In my blog posts I’ve given a lot of advice around picky eating. However sometimes children’s eating is not simply picky. Sometimes children’s eating is seriously restricted and food and mealtimes cause a great deal of distress. In this blog I’ll look at what happens when eating is affected by wider developmental difficulties and at what point parents might choose to seek professional support.
Physical development and eating
Developing the ability to eat solid food when you’re a baby is a fascinating process. New born babies’ mouths are built for sucking. Space is very limited; their palates are soft and low; their mouths and throats are close together and they have large, plump, sucking pads in their cheeks. There are other differences. Babies have a lower jaw that is slightly pulled back and a tongue that fills their mouth at rest.
Of course this mouth shape is extremely helpful for suckling from the breast and swallowing milk but it makes eating solid foods tricky. So babies’ mouths develop and change to create extra space for eating. Throats move back, palates harden and move upwards and cheeks hollow out. Many people believe that we need teeth to chew but babies manage to deal with a surprising range of foods by moving them around increasingly spacious mouths.
As babies turn into toddlers their gagging reflex reduces and they become more experienced swallowing solid food. They are able to sit up and feed themselves, judge how to get food into their mouth, how to manage cups and cutlery and how to hold their body so that they can eat comfortably. These bigger movements are referred to as gross motor co-ordination as opposed to fine motor co-ordination.
Sometimes a child’s development is disrupted or delayed and this can impact significantly on their eating. For instance:
frequent gag response even as they leave toddlerhood far behind.
difficulty with fine and/or gross motor co-ordination,
becoming easily overloaded with sensory information or
more globally impaired development.
When children have significant developmental delay or difficulty, advice that is helpful for general fussy eating can in some cases become counter productive. Spacing out meals and insisting that children are allowed to become hungry can act to reduce appetite rather than improving it. Trying to balance different foods by serving rejected foods can lead to a child refusing previously accepted food. And of course children and parents become extremely distressed.
How to tell if you need extra support
It is difficult to give clear advice about when to seek help because every child and family differs. Below I outline five potential pointers which might prompt you to visit your GP or find expert support:
If a child’s height, weight and growth are affected: If you notice that your child is smaller than peers or you feel he or she is particularly thin or seems generally unhealthy.
If, after you try and keep to a positive, gentle routine, introducing new foods very gradually, your child continues to cut down the already restricted foods that he or she will eat.
If your child experienced a lot of reflux as a baby or was tube fed leading to delays learning to feed which have never been fully resolved.
If your child has developmental delays such as ADHD, autistic spectrum disorders, sensory integration problems, gross motor delay (such that they have come to the attention of specialists previously).
If you find yourself caught in a cycle of stress and anxiety around food and mealtimes and you simply feel, as a parent, that things are not right or that you and your child could do with some support.
The type of help that will be suitable will vary. Sometimes for children with significant difficulties or delay it will be helpful to involve a team of professionals including dieticians, speech and language specialists (who understand the mechanics of eating) and psychologists who will look at the emotions and behaviours around food refusal. Sometimes when a child's difficulties are more emotions based a psychological approach on its own is enough.
I've outlined physical and developmental difficulties that might indicate the need for further support. However sometimes the level of distress you feel around a child's eating when there are no other complicating factors can be enough to make seeking extra support important. The bottom line is that if you're in any doubt ask for advice. If all is actually fine then you'll get support and some thoughtful ideas. If there are problems then a timely intervention can make an enormous difference.