How to Help Your Child Eat
From March 14, 2017
“Turning a Grasshopper Into Food”
What do you know about an eating disorder called “problem feeding”? This was the term presented to me at Primary Children’s Hospital, where my son first went to receive food therapy. It’s different from other eating disorders like anorexia or bulimia. “Problem feeding” happens when children are scared of most foods, and can only tolerate a select few.
Children with “problem feeding” are different from picky eaters. Picky eaters may eventually give in and eat what’s in front of them if you hold out long enough–and if they are hungry enough. An eating disorder pushes a child to starve or eat something harmful rather than eat an undesired food. Children with this “problem feeding disorder” are only willing or able to eat about 20 or fewer specific food items.
The “undesired” food seems threatening to them, like a grasshopper on their plate, or worse, some kind of monster. Some kids can’t even stand to be in the same room as food they don’t like, because it appears so threatening. It turns out my son is a “problem feeder”, but that hasn’t always been the case. My son used to eat everything, even vegetables! Now I’m learning the skills to turn the food that seems threatening back into something appetizing for him.
My son’s “problem feeding” started when the neurologist, who diagnosed him with autism, strongly recommended that I try a gluten free diet. I did. Following the doctor’s advice, I switched everything with gluten to a gluten free option. Well, my then almost three-year-old revolted. That’s right; it was a one-man-revolution, and it was just the beginning.
He went on a hunger strike meal after meal after meal. When he’d been starving for days, and exhibiting non-stop hunger-induced meltdowns I finally resorted back to his old foods. But he wouldn’t even touch most of that anymore, let alone eat it, except for everything with gluten—ironically.
I’d been struggling ineffectively to get him to eat more, until I discovered he was eligible for food therapy. During his first evaluation I learned multiple strategies from a professional. In the first two weeks of food therapy I made more progress with him than I had in the past two years. Here’s how:
Divide Eating into Several Steps
(It’s a little more complicated than just chewing and swallowing):
- START: The food is a grasshopper.
- Tolerating being in the same room with the food.
- Allowing the food on their plate.
- Interacting with the food:
- Touching the food,
- Smelling the food,
- Playing with the food.
- Touching the food to lips.
- Tasting the food.
- Allowing the food in the mouth.
- Chewing the food.
- Swallowing the food.
- FINISH: The food has become appetizing FOOD.
*WARNING* Pressuring your child to interact with an undesired food can lead to increased issues with problem feeding. Don’t force it. And don’t push your child through the steps too quickly. The process could take weeks or longer for each new food.
Other Tips and Strategies:
- Limit “grazing” (snacking between meals). Make sure the child is hungry at meal time.
- Encourage your child to sit while eating. (This might seem like a no-brainer, but my son is very active and would not tolerate sitting for meal times until recently.) You may consider a high chair OR—if they are older—a chair with arm rests to provide an obstacle to standing up.
- Offer food that is similar to food they already eat—varied in just one way: for example a different shaped chicken nugget, but the same brand; or a different type of cereal, but the same color and similar taste.
- Sensory play with various types of food such as; lentils, rice, beans, and homemade edible playdough. Get creative with this. Maybe allow your child to help prepare dinner by dropping handfuls of rice in water.
- You may consider dipping foods such as Nutella, peanut butter, or honey on cookies or crackers. Dips are transition foods. Even just putting a bit of honey on the plate and dipping the very edge of a cracker in it allows your child a little exposure to a new food.
- Suggest your child give a kiss goodbye to all the undesired food on their plate when they are finished eating. If a child knows this means they can throw it in the trash immediately, they may be comfortable doing this.
Update Spring 2021
With all the delays in addressing aggression, we had to wait to prioritize food therapy again. My child was kicked out the first time for biting his food therapist. (Note to child; Don’t eat the food therapist! Bite food; not people.) We were told to try again after going through more behavior therapy.
We addressed the food problem again at home when my son was in a regular elementary school for second grade. (Fall 2018)
The one-man-revolution continued. And this time he landed himself in Primary Children’s Hospital for surgery. He’d refused to have his diet interfered with to the point of boycotting his main staple at the time—goldfish crackers. Then at a friend’s house he found some magnet jewelry, and ate that instead.
At the hospital they tried to use a minimally invasive method of extracting them by suctioning. But he’d also swallowed slime, so the magnets wouldn’t come out without surgery.
It took another two years before I was willing to try food therapy with him again. He’s down to five or so foods that he is willing to eat, and even more limited with liquids. His behavior team is working on helping him tolerate drinking water.
The plan is to slowly increase the amount, and add more things to his liquid and solid diet until he’s getting the nutrients and hydration he needs.
Progress and survival for the win!
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