Understanding Feeding and Eating Disorders in Children
Assessing the underlying reasons behind "picky" or "selective" eating can be tricky when doing so independently. That is why, our therapists working as part of our eating disorders sub clinic are able to assess underlying reasons, provide psychoeducation and further support, intervention and direction as needed. The following provides a helpful summary of the complexity of feeding and eating issues in young and school aged children:
What is typical eating?
There is significant variance in the development of eating habits, amount of food consumed and the types of food consumed that would fall within 'typical' eating habits of children. Children's eating habits are also very different to adults therefore we cannot use the same criteria to compare.
Typical children's eating habits include the following:
- They may eat one food item at each meal rather than a mixture
- They may eat far less or far more than 'recommended' but still be healthy and developing appropriately
- They prefer carbohydrates such as bread, pasta (which is needed for fueling growth and activity.)
- Intake varies significantly depending on energy and activity such as during growth spurts or at times of illness
- There is a normal decrease in intake when leaving the growth spurt phase of infancy
- Children will refuse previously eaten foods and come back to them naturally on their own months later
- Learning to eat solids is a process that takes 2-3 years starting from approximately 6 months old (adjusted for prem babies)
- Children with developmental delays will take longer to learn to eat.
As a child develops they pass through a few developmental food milestones as described below:
Infants (6mo to 15 mo) – This stage is characterised by the transition to solids and self-feeding.
Toddlers (15m to 4 years) – This stage is characterised by 'Caution and control', it is a stage of developmentally appropriate picky eating. Children are learning that they are individuals and have some control over what they do (and eat).
Preschoolers and older (3-10 years) – This stage is characterised by 'Competence and Relationship'. At this stage children are motivated to please their parents, learn and try new things and feel competent.
How do I differentiate typical eating from feeding and eating disorders?
In order to differentiate typical eating from being something more, we can ask ourselves the following.
Are there emotional signs of distress around food??? – does the child cry or become upset around food, do they feel bad about eating.
Are there physical signs of nutritional deficiencies???- are they falling off their growth curve, do they have low energy or frequent meltdowns when hungry.
Are their social experiences impacted???- are they unable to go to or participate in social gatherings, sleep overs, restaurants, are they teased by their peers or getting excessive attention from family or teachers.
If you answered yes to any of these questions it may be worth further exploring your child's eating.
Why do feeding and eating disorders start in children?
Feeding and eating disorders can begin for a range of reasons as summarised below:
1. Medical – allergies, reflux, eosinophilic esophagitis (allergy related to erosion of esophagus), severe constipation, cardiorespiratory or muscular conditions effecting breathing (congenital heart defects, chronic lung disease, muscular dystrophy). All these conditions will make eating more difficult for a child.
2. Oral motor impairments – any issue that makes it difficult to get food into the mouth, chew, breathe, swallow or sit up can be a reason to avoid food or food groups. For eg: cleft palate, malformation of the trachea/oesophagus, dental issues, enlarged adenoids or tonsils or tongue tie. Also any jaw malfunction which impacts coordinated movements of the tongue and cheek, Poor chewing technique (biting and chewing with front teeth only) or limited movement of tongue (especially if unable to move side to side).
3. Sensory processing disorder – Means that sensory input is experienced in a more intense or dulled way. Children may crave certain sensory experiences (spice, sourness, crunch) or be unaware of the sensation of food in their mouth. Some children with SPD will only eat uniform textures (all smooth or all crunchy).
Examples of sensory presentations:
- Taste/Smell – only eating bland or strong flavours, same few flavours preferred, turned off by strong smells.
- Tactile – wants hands wiped of any mess, or unaware of food all over face, not mixing textures, preference for crunchy, distracted by feet dangling at meal times, prefers food at certain temperatures.
- Visual – only eats certain brands, finds patterns distracting, doesn't like bright lights.
- Auditory – reacts to noise more than peers, prefers steady background noise, stressed long after after unexpected noise ends.
- Sensory seeking – crave intense sensory input particularly seeking out strong and intense flavours, can be unaware of foul tasting foods, often bite tongue, drool or eat with mouth open.
4. Temperament/Mood – Children with feeding or eating disorders are often highly verbal and intelligent. They tend to be independent natured and want to do things 'on my terms, in my own way'. This can lead to them becoming increasingly frustrated when things don't work. They often feel and express intense emotions. They also tend to be sensitive to their parents agenda and pressure leading to increased risk of experiencing anxiety. Food refusal also links to shyness, emotionality and irritability. (Children with this independent temperament also often have toilet training issues and constipation for similar reasons).
5. Negative Experiences – If in the past eating or feeling hungry has resulted in an uncomfortable or scary experience, such as choking, food poisoning, vomiting, forced feeding or illness, appetite can decrease.
By: Amanda Kenyon, Psychologist at ACPC, Adapted from resource: Helping your Child with Extreme Picky Eating. By Katja Rowell.