Fear and Food Anxiety

We are making progress.  We have narrowed down the reasons for TJ’s resistant eating as part anxiety and very possibly an impaired sense of smell.

Smell is very important in the function of taste.  Jelly beans are a great way to better illustrate this.  Pinch your nose closed and without looking at the colour, pop a jelly bean into your mouth.  While you chew it, you’ll detect the texture (crunchy, sticky, gooey), the temperature, and the taste (sweet).  Now, unplug your nose and continue chewing.  This is when you’ll detect the flavour of the jelly bean (strawberry, watermelon, etc..).

Without the sense of smell, you can still detect the taste of sweet, salty, sour, but without retronasal air flow (from the back of the mouth up through the nose) the flavour will be missing.  It is this retronasal air direction that is blocked during a cold, for example.  TJ’s allergies, we suspect, impairs this direction of air flow.  Meat without the flavour, to him, is much like chewing on an elastic band.

Anxiety feeds a large part of TJ’s food selectivity and unless we break the anxiety cycle, he will never have a comfortable relationship with food. I’m not certain that he remembers the episodes of choking, but the trauma of the event has certainly stayed with him.  He ate something that caused him to stop breathing, obviously a frightening experience.  The next time this item shows up on his plate, he thinks it could kill him, so he avoids this particular food.  Soon, he avoids all unfamiliar food, secure in the belief that all unknown edibles are dangerous.  Familiar foods that have changed flavour or texture are seen as strange and strange things are unfamiliar… and around and around we go.

I’ve known for years that when TJ is willing to try something new, the time is golden for reclaiming lost ground, but there’s a catch.  As soon as he meets something with an unpalatable taste or an unfamiliar texture, this rare window of opportunity seals shut and we have no other choice but to wait, often several months, for it to open again.  When this happens, TJ will start to reject foods off his safe list.  At the moment, this rare window of food exploration is open and I’ll do anything to keep it that way.

While our pediatrician steers us toward (tick tock) now a five month wait for a specialist to rule out the unlikely diagnosis of autism, I focus on learning more about anxiety and how to deal with our specific brand of it. More than transforming him into an adventurous foodie, I would like TJ to feel comfortable enough with his food choices so that the inevitable future ridicule about his picky eating doesn’t continue to feed his food anxiety. Accomplishing this means knowing how to feed the child and not the monster that dictates the menu.

The following are excepts from an Anxiety UK online pamphlet that discusses common childhood anxieties:

  • Anxiety has been found to be one of the most common causes of distress in children and young people. As many as one in five primary school children suffer from a low sense of well being.
  • Anxiety can affect us all in very different ways. Experiences of anxiety can vary greatly from person to person and no two people have precisely the same experience.
  • Not all anxious children and young people will display classic characteristics (pale, clammy, crying, shaking, feeling ill). Some hide their anxiety for fear of someone finding out that they are anxious, with others showing no signs of anxiousness at all containing their feelings of anxiety inside.
  • Anxiety is not only common, but also extremely debilitating. The impact an anxiety problem impacts the whole family’s life.

The ‘fear of the fear’ often makes people feel worse as they are literally on edge waiting for bad feelings to happen; they stop doing things that link with the negative (bad) feelings or thoughts. This is called avoidance. The more that someone avoids the thing that links with feeling bad, the more they think of it as being dangerous.

Image courtesy of Anxiety UK

The fear of new foods
Some children, mainly boys, can only eat a very narrow range of foods, and show extreme anxiety if they are expected to try new foods. The foods that they usually are able to eat are usually beige, dry carbohydrates, such as biscuits, crisps, cereals or bread; dairy products such as milk or yogurt; and chocolate. This diet does not seem to be harmful to the child, who will grow normally if they are allowed to eat from their acceptable range of foods.

The fear of trying new foods stems from a normal development stage that occurs at around the age of two years (the neophobic stage). At this age children narrow down the range of foods accepted and commonly refuse foods that don’t look the same as foods that they have learned to like. Most children grow out of this stage, and are able to try and accept new foods into their diet. Some children do not move on from this stage; whatever the parents try to do. The reluctance to try new foods becomes a fear, and all new foods trigger a disgust response in the child. If the child is forced to eat foods that they cannot accept then they will often vomit, or show a gag (disgust) response. Certain food textures, such as lumpy or slimy food, can be more disgusting than others.

How to cope with food related anxiety

  • Never insist that your child eats food that they do not like.
  • Make sure that your child gets the calories that they need from the foods that they do like; whatever those foods might be.
  • Get your child used to being around the food that they fear, just getting used to the smell and being able to touch ‘disgust foods’ is a start.
  • If you are trying to get your child to taste new foods, don’t do this at mealtimes. Do it at a time when other people aren’t watching and your child is less likely to be anxious.
  • Start with very small amounts of food; just a taste will do. A food needs to be tasted quite a few times before it is accepted.
  • Make sure that your child’s school is aware of the problem. Your child may need to take ‘unhealthy’ foods in their lunch box, or be able to eat at break time. Get a letter from a health professional to support this if need be.

We have made progress. In the past year, TJ has transformed from a child who was terrified to sit at the table to one who will openly ask for something else to eat.  I have abandoned my hobby as a short order cook and found ways to let the family explore different dishes and still accommodate TJ’s food selectivity.  We have found strategies that keep that elusive window of food exploration open for longer periods of time.  Most importantly, we’ve learned that eating “normally” is not a standard that should be imposed upon TJ, instead, we encourage him to eat in a way that feels normal to him.

Fighting anxiety a long journey that we take in very deliberate and small steps, one positive experience with food at a time.

Sources:
Anxiety UK

16 thoughts on “Fear and Food Anxiety

  1. Hi, I found your blog very interesting and if you could offer me any advice on were to start with my 17 year old son I would be most grateful – he has been a poor eater from an young age and reading yours and others on google I feel it’s definitely from when he was just under 2 years old and had very enlarged tonsils. But now it’s affecting him more and more as he is an elite sportsman (golf) and his performance drops so dramatically during competitions we can guarantee his last round will be poor ! It’s a standing joke with family and friends now and we finally got him to admit yesterday in his words ” yes mum I have a problem with eating” :( any help on our first path for direction would be greatly appreciate from this concerned and worried parent :)

    • I would suggest to start with some reading:

      http://ellynsatterinstitute.org/htf/iwfr4.php

      Try to be as supportive as you can without pressuring your son to eat. Is he able to carry a snack or beverage with him while he is playing? Talk to a RD (registered dietitian, preferably knowledgeable about the DOR) about keeping his daily caloric and nutritional intake stable.

      You may also wish to see if your son’s food aversions are sensory based – the texture and smell can make food anywhere from unpalatable to downright offensive.

      Anxiety is also very common. It will help you both to shift the focus to eating enough to sustain his energy needs (with respect to your son’s hunger), rather than eating a wide variety of foods.

  2. Hi my youngest son wont touch foods and has a fear of new food , And advice on how to get him to even feel likes of bread etc , he is nearly 5

    • I would dig into the reasons behind the food refusal. Are there oral-motor or gastrointestinal issues, food allergies, a traumatic experience…? Is he reacting to the feeding environment – pressure to eat certain foods, certain amounts, etc..? Is he sensory sensitive and sitting with poor body support, or overwhelmed by the environment. So many things to consider.
      I don’t suggest trying to get him to try or like new foods until he’s able to satisfy his hunger on foods he is already comfortable with.
      For a more detailed explanation, “Love Me Feed Me” by Katja Rowell (MD), and “Secrets of Feeding a Healthy Family” by Ellyn Satter will be very insightful.

      • Hi Thanks for info
        He suffered a lot of very bad throat infections and bouts of tonsillitis up until recently (fingers crossed it stays away ) He will eat big dinners with veg , meat and spud , diet is limited to yoghurts after that .

      • Your best bet is to focus on creating a relaxed and pleasant mealtime atmosphere. Including a “safe” food amongst what you serve provides your son the opportunity to satisfy his hunger within respected boundaries of feeding responsibility. Typically, once kids trust that they can find enough (even of only one thing) to eat, they tend to naturally start exploring on their own.

        Don’t worry about nutritional guidelines
        or how varied his diet is right now. Behaving nicely at the table and being relaxed around unfamiliar food is a sign that you’re on the right path.

  3. This was very interesting reading, we are having a nightmare as our daughter has fears with texture and refuses to eat any fruit since her vomiting episodes when she was younger and we didn’t know about all the food allergies. Unfortunately, her school do not distinguish between food fear anxiety and normal fussy eating. So we have having to establish ways for our daughter to communicate her needs and how she wants it to be instead of eating or biting a food like an apple in class.

  4. It was as if I was reading my 4 year olds food story. She becomes very anxious if I suggest for her to try something new. We have made progress, she licked some mashed potato but didn’t want to try it again. For breakfast she has a protein drink, lunch is peanut butter sandwiches, bland biscuits and the only thing she will eat for dinner is another peanut butter sandwich or plain cooked pasta with butter. And it must be penne. She took a huge jump tonight and I convinced her to try spaghetti and she enjoyed it. She always says she’s scared to try new food. It frustrates me because going out is a nightmare. I have to pre packed things she will eat. We went on a 2 week cruise and all she ate was buttered bread rolls. She steers well clear of colourful food. Strictly no meat. I worry she doesn’t get enough nutrition, her nails peeled off at one point and I thought it was from her diet. She will eat peeled apples, bananas and strawberries at times but not much. I’ve been to the doctor many times and he says she will grow out of it. I’m not so sure. Any advice would be greatly appreciated. I would love nothing more than to go out for dinner and she would eat something off the menu.

    • I just finished reading Katja Rowell’s book Love Me Feed Me. You can buy on Amazon. I highly recommend it. I don’t have much other advice as I am struggling with a selective eater too. We also did a cruise and all she ate was ice cream if she even ate that some days. She also has a smell aversion issue and got sick every night at dinner, ruining her appetite for days on end. We are going on another cruise next month.

  5. My 11 year old has always been a selective eater. She developed an aversion to seafood about 5 years ago. Others food started bothering her over the following years, but it was tolerable. Diagnosed with GAD after a fire in June of last year, has had CBT and is now on zoloft. Zoloft has helped in most all other areas of anxiety reduction, but we cannot make any progress with the smells. She gets nauseated/gagging with just about every restaurant. We tried in vivio exposure therapy, which led to panic attacks. Am looking for any ideas of what to try? Did recently start DOR, but trying not to pressure and just making her sit at the table with the family is making her anxious.

    • Anxiety is a nasty monster. My son would not sit at the table with us for a long time. He did not want to be around others while he ate, and is still uneasy eating around people he doesn’t know well. Guiding him to the table was a process of giving him permission to do what he was capable of, and accepting what he wasn’t. A definite turning point was the dinner of pure pasta chaos http://mealtimehostage.wordpress.com/2012/08/26/operation-pasta/
      that entirely redefined meals, all of which we did before fully embracing DOR.

      I am currently intrigued by the work of Dr. Ross Greene and his collaborative problem solving model. His book “Lost at School” goes into detail about his approach, (and how to apply it to challenging behaviour in an educational setting), however, I find it useful to help me understand what is driving the anxiety and to give my son a better sense of control over his fear.

      Another workbook by Dr. Dawn Huebner
      “What to do when you worry too much” has also been helpful.

      • Thank you for such a quick reply. Looking forward to reading much more of your blog. Hard to find anyone who understands that just eating at the table can be a huge ordeal. Those who understand have no idea how to help remedy the situation and as I explained, exposure therapy was a disaster.

        We did complete the workbook by Dr. Huebner in the summer of 2012. I will have to look into Dr. Greene’s book, thank you for the recommendation. May help in other areas too as we had to pull our daughter out of her catholic school and start homeschooling her as she was having so many issues. The school was not very helpful despite us having three physicians recommending things( just one example, she started worrying in April which locker she would get in August and they would not try to work on it with us. She didn’t want a particular locker, just any of them on the open end of the hallway, rather than the closed portion that seemed very claustrophobic to her). The only area they did give her some slack was she was getting sick in the cafeteria so on certain days she was allowed to eat alone in her classroom. Amazing thing about that, she didn’t want the other kids to know why she was eating in the classroom, so she let them think she was in trouble.

        As we have been working on DOR(at least with our dinner meals to start), your comment of “Guiding him to the table was a process of giving him permission to do what he was capable of, and accepting what he wasn’t.” really sinks in. This afternoon she got up and just pulled a stool up, but my husband made her go back to her seat. I could see she was getting so uncomfortable and used a distraction of reading some of our thankful moments that we put into a jar all through 2013. My husband and I are really trying hard to work collaboratively on this. The last thing she needs is mixed signals from us.

        Thank you again, I really appreciate anyones advice or suggestions.

  6. Hi, just found this sites tonight. T J sounds just like my son (he’s four). He was a fab feeder to breast feed then at 8 mths I stopped breastfeeding and was introducing cows milk aswell as more lumpy textures of food and meat etc. He became very ill couldn’t stop being sick,pale etc in and out of hospital no explanation from doctors so a friend suggested I take cows milk and all dairy from his diet well it changed everything behaviour, development everything improved except his eating. He has this huge fear of eating foods he doesn’t like the look or smell in fear of being sick often gagging, crying refusing to even have the food any where near him! He even tells me I’m trying to poison him!! He won’t eat any fruit or veg or pasta or rice just plain beige food! It’s taken over two years with various useless paediatricians and a phone consultation with a dietitian to get him gradually back onto dairy. All this hard work and my mum in law over the Xmas hols refuse to let him leave the table until he ate her stew (my son’s worse nightmare stew /sloppy food). Making a real point of in her house younsit still and eat all your dinner and “we don’t put jam on yorkshire pudds” ectopic resulting in him sobbing. Now he’s refusing to even have veg on his plate (I always put it on as advised just incase he tried it). She’s sent him right back and believes I’m baby in him and should stop giving him what he wants no understanding and it’s really annoying me how do other people cope with interfering family who make hour child cry and damage your progress! I just wanted to scream at her but instead felt I was making excuses and then awful for my son to go through that help!

    • Oh Nicola, :(
      Unfortunately, your experience with ‘know-better’ relatives is far too common. Trust is so crucial to feeding children – it’s so difficult to gain after repeated early negative experiences with eating and so very easy to lose. Thank you for sharing your story. If you don’t object, I would like to use it as the subject of a post. Your story is a perfect example of why we need to be vocal advocates for our children.

      Join us:

      https://www.facebook.com/groups/MealtimeHostage

      • Hi, yes please do. All too often I hear people saying just make him eat! My mum is the only one who understands as she too has a fear of eating certain foods and knows that texture and smell are what affects her the most! She’s never eaten cheese in her 63 yrs of living due to smell, colour and the texture! Thank you for showing an interest. Kind regards nikki

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