Food Neophobia and Selective Eating Disorder In Children: More Than Just Picky Eating

Gavi Kestenbaum is a board certified Registered Dietitian (RD) and a Certified Lactation Consultant (CLC).  She specializes in prenatal and pediatric nutrition.   She promotes family nutrition by empowering parents to create happy, meaningful and memorable family mealtimes.  Her goal is to help individuals and families gain a positive relationship with eating, food and meal preparation. Reblogged from original post found here.

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Get out the video camera…here comes baby’s first bite of food. For many parents, this is a joyous step leading to a lifetime of shared memories and happy mealtimes. Unfortunately, for parents of children with feeding delays and disorders, this is the start of a long and painful journey that will include gastrointestinal specialists, feeding clinics, speech therapists and occupational therapists.

Many early feeding problems are a symptom of a diagnosable problem and can be corrected. GI impairments, such as reflux or delayed gastric emptying, can be treated through medical intervention. Oral motor delays can be aided through speech therapy. Occupational therapy can ease oral texture sensitivity. Children with autism spectrum disorders also tend towards selective eating. These children can benefit from behavioral modification that can encourage a wider range of food consumption. With time and proper intervention, young children who cannot eat properly due to a developmental or physical impairment can gradually improve.

What about children who won’t eat? This is different than a child who cannot eat for a definable reason. Yes, a child who won’t eat. A child who passes all tests for autism spectrum disorders and still exhibits extreme selective eating. A child who is shown to have no oral motor delays and still chokes when eating. A child who gags and vomits just getting too close to an unaccepted food. A child who has no hyper-sensitivities to touch, light or sound, but still cannot tolerate certain textures in his or her mouth. A child who has been through a range of GI tests and procedures and has been given no diagnosis. A child who simply does not eat enough volume or variety to sustain normal growth for no explained reason.

It seems as if these children are actually afraid of food. Perhaps a GI illness, reflux in infancy, or a choking event is possibly the cause in some children, but in most cases the source of the fear is a mystery. There is so little written on the topic of childhood food phobias and most literature groups it together with difficulty swallowing. The term food neophobia, which is the fear of new food, has long been used to describe the hesitation most children experience in adding new foods to their diets.  However, this term is now being used to describe children with extreme food refusal and it is just now being openly discussed in the field of pediatric feeding disorders.  

Extreme food refusal is also referred to as Avoidant Restrictive Food Intake Disorder (ARFID) or Selective Eating Disorder (SED). The dietetic community largely does not recognize extreme food refusal as an issue. Most dietitians will tell a parent that children will try a food with repeated exposure and go on to explain information on picky eating. Feeding therapists working at major pediatric hospitals, such as Children’s Hospital of Philadelphia, handle food refusal as a behavioral problem and completely ignore the fear and anxiety that many of these children show when faced with certain foods. The Kartini Clinic in Oregon and Duke Center for Eating Disorders are the only hospitals with a program specifically designed to handle food phobias.

Parents of children with this type of extreme food refusal must first take steps to restore positive mealtime dynamics. If poor eating has been going on since infancy, there is a good chance that meals and the subject of food have become sources of negativity and tension.  Sit down with the child and have a shared meal.  Let the child select a seat where they feel comfortable and will be least likely to gag, choke or vomit smelling or being too close to offending foods.  Have the child watch you eat a variety of foods. Reassure the child that you are not going to make them eat and try to create a normal, mealtime atmosphere.  If that means the child sits and watches and eats nothing, that is okay.  The goal here is to get the child sitting at the table, watching family members eat, conversing, spending time with family, and hopefully getting curious as to why everyone is enjoying their food.  Focus on light, pleasant conversation and not on what is being eaten.

Refrain from making special foods for your child at these family meals.  Your child will be expected to join at the table and to choose from the foods the rest of the family is offered.  A child who is catered to may never work up the nerve to explore new foods.  Put something on the table that the child will eat, perhaps bread, and then sit down as a family.

Next, ensure that the child arrives at each meal hungry.  Keep snacks to no less than two hours before a meal and have them at planned times.  A well-timed, planned snack can help provide a balance between challenging the child at meals but offering enough preferred foods to keep the child happy. Grazing is no longer allowed.  A hungry child may push themselves to break out of their comfort zones or at least increase the volume of preferred foods they are eating and sit with the family for a meal.

Most importantly, consider supplemental nutrition as the child continues to work through his or her underlying food anxieties. This will allow normal growth to be maintained without the daily battles and fights. If the child is able to drink, a high calorie, high protein formula with added vitamins and minerals can be offered. Bright Beginnings pediatric drink comes in both soy-based and milk-based formulas and provides 100% of vitamins and minerals when four cans are consumed. Perhaps even a feeding tube is necessary to ensure adequate nutrition so the focus can shift away from food and towards the creation of a happy family.  Supplements can be given between meals so that the child has time to become hungry for the meal.

Many children with food phobias and selective eating have behavioral problems. This is not surprising considering the daily battles over food and the constant worry and anxiety on the part of the caregiver over proper nutrition. Some of these issues may resolve themselves when the pressure to eat is removed.

Once family meals with at least one caregiver are put in place and positive associations with eating are established, the child may slowly add new foods. The steps may be extremely gradual. Perhaps the child may put a food on the plate but will not actually eat it or touch it. Perhaps the child will proclaim that they now like a food without even coming near it. This is all part of the process of healing.

Continue to get the child psychiatric help, but stop any therapy that causes heightened anxiety, increased behavior problems at home, and unravels relaxed mealtimes and positive eating experiences.

With time, a lot of patience and appreciation for tiny steps, a child with food phobias may broaden their accepted foods just enough so that things so many families take for granted, such as going to restaurants and having a pizza party, are possible.  Although it may take years for the anxiety over food to lessen, a sense of normalcy can be reached despite it.   In the meantime, caregivers should focus on enjoying their children.  A healthy diet is important, but a healthy family dynamic is more important.

What is the difference between food neophobia, or food avoidance emotional disorder, and picky eating? Read More.

For more information on pediatric food phobias, click here. If you would like a private consultation to discuss more strategies for coping with extreme food refusal, contact Gavi RD.

Originally posted December 22, 2010 on www.gavird.com. Reprinted with permission from the author. ©2014 GaviRD, LLC.

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One response to “Food Neophobia and Selective Eating Disorder In Children: More Than Just Picky Eating

  1. “What about children who won’t eat? This is different than a child who cannot eat for a definable reason. Yes, a child who won’t eat. A child who passes all tests for autism spectrum disorders and still exhibits extreme selective eating. A child who is shown to have no oral motor delays and still chokes when eating. A child who gags and vomits just getting too close to an unaccepted food. A child who has no hyper-sensitivities to touch, light or sound, but still cannot tolerate certain textures in his or her mouth. A child who has been through a range of GI tests and procedures and has been given no diagnosis. A child who simply does not eat enough volume or variety to sustain normal growth for no explained reason.

    It seems as if these children are actually afraid of food.”

    This describes my son to a T. Between his trichotillomania (diagnosed around the same time (age 11) as his SED and only after we switched pediatricians) he has been tested 100 ways from Sunday. He has no other problems or disorders. (He is gifted which comes with high intelligence and a heightened sense of the world around him.) The Children’s Feeding Disorder Center (in our home state) said from our description of his early childhood and eating habits, he had a clear case of reflux from ages 0 to 5 that went undiagnosed. (Thanks to our ex-pediatrician yelling at us for giving our son “too much milk” and that we should stop, thereby forcing him to eat more solid food, to the point where we started lying about what he was eating. We knew he wouldn’t eat most foods and he was growing just fine back then.) We were told that by age 5, K’s brain had learned to fear most foods. It would only accept “safe” ones such as milk and carbohydrates (bread, certain cereals, french fries, etc.) He also has a heightened sense of smell and taste which add to his SED. We were told that we had done nothing wrong. We had been feeding him what he would eat because we knew he would starve without his safe foods. We were told to try to switch him to higher fat versions of said foods, start food chaining, and get him therapy. (Insurance wouldn’t pay for any of it though since he’d started to grow again.)

    Anyway, he’s now nearly 16 and thriving. He’s tried some new foods on his own and without pressure from us. (Relatives & strangers making rude & uneducated comments not withstanding.) We make sure he has his safe foods. K likes that he gets pizza once a month – his most nutritionally complete and only “combination food.” He’s working towards adding more “will eat at any restaurant” foods to his short list.

    The one thing we don’t do is the “everyone eats the same thing for dinner, one accepted food is provided” type of thing. All 3 of us have different food allergies, health concerns, & taste preferences. What I can eat, my husband can’t & visa versa. And of course this is the case for our son. However, he is always welcome to help cook, smell, touch, taste any food. He’s often at the grocery store with me and knows that if he wants to try something, it’s welcome in the cart.

    Our son knows he’s not going to live an unhappy life if he never has a hamburger or macaroni and cheese. He tells those who try to pressure him into trying something new or something he knows he doesn’t like, “Here, let me give you a bowl of dog poop and sticks. How do you know you won’t like it if you don’t try it? I bet those sticks would taste great with some poop on them!”

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