Written by Joanne Tattersall
Experienced in many households, children refusing to eat meals that have been lovingly made for them can cause a lot of anxiety for everyone in the family. Fussy eating can be a source of family feuds, result in different meals being cooked for each family member and result in many sleepless nights.
What is fussy eating?
There is no exact definition of fussy eating, although it can be described as part of a spectrum of feeding disorders. The current definition under review is "impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction." [1] Fussy eating can present in many ways including a limited range of colours or textures of foods, to exclusion of whole food groups. Due to the variation in definition, exact prevalence of fussy eating is difficult to identify, with studies’ results ranging from 5.6-59% of children experiencing it [2].
The Division of Responsibility
Ellyn Satter is an internationally renowned Registered Dietitian and Psychotherapist who specialises in eating and feeding. Her ‘Division of Responsibility’ approach stresses the importance of family meals, enabling children to be capable of eating, with parents taking appropriate leadership. At each stage of a child’s development, the parental responsibility around feeding gradually changes.
For babies. Parents are responsible for what to feed (i.e. breast, formula or combination feeding); the baby decides volume, speed and frequency
Moving onto solids. A transition phase is occurring; as parents, the responsibility for what to feed the infant remains, but when and where feeding happens are also becoming responsibilities. The infant is responsible for how much and whether they are going to eat.
From toddlers to adolescence. Parents are responsible for the what, when and where of meals and snacks; the child is responsible for how much and whether [3].
At all times, maintaining a level of trust between the parent and child is key. By establishing mealtime structure, children can be sure that they will receive routine nourishment and therefore eat appropriate quantities for their hunger on that day. Eating is a learning process. Achieving a varied diet and 'normal' eating habits takes years – a progression that each child takes at their own pace.
Meal time environment
Speaking of pace, the P.A.C.E. Model [4] can be really helpful in creating a safe environment for parents and children to connect emotionally. This can help troublesome behaviour which may be present at meal times.
P: Playfulness
Approaching difficult behaviour in a light tone of voice is more likely to get through to children than that associated with anger or irritation (which can lead to rebellious behaviour).
A: Acceptance
Accepting the thoughts, feelings and perceptions behind the behaviour does not mean the behaviour itself has to be accepted, especially if hurtful. Helping the child understand they will be accepted unconditionally enables them to develop a feeling of safety.
C: Curiosity
Expressing non-judgmental curiosity around the reasons for behaviour can help the child know their parent understands; as a result, the child may be able to express their feelings or perceptions in a different way.
E: Empathy
Empathising with the child is of utmost importance. This shows the child that their parent will be with them through difficult times, which they can get through as a team.
You can read our top tips for overcoming fussy eating here.
Should I be worried about my child’s eating?
It’s natural to be concerned about your child’s eating, especially if it seems they are eating a very limited diet. If a child is growing as expected, wearing approximately age-appropriate clothing or following their growth centile lines, be reassured they are receiving enough energy from their food.
Although difficult to hide, children can pick up on parental anxiety, making it seem as if food is something to be worried about and further heighten tension around mealtimes. ‘Force feeding’ similarly can be traumatic for children, despite the best intentions of trying to ensure they are eating enough in terms of quantity and/or variety. This can have the opposite of the desired effect, reducing a child’s intake at meals as they enter ‘fight or flight’ territory. Maintaining a calm environment, or perhaps playful as outlined previously, is key.
At the far end of the spectrum, presenting as a lack of interest in and avoidance of food based on the sensory characteristics of food, is an eating disorder called ARFID (Avoidant Restrictive Food Intake Disorder). This is not just an extreme case of fussy eating but requires specialist support and intervention to broaden the dietary intake.
Does my child need vitamin supplementation?
It is recommended that all children aged 6 months to 5 years take multivitamins containing vitamins A, C and D if they are not drinking over 500ml of an infant formula per day. If a child’s diet is particularly restrictive of certain food groups, they may benefit from additional micronutrient supplementation; if there are concerns around a child’s growth or nutritional intake with persistent fussy eating, it’s helpful to speak with a GP who may refer onto a Dietitian for specialist input.
Fussy eating can be a normal part of child development, exploring not only new textures and flavours but boundaries too. Although frustrating, it’s usually something children grow out of, with no long-term effects.
Our team of specialist eating disorder dietitians at TCN can help to support you to heal your relationship with food and raise happy eaters. Get in touch to enquire about private nutrition consultations and book your free discovery call.
Joanne Tattersall, Paediatric Specialist Dietitian
Guest Contributor
References
[1] Goday PS et al. Pediatric Feeding Disorder Consensus Definition and Conceptual Framework. Journal of Pediatric Gastroenterology and Nutrition. 2019; 68(1):124-129. Available from: Pediatric Feeding Disorder: Consensus Definition and Concept... : Journal of Pediatric Gastroenterology and Nutrition (lww.com) [Accessed 12th March 2021]
[2] Wolstenholme H et al. Childhood fussy/picky eating behaviours: a systematic review and synthesis of qualitative studies. International Journal of Behavioral Nutrition and Physical Activity. 2020; 17(2). Available from: Childhood fussy/picky eating behaviours: a systematic review and synthesis of qualitative studies | International Journal of Behavioral Nutrition and Physical Activity | Full Text (biomedcentral.com) [Accessed 30th April 2021]
[3] Ellyn Satter. Raise a healthy child who is a joy to feed. Available from: https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/ [Accessed 14th March 2021]
[4] DDP Network. What is meant by PACE? Available from: https://ddpnetwork.org/about-ddp/meant-pace/ [Accessed 13th March 2021]
[5] NHS. Vitamins for children. Available from: https://www.nhs.uk/conditions/baby/weaning-and-feeding/vitamins-for-children/ [Accessed 25th May 2021]
Talia Cecchele Nutrition is a team of registered dietitians specialising in eating disorders, disordered eating, digestive issues and sports nutrition. We aim to bring balance back to nutrition, help you to break free from food rules and find food freedom. We offer virtual consultations and group programs so whether you are based in London, the United Kingdom or around the world we would love to support you. To enquire about private consultation please fill out a contact form.