that danger that they will drop most of their “ safe “ foods ( ie the foods that they feel comfortable with ) I have seen this many times at my clinic and this is why I try to get mums with very young children to really encourage them to eat a really good mixed variety of foods from ALL food groups. I have treated children who have stopped ALL solid food and are simply just drinking milk and water
The other more serious problem of course is what this disorder is doing internally! Children are growing and developing for the first twenty years of their lives. Each internal organ needs good nutrition for it to develop so when a child doesn’t get a balanced diet and becomes malnourished – the organs are affected. I’ve known children become infertile (both boys and girls), have visual problems, teeth crumbling, osteoporosis (serious bone deformities) and much more. So, even though you may think “ this will never happen to MY child” – read this:
“My daughter now 19 years old, suffered from severe picky eating. She has only just stated eating proper food after seeing Elaine, she has been told she is going blind and the Opthalmic consultant has said it’s due to her not eating the right foods. As you can imagine I feel guilty – I blame myself – I should have got here treated when she was younger!”Jane Barston, Winnersh.
I have several testimonials similar to Jane’s above – its frightening how just being a picky eater can turn into something so serious. But it does.
A gastric feeding tube
A child who is failing to thrive
This can of course lead to failure to thrive and shut down of vital organs if they are not admitted to hospital to be tube fed gastric tube into the stomach) I’ve also treated children who have gone down to just two or three items of foods (usually bread, biscuits and chocolate!!) Naturally this mean they are getting no real nutrition and they become malnourished with deficiencies in nutrients, vitamins and minerals. This of course can lead to all sorts of ailments and illnesses for them in the future. One child has been known to go blind from malnutrition even though she was of a decent weight!! It is, quite honestly, or at least can be, an extremely serious condition.
Whilst therapy is available for SED sufferers, there are very, very few therapists who specialise in it. Finding a good therapist – working with them as a team (Therapist, mum and child together) is the best way to make progress.
For further information on therapy for your child with selective eating disorder please visit my website : www.focus-hypnotherapy.co.uk
Alternatively you can e mail me with a brief history of your child’s eating (since birth ) and any medical problems he may have had.
Remember – your child may be eating a “few” foods now – but what happens if he drops those very few safe foods? It really is important for your child to be treated for any food disorders asap.
I have clinics in central London and Woodley in Berks. I also offer Skype sessions for patients abroad or who live too far away to get to my clinics.
I look forward to helping you and your child.