I have read a lot of books on how to reform a picky eater and I have yet to find one that actually does. There is a lot of “The parent decides what, where and when to eat” and from there, the message quickly goes south. The child is just expected to eat whatever shows up on their plate, followed by advice for the parent on how to put on a brave face and not break down in tears in front of your family.
It’s only been about 6 months since TJ has been comfortable enough to join us at the table for meals. Before then, there would be crying, terror, and attempts to get and remain as far away from the table as possible. There would be no eating. Meals were guaranteed to be a catastrophe that everyone in this family dreaded. We followed all the advice – be sneaky, be firm, praise, punish… What we ended up with was a child who did not want to be around any food that wasn’t considered familiar and safe. Needless to say, I now read any book about separating the picky from the eater with trepidation and great skepticism.
Fortunately, my online support groups of selective eating adults have given us plenty of helpful and useful advice, such as, “give him some space to try new foods in his own time”, “make sure there is something on the table he can eat”, and “accept him for who he is, not what he eats”. So, when I found an article in the Seattle Times that suggested to focus on interacting with food and less on eating it, I put dinner on the table, buffet style and Operation Pasta ensued.
Simply changing the way food is served significantly reduced the amount of anxiety at the table. Once he was given the option to choose what he wanted on his plate and permission to do with it whatever he wanted, family meals immediately took a turn for the better.
We took as much pressure away from the table as we could. TJ always had something he could eat, although we often ate something different than he did. We ate with the TV on in the background. We served dessert first, ate breakfast for dinner, dinner for breakfast, and had the option for a snack of fresh fruit available for anytime grazing. TJ saw our meals from a comfortable distance and sometimes I would ask if he wanted to try anything, but the offer was always refused.
And then, about two months ago, weird stuff started to happen.
He started to ask questions. “What is that?”, “Can I look at it?” Maybe there is something to this approach of letting him discover food on his own terms approach. Recently, he insists on choosing a coupon from the display at the entrance to the grocery store and searching for that product in the store. Sometimes, he even wants to try it. Not everything is a success, but very slowly, he is adding a few things here and there. Kool-Aid Jammers (orange), Fruit Roll-Ups (strawberry), and just today, Philadelphia Cream Cheese (chocolate).
In the past month, TJ has been cautiously exploring food within his safe zone. He is occasionally curious about unfamiliar food. His twin sister, however, had begun pushing favourite food away, or spitting previously accepted items out, feigning disgust. She started to question why her brother got special meals and she didn’t. She tries to skip meals, but can’t ignore the pangs of hunger. We seem to be solving one problem by creating another.
* * *
I have just started reading “Love Me, Feed Me: The Adoptive Parent’s Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More” written by Dr. Katja Rowell. Dr. Rowell found the Mealtime Hostage blog, left some encouraging comments and kindly suggested that I read her book. When she learned it was back ordered in Canada, she generously mailed one to me. Why? Because she honestly cares. Not only does she understand the nature of our monster, but has also personally experienced how anxiety over food affects the whole family.
Dr. Rowell’s approach is very different from other books I’ve read about dealing with picky eating children. For starters, she recognizes that there is “picky” and then there is “selective”, although she believes her no pressure, Trust Model approach is equally effective for dealing with both. Refreshing is the focus away from what to feed my family and more concentration on how to instill a healthy relationship with food. Dr. Rowell’s experience (and success) with overcoming mealtime challenges comes from helping families that include adopted children. It’s reasonable to expect any child adjusting to a new family, (often in a strange country and coping with past trauma), to experience some degree of anxiety. For completely different reasons, that’s very similar to the monster that lurks around our table.
“Love Me, Feed Me” arrived as TJ was recovering from illness. His bony stature and weight nibbles at my natural mom instincts to worry on a good day. Losing almost 10% of his mass in under a week turned that little nibble into giant chomps of concern. Eager for information, I started reading (in my typical non-linear way) the chapter most relevant to our situation. Of course, I opened “Love Me, Feed Me” and went straight to Chapter 4: Selective Eating, “Underweight” Worries and Ending the Power Struggle”.
In retrospect, that may not have been the best place to start reading.
As I skimmed through the paragraphs, I learned that when children are first trusted with eating, their food intake initially can be erratic. They might even lose a little weight. Then, I came across a little cautionary paragraph advising that children who are losing weight, have nutrient deficiencies etc.. should be monitored while they transition to the Trust Model. I had no idea that a shaded rectangle containing three lines of text could be so terrifying.
TJ could use a little more padding on his bones. He doesn’t lose weight well. Every lost ounce has a huge impact on his behaviour, and he certainly doesn’t need to lose any more weight. A skipped meal just isn’t an option at a time when every calorie counts. To be honest, I’m not prepared to go back to the meals that included panic and tears when he didn’t find something safe on the table…
Dr. Rowell was quick to respond to my e-mail, and acknowledged my concerns about TJ’s weight. On her FaceBook page, The Feeding Doctor, she used our situation to illustrate the importance of listening to parents. “Under all the fear about many of these children is [the death of the child]. Horrifying, isn’t it? Sounds like mom hasn’t felt heard by her son’s doctors, who blow off the concerns, rather than reassuring. When parents aren’t heard, and are pacified, when things don’t feel right, I think it makes that fear far, far worse.”
If his nutritional reserves are dire (losing weight or not gaining, other nutrient deficiencies, dehydration, poor energy, after a full intake analysis with an RD to help determine his needs and how far off he might be, what follow-up and support is like etc.) and he can’t handle a few days or weeks of decreased intake, trusting the process will be close to impossible for this mom.
That’s exactly where this process is breaking down. It’s not TJ and the limited list of accepted food. It’s me. I need to trust him and his ability to know when he is hungry and when he has had enough. There is this adage that states “no child offered food will starve.” It’s missing a few words to turn it into a truth. If I was offered a plate of crickets, I would most certainly starve. There is a valuable and comforting message here that has somehow been lost. No child offered food they are comfortable with will starve. Big difference.
Contrary to the advice that is usually suggested to parents of selective eating children, Dr. Rowell is not at all suggesting that I toss a plate full of green things and meat at TJ and say, “well, there’s dinner!” because that would be horribly and unusually cruel. In fact, she doesn’t suggest that I fill his plate with anything, really. At all. Remember Operation Pasta? Dinner goes in the middle of the table. Everyone (including each child) gets choose how much they want from what is available to eat.
My job as the parent is to decide what food is available. “Every meal and snack must include one, better two, items on the child’s safe list,” explains Dr. Rowell, “It feels odd for parents to have a bowl of pretzels next to the rotisserie chicken and the carrots on the table, but in addition to having those safe foods, kids need no-pressure chances to get comfortable around the foods parents like to eat and want they want the child to grow up eating.” She also strongly encourages parents to follow their instincts and consider their child’s temperament, “Every child is unique, and tuning in to how he feels and how you feel will continue to help.”
So, as TJ started to gradually eat more as he recovered, I started putting the food back in the middle of the table. Our favourite family meals plus at least two safe options for TJ. In just a little over a week, my husband and I are enjoying eating like adults again. My daughter enjoys eating some grown up foods and having the option to have some of her brother’s safe foods as well. The complaining and the pushing away have stopped. In fact, she willingly tried marinara sauce one evening, something she always said she didn’t like. Turns out, she really enjoyed it.
My son not only has his safe options, but exposure to foods we eat as a family. It’s his choice to have as much of whatever is available on the table. He has not yet skipped a meal. In fact, he has gained back all the weight he lost, plus half a pound.
So what does the Trust Model actually look like? I asked Dr. Rowell about a specific meal we enjoyed with friends:
Tonight’s dinner is a fairly typical example. We had company (which is not typical). On the table: meatballs, a veggie tray (cauliflower, broccoli, tomatoes, carrots), a fruit tray (melon, pineapple, strawberries and blueberries), sourdough buns, cheese and deli meats. The bread was too hard for him to bite and the only other safe food in that whole spread was the strawberries (which were now all eaten). He wanted a sandwich (because that’s what everyone was having) but with some marinara sauce on a softer bun.
Should I have said choose from the food on the table (and know he’d be hungry) or get him a bun he could eat and marinara sauce (which I did and watched him devour most of a foot long sub?) I should have done the ‘what’ part better and had that option available? Because hungry be damned, there is just no way he was he going to eat anything else.
Dr. Rowell responded:
I think you did great. He needs foods he can handle, and crusty bread is very tough, particularly if he has a fear of choking. With guests, it is harder. Sounds like you followed you intuition, there was not enough food on the table that he could eat and fill up on. No worries, that part will get easier. He had a bread option that he could handle, then put marinara on it, a variant of what others were having. You could have simply put this softer bread in a bowl on the table as another option. (Others may have enjoyed the option too, sounds like a feast!) He responded with a hearty appetite and enjoyed the meal and the social event. It sounds like a positive experience at the table, and I’d give yourself a pat on the back, enjoy it, and continue to read and learn about this new way of doing things.
When I first started feeding this way when my daughter was a young toddler, I had to be very thoughtful and purposeful about what I was doing. I thought a lot about my motives, what was happening, watched it all very closely, after about 6 months it felt more natural, and a few years in, I could not imagine doing it any other way and it was second nature. This is a process, and be kind to yourself and your son during the process. You will “mess up” and reflect, and learn more, and that’s the process.
I have more reading to do, and have started “Love Me, Feed Me” from the beginning. Within the first few chapters, I have gained valuable insight on how to feed my family without using any kind of negative or positive pressure. Slowly, I am learning that TJ is competent enough with eating to accept that he can be completely trusted to eat. I worry less about how many servings of vegetables we ate today and focus more on the incredible people that are my family. More than what TJ will like to eat, it would thrill me to know that he no longer considers eating to be a dangerous activity, and may even one day, trust the act of eating enough to actually enjoy it.
I think we can get there! It’s quite possible we may even enjoy the journey until then.
* * *
Special thanks to Dr. Katja Rowell, a.k.a. The Feeding Doctor (check out her blog and FaceBook page), and Ellyn Satter Associates for giving us clean tools to feed this family, without the mealtime monster.