Article: Understanding Why Children Won’t Eat and How to Help

Author: Kay Toonmey, Ph.D.

When children won’t eat, parents and professionals are often tempted to classify them in one of two categories: those who have “physical” problems and those who have “behavioral” problems. These kinds of labels are not particularly helpful. First, because there is an implication of blame in this system, which is neither very accurate nor useful when trying to help children with feeding problems. Second, children with physical difficulties often develop behavioral problems after their attempts to eat don’t go well, and children with behavioral eating difficulties develop physical disorders after having poor nutrition for a period of time. So, there isn’t a clear-cut distinction between the two.

Rather than force children into categories where they don’t belong, we need to think about children who won’t eat as having had poor learning experience with food. In other word, just as children learn to eat, they can also be taught not to eat by the circumstances in their lives.

Research shows that learning about food occurs in two main ways. The first is when a connection is made between one stimulus (a natural event, behavior, or object) and a second neutral stimulus. For example, we know that feeling sick to your stomach causes the physical reaction of appetite suppression.  If feeling nauseous (a natural event) is consistently paired with a specific food (previously a neutral thing), eventually the food itself will cause nausea. Another example would be when pain is paired over time with food, as occurs with Gastroesophageal reflux (GER). When that happens a person learns to avoid or escape from situations that involve eating.

The second way that we learn is through reinforcement and punishment. Eating followed by praise or imitation (positive reinforcement) leads to more eating. Similarly, refusing food followed by lots of attention/interaction (also positive reinforcement) leads to more food refusal. So, in addition to increasing desired behaviors, positive reinforcement can cause more of an undesired behavior as well.

Punishment around food is also very powerful. Booth showed that if the learning about food is unpleasant, our bodies turn off our appetites. Weingarten and Martin showed that if negative connections are made to the cues of eating (e.g., sitting down at the table, the utensils used, the people present, the room where meals are eating), a child learns to avoid the feeding situation completely.

The overall goal of all treatment with children who won’t eat is to create a situation that positively reinforces normal, healthy eating patterns through:

Structure- Have a routine for mealtimes, eating in the same room, at the same table, with the same utensils, which capitalizes on the need for repetition in learning.

Social modeling- Allow children to learn through the observation of good mealtime role models. Parents who are poor or picky eaters will have a difficult time helping their children.

Positive reinforcement- Meals need to be pleasant and enjoyable, and any interaction with food should be rewarded. Verbal praise, a smile, a touch, a cheer, and hand clapping are all great options.

Manageable foods- Foods need to be prepared in small, easily chewable bites, or in long, thin strips that a child can easily hold.

Learning about “the physics” of food- The mouth and teeth will need to use hard pressure to break apart a carrot stick. Wiggly, squishy string cheese is chewy in the mouth. Yogurt, which is cold, wet and smooth, can just be sucked down.

When parents understand that eating is a learned behavior, in which there is an interplay between their child’s physical capabilities and his experiences with food, they can take on a positive teaching role with their children rather than a negative/forcing or no-limits approach to feeding. It clarifies for parents that there are things they can do to make the feeding situation better, and gives them hope. The approach also teaches parents, and reminds us professionals, that there are things we can do that may make the situation worse and reminds us how to avoid the pitfalls of working with children who won’t eat.

Article: End your dinnertime battles!

Author: Dr. Lawrence Cohen

Play Dinnertime Games

  • When it’s time to get supper ready, let your child play chef with you. Put on aprons and pretend you’re cooks in a restaurant. Make up silly names for dishes you’re preparing and have some fun adding food coloring to mashed potatoes or other foods. If your child is invested in making the meal, he or she may be more likely to eat it.
  • Avoid real arguments at dinner by making up something unimportant to “pretend argue” about. For example, “Let’s see if we can get through a whole dinner without anyone saying the number seven!” Of course your kids will shout out that number, and you’ll pretend in a silly way to be very upset. While they laugh and play, they may eat up their dinner without a fuss.

Give Kids More Control

  • Some children choose mealtimes to fight battles about independence and self-determination, so giving them some (limited) control over the weekly menu could alleviate some of that tension.
  • You can give kids non-menu control over dinnertime, too. Let your kids choose what color napkins to use and who sits where.
  • Give your picky eater some control over situations in other parts of the day, like selecting what to wear to school and choosing what games to play with you.

Don’t Play Favorites

  • Try not to get into the habit of making kids their favorite foods every night–out of desperation to get them to eat! It’s wonderful to put our love into cooking for our family, but it doesn’t work to cook a child’s favorite food as “proof” of that love.
  • Research on family mealtime suggests that if a child is given the food that everyone else eats, and is matter-of-factly expected to eat it, then they end up eating what the family eats.
  • To make the adjustment to eating the family dinner easier for your child, you might try telling him that you are going to change the rules and only make macaroni and cheese once a week as a special treat. And, again, get your kids involved in the menu planning, the shopping, and the cooking.

See the Big Picture

  • Think about your child’s diet in terms of a week rather than meal by meal. If she gets a decent amount of good food on a weekly basis, it is perfectly fine if she has a dinner that consists of one noodle or one pea!
  • Consider cutting down on snacks and treats (so your child is more likely to be hungry at mealtimes).
  • Try not to worry about your child starving unless she is actually losing weight or getting sick. If you are really concerned about your child not eating enough, a visit to the pediatrician and/or a nutritionist may help calm your worries.

Encourage Adventure!

  • It is important that we understand there is a difference between a child who is reluctant to try anything new or different and a child who has a well-established dislike for one or two foods. It isn’t torture to expect kids to try a taste of a new food every few months, but don’t insist kids eat things they absolutely can’t stand.
  • If kids say they “hate” a food they’ve never tried, what they really mean is that they don’t want to venture beyond their two or three safe foods. In that case, you should keep encouraging them to try it.
  • Here’s a good dinnertime rule you adopt with your family: You don’t have to eat what you hate, but you are only allowed to hate a few things. In other words, you can’t hate every single vegetable and every single protein source. And you can’t hate something you’ve never tried!
  • Whenever your child tries a new food, offer praise.
  • Another approach is to just keep offering the foods that are on your regular rotations of favorite meals. By sheer repetition, these foods will become familiar, and kids will eventually try them and possibly like them.
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