Many children are fussy or selective eaters, which means that they eat little varied or limited food. This can be temporary or long-term. If a child has an autism spectrum disorder, there is a greater chance that he or she will also develop eating problems, but children without a diagnosis can also be picky eaters. For example, such a child eats too little, too much or is very picky. How do you determine if your child is a selective eater? And what can you do about it as a parent or educator?
- A fussy or selective eater?
- Eating problem?
- The conditions for a good approach
- Plan of action part 1: You change the environment
- Plan of action part 2: You practice the child’s skills
- Improvement or acceptance?
A fussy or selective eater?
Children with or without autism can be fussy or critical eaters. They like to decide for themselves what they eat and can be very rigid about what is or is not on the menu. They may have a preference for food with a certain color, smell, taste, shape or texture (the texture is how the food feels in your mouth). For example, children with autism are known to like to eat beige foods: pasta, bread, and the like. Selective eaters are children who may only eat ten to fifteen foods. They often do not eat dishes, but types of food: plain pasta, sausages, cheese, or desserts of a certain brand (and not otherwise!). There are children who do not feel the hunger stimulus sufficiently. You have to remind them often that it is time to eat. Other children are hungry all the time. When they see food, they immediately want to taste it. It is understandable that as a parent or educator you want to try to influence your child’s eating behavior. So that your child eats healthier or more/less.
Eating problem?
Children can sometimes have little appetite, for example when they become or are ill. Temporary loss of appetite also occurs. Especially when children have been ill or when they are going through a growth spurt. In times of stress, fatigue or tension, your child may be a bit more fussy than normal. It doesn’t want to eat certain things, or it does. Or want it served in a certain way, for example that the pasta and sauce should not be mixed.
But sometimes it doesn’t just go away. If you continue to worry, you can keep a food diary. You write down everything your child eats and drinks in it. This way you can assess whether your child is getting enough, too little or too much and whether the food meets the guidelines for healthy eating of the Nutrition Center. If necessary, you can start a conversation with your doctor, dietitian or other expert based on this food diary. If you want to tackle eating problems, it is important to ensure that they do not degenerate into a power struggle with your child. That doesn’t help anyone. That is why it is important to make a good plan of action. A number of books such as ‘Oh dear, I eat. Food book for children with autism’ by Karen den Dekker (2017) and ‘Small eaters. Toddlers and Preschoolers with Eating Problems’ by Els Hofman (2006) provides good advice for dealing with eating problems. They then focus on the basic conditions, the family and the child and thus arrive at a broad approach.
The conditions for a good approach
Before you start, it is important to list a number of things so that they are clear. These are the conditions for a good approach to your child’s eating problem.
Look at your child
As a parent you are your child’s expert. By watching carefully you often know what your child is reacting to. You know in advance whether he or she will like something and why and what makes him or her anxious or angry. If you consider how an eating problem arises, you can find out what this is like for your child. How are his or her oral motor skills? Does it have difficulty swallowing and therefore prefers to eat pureed food? Is your child very sensitive to the smell of food? Does it help to cook with the window open, so that your child does not feel full before the meal can start? Remember that the cause of difficult eating is also an entry point to its solution!
Set priorities
Before you start changing anything, first think carefully about what the biggest problem is. If your child eats little, has a very limited diet and experiences a lot of tension and stress around eating, choose something to start with and don’t try to tackle everything at once. If necessary, use the completed food diary as an aid. If necessary, consult with your GP, dietitian or expert, so that they can take a look with you.
Tackle the fear first
It is important to first ensure that your child feels safe enough. Look at where the fear and confusion is coming from and address them first before addressing the eating issues. Involve the child’s entire environment, including school, for example.
Many children are not just rude or stubborn when they don’t like something, but are genuinely afraid. If you, as a parent, accept that it is inability and not unwillingness, it will help you come up with a good plan of action. How do you know that your child is afraid if he or she does not express it?
- He or she keeps asking questions
- He or she talks constantly (and sometimes incoherently) about a certain topic
- He or she clings more strongly to routines and rituals or suffers more from tics
- He or she sleeps worse, has difficulty falling asleep, staying asleep and/or wakes up early
- He or she has a stronger resistance to change
- He or she has an increasing need to avoid or control
The very idea that something is going to change is exciting for many children. Before you know it, it digs in its heels and becomes impossible to move. You want to prevent that. Reassuring, keeping an overview and showing what is happening can help. There must be a basic peace as a foundation. Otherwise you can’t build anything. Karen den Dekker calls this in her book ‘O dear, I eat’ (2018) completing the circle of safety. Only when everything is safe for your child can you make a small opening in the circle, so that you introduce something new from a safe situation. For example, a child who attaches great importance to safety and finds support from rituals or a child with autism can develop more easily.
Visualize as much as possible
Use as many pictures or pictograms as possible of the food, of the eating moments, the menu, the meal, and the number of cups of drinks needed per day. Images say more than words and come through faster. By visualizing what you expect and/or what your child can expect (in time and activity) you can communicate this better.
You can make the dining situation and the menu clear with the help of icons. Explain in pictures what happens and what the rules are: washing hands before eating, at the table, eating, clearing the table. What is eaten: bread meal, breakfast cereals or yoghurt, hot food?
Think in (very) small steps
If you know what you want to tackle first and your child feels safe enough, divide what you want to achieve into small steps. And then make it even smaller steps if you can. Everything is profit. If you want a child to taste something, a first step is, for example, to show the food, this can even be done first on a picture and then in real life, then your child may be able to touch it with his fingers or feel it with the tip of his finger. the tongue. But maybe playing with it is a step ahead, depending on your child’s age. Let your child stamp with potatoes, string chains with pasta, paint with fruit or vegetable juice. Playing with food can be a good way to get your child used to food. Especially if they have sensory problems. You can then agree to taste a snack and not do anything else. You can expand this again later, depending on your child’s reaction. This is about slow habituation.
Dietary supplements?
If you are very concerned, consult your doctor or dietitian about your child’s nutritional supplements. If you worry a lot, you are probably too tense to look at your child objectively. That hinders you and your child. That is why it is important to see if you can reassure yourself (and thus calm your child). A multivitamin preparation can never replace whole food (although it can help). Fortified foods, such as syrups with extra vitamins, can also be an option if your child does not consume enough vitamins or minerals. Through the dietitian or GP it is possible to arrange nutridrink, calogen or phantomalt as medicinal supplementary food, for example, if a child is consuming worryingly little and is in danger of becoming malnourished. This should always be done under medical supervision and is often reimbursed by health insurance. It is then important that the correct indication is stated on the application form that the treating doctor or dietician completes for the supplier. In addition, a supplier must be selected with which the health insurance has a contract for the supply of this supplementary food (otherwise special permission is required in advance). A phone call to the health insurance often provides a solution.
Distinguish between a social eating situation and a physical eating situation
Children who have difficulty eating may find it extra difficult when they are asked to eat or eat in social situations. You can hardly expect a child who receives so many stimuli during a party to also be able to eat. For example, let it be eaten separately first, separate from the party. Then you make a distinction between the social and the physical eating situation. This way you keep it fun and your child won’t be hungry during the party, so that they can enjoy themselves and have a positive social experience. Eating some of it during the party is nice, but not necessary. For example, you can also let a child who does not eat at school eat separately in a classroom, possibly at a different time than the usual break and lunch time. In primary school, where the issue of supervision is even more important, the child may be able to eat in the secretariat or outside the classroom in full view of the teacher.
Plan of action part 1: You change the environment
By adapting the environment to your child, you can make eating and mealtimes easier.
Pay attention to the diet and the message policy
As mentioned, you can use the Wheel of Five as a guideline. Pay more attention to quality than quantity, if possible. Also try to pay attention to what your child eats. This way you naturally keep things more positive. Make a shopping list and don’t go shopping hungry or tired, so that you are sure to get healthy food.
Build up eating rhythm and hunger
Provide fixed meals and times: three main meals and a maximum of three snacks, if possible.
Give time and structure to the meal
Warn your child in time when it is almost dinner time. Give meals a clear beginning and end. As a parent you set the rules and are in charge, but your child decides how much to eat and what to eat. Avoid haste, tension and stress. If your child is too tired to eat in the evening, try moving the meal time forward.
Give due attention to food
Don’t pay too much attention to bad or no food. Don’t divide food into healthy and unhealthy. By emphasizing that vegetables are healthy and sweets are unhealthy, for example, you only increase resistance to vegetables. Of course it is good to emphasize that your child needs all the building materials to grow properly. But don’t label your child as picky. Avoid labels or comparisons. Focus on peace and conviviality while eating. Let everyone take turns talking: nibble and chat.
Pay attention to communication, presentation and atmosphere
Make sure the rules for meals and eating are clear and concrete. Share your day with each other. Talk to each other and listen to each other. Set the table nicely. Present the food beautifully on the plate. By being positive you link the meal to a good feeling. You can ensure that there are fewer stimuli for your child while eating. So don’t leave the pan on the table while eating, if your child can feel full just from the smells of food. It may be too busy at the table and it is more convenient for your child to eat first or after the rest of the family has eaten. Sometimes seeing others eat can provide too much stimulation. At daycare or school it can be useful to designate a separate corner or a separate eating moment, separate from the others, so that your child can eat in peace. Many children love the crunchy feel and sound of food in their mouths. It is often also a sign of freshness, so this preference is also obvious from an evolutionary perspective. Just because they think it sounds nice to themselves does not mean that it is not an extra stimulus when others are eating. Strong odors such as peppermint can also take away your appetite.
Maintain a certain approach for a pre-agreed amount of time
Agree in advance how long you will try an approach. That gives you something to hold on to. Don’t set the bar too high. Neither for your child, nor for yourself. In the meantime, monitor your child’s growth and health. If necessary, make an additional appointment at the Consultation Bureau (CB), the Parent and Child Center (OKC) or the Youth Health Care (JGZ) to keep track of your child’s weight and height. Keep a food diary. Write down everything your child eats and drinks. If necessary, refer it to an expert. If you let your child taste an unfamiliar food (whether this is a dish or a food item), you should continue to offer it regularly for at least six months or more.
Give rewards and praise
Children can be very sensitive to rewards. Don’t punish your child. A child learns more from positive feedback, what do you expect from him/her, than from negative feedback, what is he or she doing wrong, because he or she does not automatically know what he or she must or may do. Be careful that a reward is not seen as coercion. If you promise something that your child really wants, your child may experience it as coercion. Give a child specific compliments and focus on what your child does, not what your child is. After all, it cannot do or change anything about that. Try not to comment, positive or negative, about what your child eats or how much they eat.
Investigate what place food has in the family
Write a description of the family’s eating habits. What are the rituals and routines surrounding food in the family. Sometimes your child not eating or eating a lot is a signal. For example, there is a lot of tension at home. Solve family problems together. The food can also be stressful for the parents from the past, causing your child to suffer from it now. Address this and, if possible, involve all generations involved. Take a critical look at your own eating habits and weight. Try to prevent problems for your child. Trust the strength of yourself and your child. Focus not only on what is not going well, but also on what is going well. Find relaxation and fun alone and together. This is how you keep it up. If you need help, reach out. You can be the chairman or the trainer of the football or hockey club, and thus determine who walks around on the field and what happens, but you cannot possibly occupy all the positions on the field to score goals. And you don’t have to.
Plan of action part 2: You practice the child’s skills
Learning to get used to food: how do you learn to like something?
Habituation
There are more ways to taste food than just with your mouth. Smelling, looking, holding, kneading all provide information that helps you get used to certain foods.
Prepare your child for what he will taste, predict in words what he will taste. Don’t make a promotional speech, but provide neutral information. Describe the taste, tell something about the texture, the taste, the smell, the color. Put words to the food and its preparation. In this way, children develop their frame of reference and learn not to always experience one type of food separately, but to classify it into food categories: a cucumber is a cucumber, a hard dark green skin and a soft light green inside with seeds. Even though it is sometimes bigger or smaller, thicker or thinner, harder or softer, more ripe or less ripe, cooked, fried or raw.
Let your child smell the food first. This way it already gets an idea of what it will taste. If you expect coffee and you drink a sip of tea, it doesn’t taste good. Good preparation, in word and deed, gives your child a better idea of what to expect.
You can agree on a fixed time with your child, on a fixed day every week, to try something new. You can let your child choose from a number of things. Then your child has a choice, but you still remain in control.
You can also agree in advance on certain types of food to taste. You can put this on a list, with a picture, so that your child can check when he or she tasted it and what he or she thought of it: smiley or not?
Let your child taste a bite of the new food and then give the child the familiar food. This could be a snack of sandwich with unknown toppings, it could be a snack of a hot meal. It is important that your child knows that after tasting he or she can rely on the safety of his or her familiar food. You can
make a list of his or her favorite foods with your child. You can divide this into the Wheel of Five and then look together at what is lacking and how you might be able to tackle this. Is there anything your child would like to try?
Make a list with your child that includes food that your child does not like (red), food that your child is going to try (orange) and food that your child does not like (green). Place these in columns next to each other, so that you have a vertical traffic light. This way you help your child keep an overview and give the child a sense of control. To be able to make the list and keep control yourself, you can make a test table. You then place a number of foods on the table, which your child can divide into red, orange or green.
As a parent you can pay close attention to what your child is eating and follow up accordingly. If your child eats pasta, maybe he or she also likes noodles?
For young children, shape is still very important. If a child does not eat bread, try making shapes in the bread in the shape of his or her favorite animal or object. You may also be able to adjust the color.
Is your child very restless while eating and tasting new things? Then provide aids, such as watching a movie or letting him or her hold something that he or she likes to feel .
The function of food
Help your child understand why we eat as humans. What does our body need to grow, to live? What are the building blocks for good nutrition? How does digestion work?
Read a book with your child about the body, about digestion, or about how your food ultimately ends up on your plate, via farmer or factory. Karen den Dekker’s book ‘Oh dear, I eat’ provides many practical examples, tips and recipes, with a chapter specifically aimed at children with autism.
Let eating be an adventure
Tell a story about food or nutrition yourself or make up a story with your child. There are also beautiful stories about food, such as the Big Eet book by Guido van Genechten (Clavis publishers), Broccoli in my ice cream! from Emily MacKenzie (publisher Van Goor), Anna likes to eat fruit from Kathleen Amant (publisher Clavis) or Chef Sjef from Esmee van Doorn (publisher Van Holkema & Warendorf).
Let your child cook for himself
Cook together with your child or let your child (as a first step) choose the menu. Also involve your child in the shopping list and shopping if possible. You can come up with something yourself, but there are also very fun and accessible cookbooks for children.
Do it together
Don’t just let your child taste it, but set a goal for the whole family. For example, agree that you should all taste something new.
Improvement or acceptance?
Sometimes you have to leave your child’s eating problem aside for a while. When they are just starting a new class, when they are on holiday or when their birthday is approaching. ‘Choose consciously’ is the motto. Are you still in doubt? Then seek advice from your doctor or dietician or have your child weighed and measured regularly, so that you can monitor its growth together with an expert. Sometimes it may be necessary to call for professional help, such as from SeysCentra (a treatment center specialized in food refusal and a selective eating pattern), with branches in North and South Holland, Utrecht and Limburg. A pediatrician or child psychiatrist will make the referral.
Your child may never eat as healthily as you would like. Then it is important not to continue to strive for improvement, but to accept this. The eating problem may be part of your child. The goal is no longer to learn to eat so-called normally, but to eat without tension. As long as your child follows his or her own growth curve, it is best to let it go, temporarily or forever. A good relationship with your child, a good atmosphere in the home and a child who feels good about himself or herself: that is what it is ultimately all about.