‘Picky/Fussy/Selective/ Eating’ …for neurodiverse and neurotypical children

Would you describe your child as a Picky eater? Fussy? Selective? Difficult to feed? Emotional around food? Are you a parent of a neurodiverse child that has feeding struggles? This one is for you…

‘Picky’ eating and feeding struggles are a lot more common than most parents think. ‘Picky/fussy/ selective eating’ are all terms used to label a child’s eating that may not be ‘up to par’ according to their parents or others. It could mean that your child just doesn’t like vegetables, or it could mean they only accept a handful of foods…. Those of you reading will have children with all varying levels of struggles and food acceptance skills.

In the health focused world that we now live in, society has led us to believe that our little ones should be eating all 5 five food groups, in the same way we do at quite an early age. This can be unrealistic for even non picky eaters. Because us adults have been eating for such a long time it can be hard for us to remember that eating is a very complex skill. Food learning and accepting is a long journey that requires gross and fine motor skills, and asks children to use all 5 senses. Each new food comes with a new sight, smell, feel, texture and taste. To make things harder, foods can differ a lot depending on how they are cooked and served. Children usually start by accepting ‘easy to like’ foods. These are usually carbohydrate, sweet foods (pasta, bread, treats). These foods get a pretty bad wrap (sugar now being labelled the bag guy, replacing fat) - but carbohydrate foods are essential to a child’s growth and development. These cravings slowly diminish with maturity. Children enjoying these foods should be a part of a normal balanced diet, it is ok for them to enjoy ‘easy to like’ foods whilst still learning to like others. You might have heard that children may need 10 exposures to a food before they accept it…try 100 - 1000. It can take years for a child to accept a food.

Picky eating can cause lots of worry and concern in parents - especially when children may only accept a handful of foods. Parents feel a need to feed and nourish in the best way possible, so the concern is understandable and there for good reason. Although strategies to ‘get children to eat’ come from a place of love and care…they can often backfire and cause more and more resistance from your child, causing more frustration. Sometimes these strategies used by concerned parents don’t feel RIGHT to them, and can make mealtimes start to feel like a battleground… ‘Getting’ children to eat is A LOT easier said than done - most of you know this all too well. It can be hard to hear advice from others (including loved ones) to just ‘make them eat it’ - this may come from other parents that have more enthusiastic eaters, or from those with traditional views of feeding. Most of us were brought up being ‘made’ to eat vegetables and believe this is the best way to feed. This may work for some children, but evidence has now proven this to be false for many.

Neurodiverse children can run into more (and bigger) hurdles when learning to eat new foods. Selective eating is a lot more common among these children. This can be associated with sensory issues, managing anxiety around food, appetite regulation, etc. Neurotypical children can also find eating difficult in relation to these things. Sensory issues may be associated with; sensory avoidance (food can be ‘intense’ - likes bland foods, pockets food in cheeks) OR sensory seeking (food is ‘turned down’ - likes strong flavours, crunchy textures), OR a mixture of both. Sensory preferences are also what the feeding environment looks and feels like, for example: colours of plates, noise at mealtimes (TV, siblings, pets, cutlery), seating, etc.

Understanding a child’s sensory preference is important. A child’s temperament can also impact how they approach food. For example, a cautious child may not feel comfortable trying new foods. An anxious child may find it hard to grow an appetite that allows them to eat enough for what they need. A child with an independent nature who is highly intelligent may be very tuned into parents pressure to eat certain foods and this may increase food refusal. The list goes on… Other factors that can impact eating… Medical issues including, reflux, severe constipation, anything that has caused pain and nausea can cause a child to have feeding struggles as they avoid these negative feelings associated with eating.

Oral motor challenges that includes any physical issue that makes it hard to get food to the mouth, chew, swallow, or sit up can affect eating. Negative experiences like choking, aspiration, vomiting, forced feeding can cause children to have a fear of eating. As we can see there are so many variables that impact a child’s ability to grow into a competent eater.

To get them there it is important to focus on the HOW of feeding. For children to accept new foods it takes a lot more than just putting it on their plate 1000 times.

The following are very important for neurodiverse children…

• They need to trust you. Trust that they will be fed enough of foods they can accept now to satisfy them

• They need to feel safe and comfortable. This includes a sensory friendly environment.

• They need to feel supported by their loved ones and see them enjoying new foods.

• They need to feel capable. Capable in eating, exploring, trying.

• Mealtimes need to be pleasant (whatever pleasant means for you and your family).

• Pressure to eat a certain amount or certain foods needs to be removed. This removes resistance and refusal.

When these things are achieved food learning can start to occur. Children are naturally curious and food exploring is an enjoyment. As a paediatric dietitian I can help support feeding struggles, picky/fussy eating. I aim to work alongside you and your family in a responsive way.

If you have any level of concern about your child’s eating, please don’t hesitate to book an appointment. If you have any questions feel free to email, kirsty@baysidehealthnook.com.au

Yours in health,

Kirsty, Paediatric Dietician

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