This article has advice for parents of children with very restricted diets. It was written in collaboration with Ailish Harrison, Speech and Language Therapist, and Jennifer Simpson, Dietitian.
Many children go through phases of being picky about food and this is normal. A fussy eater may not like trying new foods and may adamantly refuse certain foods, but they will still eat a reasonable range and grow as we expect them to.
A child with a restricted diet, on the other hand, will only eat a very limited number of foods, may not eat foods from each food group and can seem quite stressed and anxious around new foods.
A child with a very restricted diet could be considered to have a list of “safe foods”, which may include specific brands or foods prepared and presented in a certain way. Without their “safe foods”, a child with a restricted diet would be likely to just go hungry. A child with an extremely restricted diet may be reliant on supplements or tube feeding to support their nutrition and growth.
Children with extremely restricted diets may be diagnosed with a little-known condition called ARFID (Avoidant / Restrictive Food Intake Disorder). This is a relatively new diagnosis. It is different from other eating disorders like anorexia or bulimia, as it is not driven by issues around body image. ARFID can be difficult to diagnose as there are often to co-existing disorders, and a consensus between several health professionals is needed to give a diagnosis.
Why do some children restrict their diets?
First of all, it is unlikely to be because of something you did or didn’t do as a parent! Having a restricted diet is more common if your child has a history of another medical condition, if they were born prematurely, or if they are on the autism spectrum. We know that children with ARFID may appear to have a lack of appetite or interest in food, or they may find the sensory characteristics of food and eating difficult to manage. These difficulties are often present from a very young age. Some children with ARFID have a fear of the consequences of eating, such as vomiting or choking, and these children tend to experience a more sudden onset of a restricted diet as a result of this fear.
What can parents do?
There is lots of mixed advice out there for fussy eaters, and much of it does not apply to children with restricted diets. So, what does work for this group of children?
The most important thing is to stay calm. Having a child with a restricted diet can understandably cause a lot of stress and anxiety for parents and the wider family. But trying to reduce stress and anxiety at mealtimes is really important. Whatever works for you and your family to make mealtimes calm and fun, do it! Finding a support network of other parents facing similar issues can also be very helpful.
Offer your child’s preferred foods. Offering non-preferred food with no other options usually results in a child with a restricted diet eating nothing at all and becoming very anxious.
When offering new foods, try to find foods that are similar in one or more ways to your child’s preferred foods. Think about introducing new foods that your child could possibly tolerate, rather than a food that triggers complete disgust. You could also offer foods that your child had previously accepted and then refused.
Avoid forcing a child to eat, and don’t hide or disguise foods. If you hide foods in other foods, a child with a restricted diet is likely to discover this. That can mean that they stop eating their safe food, even when it isn’t “contaminated” anymore. Forcing children to eat tends to trigger anxiety and disgust, which are the enemies of a calm, relaxed food experience.
Reduce your child’s anxiety around food and mealtimes by:
- Establishing routine, as this is calming for most children
- Using distraction – some children need distraction to cope with the sensory experience of eating
- Increasing the fun
- Having positive conversations about food and positive interactions with food
- Cueing food/mealtimes in with songs and symbols
- Giving your child a sense of control by creating a visual list of your child’s accepted foods, and letting your child select from a choice of two items
- Managing the sensory environment. Eliminate any smells, noises, textures etc. that your child finds difficult
- Being careful about using reward systems. Non-food reward systems can work, but consider what you’re asking your child to do for a reward – is it achievable, or will it just end in distress?
Support school staff and other professionals working with your child to understand that restricted diets are more than just fussy eating. Work with the SENCO to ensure that all staff are properly briefed and understand the support a child with a restricted diet needs, including having preferred foods available. If your child finds the noises and smells of the dining hall overwhelming, alternative eating settings may need to be considered.
When will it change?
Supporting a child with a restricted diet can be a long journey and we can expect setbacks and bumps in the road, with general anxiety and sensory issues changing over time. Change tends to occur when the child wants the change, and their motivation to tackle their eating behaviour can increase as they get older. This is often driven by a social motivation to fit in with peers. However, this may not be a motivating factor for some young people.
So, how can you support your child to change their eating behaviour?
Start wherever your child is. Rethink your definition of success and have realistic expectations and realistic timescales. Your goals will depend on your child. You might need to focus on increasing your child’s calorie intake to help them grow, or you might be able to work on expanding your child’s range of preferred foods. Your end goal might not always be for your child to eat the food, but merely to tolerate other people eating it next to them, as that may increase their participation in social activities. Remember that every new food your child starts to eat is a win, regardless of its nutritional value! It shows that they felt relaxed enough to push their boundaries.
Break things down into little steps. We don’t just jump into new experiences that terrify us, we get used to them gradually. Exposure to non-preferred foods can be just that, exposure –not always eating. Photos of food, supermarkets, being near non-preferred foods – all of that is exposure and can be really tricky for some children with restricted diets. Touching non-preferred foods can be challenging, as can smelling them. Involve your child in food preparation or messy play with food, if they can tolerate it –it takes the pressure off eating, but allows for exposure. Do “science experiments”, and become curious about the sound, texture or look of foods in a playful way. Don’t give up if there appears to be no immediate impact on your child’s eating habits. Tolerances can change over time. Keep exposing your child to different foods in a fun and relaxed way, and it will be much easier for them to make the step to eating them when they are ready.
Make minor changes to preferred foods. By cutting the toast slightly differently or serving the cheese in a different shape, you can help your child to not get bored of their preferred foods, so that they won’t drop them from their diet. But make the change explicit and don’t change too many things at once!
Every child with a restricted diet is different and working out what works for your child and your family is key. If you think your child may have ARFID, or you want more support for your child’s restricted diet, talk to your child’s paediatrician or your GP.
Beat Eating Disorders: www.beateatingdisorders.org.uk/types/arfid
National Eating Disorders Association: www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid
Facebook support group for parents: www.facebook.com/groups/1188680687816813/