Do you worry that your child does not eat enough? Have you heard people say that a child will eat if they’re hungry enough? That surely, they won’t starve themselves? But what happens when a child does ‘starve’ themselves to the point that growth becomes affected?
Many people believe that eating is an instinctual process and that a child will eat no matter what. Instincts (reflexes) do help a young infant find the breast up to about 3 months of age. However, did you know that after this eating is a learned behaviour?
Just as a child can learn to eat, they can learn to not eat.
Research by Kay A Toomey (2010) -and others shows that learning about food happens in two ways:
The first is when a connection is made in time between one natural stimulus and another neutral stimulus. For example, if a child (or anyone) experiences pain or discomfort, they will try to avoid it. This a natural event. But if the pain or discomfort get associated with something such as food or eating, then they may learn to avoid the eating situation even though it’s not directly the cause of the pain. Painful gastro-oesophageal reflux can be an example of this.
The second way we learn about food is through reinforcement (imitating or praise) and punishment (such as yelling, forcing food to be eaten).
When children (and adults) are stressed, anxious, upset, angry, having a tantrum they are often in a state of fight-fright-flight. Stress hormones adrenalin and cortisol are high at this time, and these hormones also have another effect… they switch appetite off! When kids are constantly in this state at mealtimes, they are rarely feeling hunger! Over time, negative associations can ultimately lead to the child avoiding feeding which increases the mealtime struggles with caregivers. It’s an unpleasant and unhappy cycle.
Sometimes parents fall unexpectedly into feeding struggles when children won’t eat well. It makes sense that parents can start to worry and feel like they must make their children eat.
“If my child doesn’t eat, his wellbeing is at risk and that is overwhelming and scary!”
If you or someone you know is in this situation, we know that all you really want is for your child to be okay. And thus begins the confusion around feeding roles and responsibilities. You are probably feeling REALLY responsible for how much your child is eating. Many parents panic and start getting pushy with food and the problem escalates. Instead, following Ellyn Satter’s Division of Responsibility in Feeding can help you re-establish a calm and nurturing relationship with your child at mealtimes that will make it easier for them to eat.
A child that won’t eat is likely to be finding the eating experience challenging and has learned to not eat.
To work out what is going on for a child that won’t eat, it is more helpful to look at how they learned to not eat.
Do they have food allergies with reactions that cause extreme discomfort or scary anaphylaxis?
Did they see a family member scrunch up their face with refusal when a particular food was offered, in turn teaching them to approach that food with caution?
Might they be constipated and experiencing poor appetite?
Or have they not had many opportunities to learn how to eat through social modelling because they eat apart from the rest of the family? We can accidentally teach children not to eat, without intention or awareness.
When children (in particular small children) won’t eat in a problematic way, they are trying to tell us that something about eating is hard or doesn’t feel good.
We can accidentally reinforce undesirable feeding behaviours by using things such as distractions, rewards or bribes.
In contrast, examples of positive eating behavior and learning are imitating, natural praise and social modelling. It can even be the body’s natural feeling of satiety (feeling comfortably full) after eating or the simple pleasure of eating.
How can we help children to eat well?
Expressing your concerns to your health care professional with an interest in feeding and childhood nutrition can really help! A paediatric Accredited Practising Dietitian can help you understand what is normal eating behaviour and development and what is not, and identify how your child learned not to eat.
Some feeding issues can be complex and professional support or therapy from a health care team that may include Dietitian, Speech Pathologist, Occupational Therapist and/or Psychologist may be helpful.
Kids Dig Food Dietitians work together with our client families to pinpoint how to positively improve the child’s eating experience and kickstart food learning. Addressing the feeding relationship at home is often the best place to start and complementary in-clinic therapy may be helpful to desensitize to food aversions.
All food learning needs much patience and time to build feeding skills and confidence. With practice, support and positive reinforcement, a child can learn to eat. A home environment that supports the learning of eating is essential.
Learning is the key factor.
Ines Astudillo, Paediatric Dietitian, APD
Toomey, K (2010). When Children Won’t Eat: Understanding the “Why’s” and How to Help.
Posted: 24 May 2018