As parents, we want our children to eat a well-balanced and healthy diet, but when your child doesn’t eat his or her vegetables or more than a few selected food items – ensuring your child’s growth can become a constant cause for concern. A feeding disorder is defined as a child or infant who has the inability to take in nutrition in order to meet their needs. For some children the smell and texture of food causes them significant distress which can lead to low growth rates and serious health issues or a failure to thrive diagnosis.
Since 2009, the Peterborough Regional Health Centre’s (PRHC) Family and Youth Clinic has offered a focused intervention for young children and their families dealing with significant food refusal. More recently the service has been a collaborative partnership between the hospital’s Family and Youth, and Paediatric Outpatient Clinic. The clinic treats approximately 60 patients per year for feeding disorders and sees another 60 patients for picky or selective eating concerns.
Most have said or heard the classic mealtime tug of war ‘you can’t leave the table until you finish your dinner’, but this tactic can actually cause more harm than good for children with feeding disorders. “Negative mealtime experiences can be a trigger for children who struggle to eat enough to stay healthy,” says Lise Leahy, Registered Dietitian at PRHC’s Pediatric Outpatient Clinic and Feeding Disorders Clinic. “It’s hard to feel hungry when you are stressed because it’s time to eat.”
The team’s multidisciplinary assessment includes psychology, nutrition, social work and medical providers. The first appointment focuses on getting to know the family and child. “Our goal is to listen to the family’s story and learn when the problems emerged, what the child eats or doesn’t, is there a time of day they eat more, and review the child or infant’s growth and development,” explains Connie Oates, Psychological Associate at PRHC’s Family and Youth Clinic.
The clinic’s family based approach takes a holistic view of the infant or child. The clinic’s team carefully considers all issues that may interfere with healthy eating and contribute to the disorder such as medical complications, hypersensitivities, atypical neurodevelopment such as Autism, stress around feeding or food, anxiety in child or caregiver or gastroesophageal reflux disease(GERD). “Our first task is to remove stress at meal time,” says Leahy. “Through coaching, we teach parents to reduce their own level of stress through deep breaths and positive statements. Once parents believe that their child will eat and that they have a role in helping, we are well on the way to creating a positive meal time experience.”
For example if you are making a stir fry for the family and your child will only eat bread and cheese, then make sure that bread and cheese are on the table for the child to select. “If the bread and cheese are the only items your child eats in a non-stressed situation then it was a positive and successful interaction,” adds Leahy. The child was also exposed to the sight and smell of a stir fry and watched other people enjoy it.
For the Howting family, this advice was instrumental in their 13 month old daughter Evelyn’s success. Evelyn was six weeks old when she was diagnosed with a slow rate of growth. After numerous appointments it was determined that there was nothing physically wrong with her – Evelyn continued to eat, but growth was slow. Then in October 2013, Evelyn came down with the flu and high fever and refused to eat. “Evelyn stopped going into her high chair, or sleeping in her crib,” says Tammara Howting, Evelyn’s mother. “We went to Emergency, but after a week of no sleep and little feeding – it was clear that we needed help.”
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In November, the Howting family was referred to PRHC’s Feeding Disorder clinic. After gathering Evelyn’s story, clinic staff members determined that Evelyn’s illness caused stomach pain which contributed to Evelyn’s refusal to eat and sleep. For Evelyn, she associated her stomach pain to eating in her highchair and sleeping in her crib. “Connie and Lise taught us to give Evelyn foods that she always liked eating,” notes Howting. “We now give her a ‘mum’s cookie’ on her highchair to signal that it’s time to eat and Evelyn now sits in her chair again.” After three months of clinic appointment, Tammara and Evelyn are seeing progress. “Evelyn now sleeps in her crib again,” said Howting. “Another strategy the clinic taught us was to never leave her bedroom when she was upset. This teaches Evelyn that her room is a happy and safe place.”
Now at 16.5 lbs, Evelyn is still small for her age, but the Howting family has tools and strategies to help their daughter grow. “We still get the odd ‘your child weighs how much comment’, but it’s wonderful to know we have people on our team supporting us,” says Howting. “PRHC’s Feeding Disorders Clinic provides compassionate care – in the beginning they met with us weekly, answered all our questions, and reassured us that we were not to blame for Evelyn’s slow growth.”
Another strategy used at the clinic involves parents packing a picnic or snack to bring to their second appointment made up of food that their child usually eats. “With the parents’ permission we video tape these sessions, and use the footage to identify opportunities and tactics to use when trying to introduce a new food or getting a child to eat more of the same food that he/she enjoys,” noted Leahy.
“One of the biggest challenges facing families attending the clinic is that change will not happen overnight,” added Oates. “The ongoing medical monitoring of growth and liaison with the infant or child’s physician is a key to easing parental anxiety. Families are encouraged to keep a mealtime journal and document information like what mealtime was easier than others, what worked well, what your child ate, touched, or smelled.”
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It’s important to remember that children are curious by nature and will start to show signs that they are interested in other types of food. Parents are encouraged to provide opportunities for their child to interact with food such as going to the grocery store, helping to prepare snacks, growing a garden or even using food for art projects. Listen for key phases such as ‘that smells good or what is it?’ and watch for your child noticing where you place food during meals to gauge his/her interest and reaction.
If you think your child has a feeding disorder or if you have concerns regarding his/her picky or selective eating habits, speak to your family doctor or Nurse Practitioner. Some symptoms to look for include highly restrictive food choices, significant conflict involving meal times or feeding, frequent refusal to approach the table for meals, gastrointestinal distress, and failure to grow or slow growth rate.
