BEST PRACTICE
Finding the root of food refusal
Dr Gill Harris, consultant paediatric clinical psychologist and an expert panel member of the not-for-profit Infant and Toddler Forum, shares her expert advice on understanding food avoidance in under-fives
I’m guessing that, as you read this, you’re sitting in the staff room on your break. You have a cup of something hot to hand and possibly a biscuit. You know exactly what to expect when sipping your drink and eating your biscuit – after all, you made the drink and possibly bought the biscuits, too.
No-one is telling you to eat the biscuit, and no-one is watching you anxiously while you do it.
But what does this have to do with children who refuse food?
Sensory challenges
Think about your biscuit. You know what this biscuit should taste like and how it should feel when you put it into your mouth. But what if I gave you a biscuit with a strong, unusual taste – too salty or spicy, perhaps – and it had odd, chewy pieces inside?
You pull a face. You might gag on the unexpected chewy pieces and spit it out. You’d probably avoid taking a biscuit from me again. Next time, when looking for biscuits in the staff room, you’ll check the packet – is it one you recognise? You’d most likely think to inspect the biscuit before eating it.
Match/mismatch
We usually check and discard food that doesn’t look like it ‘should’ (consider all the wonky fruit and veg rejected at the supermarket). After all, rejecting food that ‘doesn’t look right’ has helped humans to avoid poisonous foods and survive for centuries. Back to the staff room.
Someone shares around a dragon fruit. It has odd speckles, so you approach with caution.
Does the person who gave it to you eat it? You might try a small bite, but the decision is ultimately under your control. No-one is telling you to eat it. The taste is odd, so you put it down. The others are watching, and that’s stressful; you won’t try any more.
The ‘picky’ toddler – sensory sensitivity to food taste and texture
A part of the brain designed to help humanity survive triggers anxiety and fear – feelings that can be engaged when toddlers are given new or slightly different foods. There is an interaction with sensory monitoring, and the effect can be seen at two age points. This reactivity can be seen from infancy when solids are first introduced. It might be that different foods have not been introduced in a timely fashion. More likely, it’s because the infant has a genetically-determined sensoryreactivity.
“I am not used to this taste and don’t like it. The texture is uncomfortable in my mouth. I don’t want to move that food into the sides of my mouth, so I have to try and swallow it whole. I gag. I am anxious.”
Fear of the different –the ‘food neophobic’ response
From around 20 months, there are neophobic responses to new faces and toys. These fears are in response to a ‘match/mismatch’ threat.
“I have learned about one thing; this different example doesn’t match, so I must be fearful.”
“I have learned to like some foods, but that one ‘doesn’t look the same’, or ‘it is like a food I have had – but not quite.”
Some toddlers will, of course, be both sensory reactive and neophobic!
How to help?
Food avoidance is based on anxiety and fear. When anxious, food intake and ‘willingness to try’ decreases, while sensory sensitivity and food ‘monitoring’ increases.
So, avoid:
- withholding accepted foods.
- putting new foods on the plate with accepted foods.
- prompting or coaxing to eat new foods.
- sitting the child in front of a plate full of new foods – they will not eat them!
How might someone get you to try that strange fruit one more time?
Perhaps, if the toddler:
- sees other children or adults happily eating the food.
- can handle the food, smell it, look at it, without being asked to eat it.
- sees the food is just around, not on their plate, without pressure to eat it.
Find more guidance and tips on coping with food refusal at bit.ly/ITF-food-refusal-tips.
Download factsheets for parents and childcare professionals on extreme food refusal at bit.ly/ITF-extreme-food-refusal.
Remember the match/mismatch
A toddler is more likely to eat new foods if:
- it looks like foods they already eat.
- they see photos, pictures, packets of the foods.
- if you remember that the texture of food can be ‘recognised’ just by looking at it.
But, for some infants and toddlers, even this will not work.
They might need sensory desensitisation before they can tolerate that taste, texture, smell – or even the sight – of the food.
The priority is then to:
- maintain calorie intake with easily accepted foods.
- keep anxiety around meals/snacks low.
- check for sensory processing difficulties, and possibly refer on. Extreme food avoidance is commonly seen in those who are on the autism spectrum.
The Alliance’s Nutrition Support Programme works to improve the future health outcomes of young children by setting a standard for nutrition practice in early years settings.
Our nutrition packages are bespoke – which means that, rather than offering a prescriptive, rigid programme, we provide flexible support tailored to your needs.
A team of qualified early years dieticians and nutritionists at the Alliance work alongside setting managers, educators and cooks to produce tailored advice and support across a range of topics – including menu reviews and allergen advice
Find out more and register your interest to receive a free, 30-minute taste support session here: bit.ly/NSP-June24.