‘My son who is six years old is an extremely fussy eater and may have an eating disorder’

Question

My son who is six years old is an extremely fussy eater and it seems to be getting worse. If he eats at all, he will only eat very plain food, such as pasta, white bread, potatoes, and chicken. Any sauces, vegetables or spices are a complete no-no. If I do try to push him to eat foods, he gets very agitated and it sets him back.

He is also very rigid in other areas, hates any changes to routines and is struggling in school. The teacher thinks he might have autism, which makes sense to us too so we have started the process of trying to get him assessed. At the moment, the main thing I am worried about is his lack of eating and it is affecting his health. He is very skinny and is prone to getting colds and every bug that comes around. I do manage to get a multivitamin into him with a glass of milk, but I don’t think this is enough.

Looking things up I have found an article on avoidant/restrictive food intake disorder (Arfid) and I think he might have this. How do I go about getting help for his eating?

Answer

Avoidant/restrictive food intake disorder (Arfid) is a newly identified eating disorder that is diagnosed when children have an extremely restricted diet that is affecting their health and nutritional intake. Arfid differs from anorexia in that it usually starts at a younger age and is not driven by a desire to lose weight, but by very narrow food preferences and the strong avoidance of certain foods. Usually, children who have Arfid have quite rigid rituals and routines around eating and have strong sensory sensitivities — many smells, tastes and textures are repulsive to them and only a small number are acceptable. Arfid is much more common in Autistic and attention-deficit/hyperactivity disorder children.

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To get help for your son you should continue to seek a developmental assessment to have his needs identified. Make sure to describe his eating problems when you go for this assessment. You could also contact your GP or public health nurse to seek a referral to a community dietician or a specialist in a children’s hospital. Alternatively, there are dietitians working in private practice which you can find on Irish Nutrition & Dietetic Institute website indi.ie. Make sure to pick a dietician who is familiar with children with selective eating problems.

In addition, there is a lot you can do as a parent to help your son. As you have discovered, pressurising your son to eat the foods he avoids can be counterproductive and actually greatly increase his food aversion. Instead, more subtle, indirect, gentle and gradual approaches work best

Build a map of the foods he likes

Make a comprehensive list of all the foods he eats and notice what they have in common. You have noticed that he likes plain foods that have similar tastes. Is texture also an issue for him? Some children only like soft food or only like food with a consistent texture. Some have a strong aversion to foods with mixed textures (such as a soup with bits) or prefer food to be in its separate components on their plate. Some children have an aversion to strong flavours and some need their food to have a certain flavour for them to find it acceptable.

There may also be foods that your son does not particularly like, but which are tolerable to him in small quantities. You want to build a map of your son’s food preferences and aversions, particularly tuning into his sensory needs. Notice also what routines work best for your son around eating. When and where does he feel most comfortable eating?

Introduce new foods very gradually

You can introduce new foods but do this patiently and gradually. For example, you might prepare your son’s favourite pasta and introduce a tiny amount of flavour to see if this is tolerable to him. Or you might introduce a small amount of a new food nearby to his plate. For example, you could put one or two peas on a small plate near him and see if he tolerates these. Remember, you might have to expose your child 10 to 20 times to a new food before it is acceptable to them. This might involve them first tolerating it near them, then handling it and then maybe smelling it before finally putting a little in their mouth (perhaps taking it out again)! All this has to be done at the child’s pace and with no pressure. Frequently, it is best not to talk about the food as they get used to it.

A child with eating problems can even experience praise as an extra pressure and cause them to resist more. Sometimes, it is best to have only non-food conversations at the dinner table. Talk about other fun things as you eat together.

Match foods to your son’s sensory preferences

Remember any food can be eaten in many different ways. When introducing a new food try to match how it is presented to your son’s sensory preferences. A carrot can be eaten crunchy and raw or cooked until it is soft or mashed or flavoured with a mild sauce they love or put in a favourite small smoothie. Aside from mealtimes, you can also help your child expand their sensory preferences through fun sensory play such as making play dough or slime, walking in mud or sand or paddling in a pool.

They may even get involved in kneading dough and baking as well as mixing or preparing food with you which may also gradually increase their tolerance of eating. Have a look online for other ideas for fun sensory play.

• John Sharry is Clinical Director of the Parents Plus Charity and an adjunct professor at the UCD School of Psychology. He is author of several parenting books including Positive Parenting and Parenting Teenagers. See solutiontalk.ie