Most of us eat at least three meals a day but if you are like me, there are multiple snacks in between. That’s a lot of time spent eating! One of my favorite times of day is dinner time, but when you have a child with food anxiety, dinner time can turn into anything but fun or pleasant. Meals can become a battle for some families. Children newly home may be nervous or feel like they have “butterflies” in their stomach and may not desire to eat. Common food related issues foster and adoptive parents face include eating larger amounts of food than necessary for a child his age or size, gorging, vomiting after eating too much, stealing, hoarding, eating slowly or picking at food, refusal to eat certain foods, craving sugary foods, having meltdowns during meal-preparation, requesting something different or a snack soon after finishing a meal, and using food as a means of control. All of these behaviors can be a sign that your child may have food anxiety. Although the challenges may differ from child-to-child, food related issues are one of the most common difficulties families face post-placement.
Why Children Have Food Anxiety: While not exhaustive, this list provides the most prevalent reasons for food issues.
¨ Medical issues: Defiance or picky eating may have underlying medical causes such as food allergies, gastrointestinal issues, or eating disorders. Discuss concerns with your child’s doctor.
¨ Sensory issues: Children with histories of trauma (including in-utero and at a very early age) can experience sensory issues that could affect their food preferences. Sometimes routine avoidance or preference to certain colors, textures, or experiences can be a sign of sensory issues or sensory processing disorder, which can create anxiety surrounding eating. If you suspect this is the case seek the help of an Occupational Therapist trained in food related issues.
¨ Neglect/malnutrition: According to the authors of The Connected Child, children who have endured neglect and malnutrition early in life have a fear of starvation that has been “hardwired” in their brains. They truly fear that “starvation is just around the corner” (Purvis et al., 2007). They may not believe that they will get enough to eat or know when their next meal will come; they operate from a place of survival. Furthermore, according to the authors of Healing Parents, Orlans and Levy, children who have experienced maltreatment may be more susceptible to swift shifts between high and low blood sugar levels leading to sugar cravings .
¨ Repeating maladaptive patterns: Children with difficult histories may have had to hoard, beg, or steal in order to get fed. A child with this type of past may have learned that these behaviors are appropriate and necessary to provide food for himself and possibly even his family. A child may continue repeating these unhealthy learned behaviors without intervention from a patient, gentle, understanding caregiver who consistently meets his needs over a long period of time.
¨ Using food to gain control: According to Orlans and Levy, many foster and adoptive families experience control battles surrounding food. Children who have lacked control in the past may desire control in many areas including when, how, and what they eat as a way to feel safe. They may think, “If I have control over my food and eating habits, there is no way someone can use it to hurt me”.
¨ Food as a source of comfort: Many of us, can relate to food as comforting. Some of you may find solace in a home-cooked meal. Some of you may seek relief from chocolate or sweets when you have had a challenging day. In the same way you find foods comforting, so can your child. A child with food anxiety may find more solace in food than in the relationships with the safe caregivers who provide it. In addition, some children place so much value on food that when they are taken away from certain foods it causes anxiety.
¨ Newness of food/placement: If your child is new to your home, either through foster care or recently adopted, your cuisine may be different to them. The food you serve may be different in taste, texture and smell. They may be used to different cultural foods or even less healthy foods than what you are providing.
How to Respond:
Now that you know some of the possible reasons children have food anxiety, I encourage you to look beneath the presenting, challenging behaviors for the need. Figuring out your child’s underlying needs will help you know how to best respond. Looking for underlying needs will also build up your compassion towards your child when mealtimes are more challenging. I encourage you to remain calm around eating and be proactively prepared for and expect challenges so you are not emotionally disappointed or frustrated when they arise. As you read the list below keep in mind your role as the parent, that every child is different, and be creative and flexible in your approach while trying different things to meet your child’s need.
¨ Post a visual daily schedule that includes food icons each time there will be a snack or meal provided to decrease anxiety of not knowing when the next meal will come.
¨ Have healthy food options available for your child to eat at all times. Keep healthy snacks on the kitchen table, common area, bedside table, in your child’s backpack or in your bag. Give your child “voice” by encouraging your child to ask for food when hungry, praise them for asking and say yes as often as possible. Instruct your child that they can eat these snacks whenever they feel necessary. Healthy options include snacks that are minimally processed, rich in vitamins and minerals, and have few or no additives, including fruits, vegetables, natural juices, yogurt, high-fiber cereals, nuts, granola bars, and whole grain bread, crackers and pasta. A well balanced diet keeps their blood sugar level and meets nutritional needs.
¨ Provide food to your child every 2-3 hours in order to keep blood sugar stabilized.
¨ Give your child a multi-vitamin daily as a supplement when they are not eating well.
¨ When child enters care allow them time to transition to a new diet. Balance healthy and unhealthy options initially, and slowly integrate more healthy foods into their diet over time.
¨ Don’t tempt your children by having a house-full of unhealthy foods that they are not allowed to eat; rather teach appropriate times for not-so-healthy snacks such as dessert after dinner.
¨ Give them some control over food by letting them help serve dinner. They will see and learn why some people need more food than others (like grown-ups) and you can teach that more food does not mean one person is more important or more worthy of food than another.
¨ If meal preparation is a difficult time, give them a role during that time or have a small snack available that they can eat while waiting for the meal.
¨ If they desire to eat a lot, let them eat until they vomit as a natural consequence. This can be hard to do as parents and should be used with appropriate caution but sometimes this natural consequence can help a child learn when he is full or what “enough” means to him.
¨ You may instruct your child that everything will go on your plate but you are not expected to try every thing. For some children you will need to start by simply saying you only have to pick certain foods up with the spoon one time then graduate to you only have to put the food up to your mouth one time, then you only have to put it in your mouth but not swallow one time, and finally you only have to try it one time. This gradual introduction to new foods can help some children who have challenges with change get used to newer foods.
¨ When a child uses food as a control tactic and eats slowly, provide them with sufficient time to eat and let them continue eating while you clean up and the rest of the family moves onto the next activity. Don’t rush them or allow them to control the amount of time the family remains around the table together. This may mean that your child has to finish meals on-the-go at times.
¨ For a child who appears to have finished his meal but routinely has a tantrum when you remove his plate, you can tell and show him where you will keep his leftovers. He can return to eating whenever he needs to throughout the day, and don’t dispose of the food immediately.
Conclusion: Be a calm, proactive, and engaged parent who expects challenges and is willing to work through challenges together with your child. Provide a relaxed mealtime atmosphere. If you feel your dinners are chaotic, the child in your care will too. Play calming music, avoid talking about the day’s problems, and plan ahead so you can take your time during meals rather than rushing. Engage in fun discussions during meals. Focus on building overall attachment with your child meeting their needs , and soon their insecurity around food will begin to diminish.
Developed by: Ashley Yeager, LICSW
References: Kranowitz, C. S. (2005). The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder. New York: Skylight Press.
Kranowitz, Carol. (2016, February). The Out-Of-Sync Child: Understanding Sensory Processing Disorder. Training presented at Harris Early Learning Center, Birmingham, Alabama.
Orlans, M. & Levy, T. (2006), Healing Parents: Helping Wounded Children Learn to Trust & Love. Washington DC: Child Welfare League of America, Inc.
Purvis, K. B., Cross, D. R. & Sunshine, W. L. (2007). The Connected Child: Bringing Hope and Healing to Your Adoptive Family. New York: McGraw-Hill.
Purvis, K. B., Cross, D. R. (2011, September). TBRI® Professional Training Program presented by the TCU Institute of Child Development. Training conducted at Texas Christian University, Fort Worth, Texas.