The latest question for our Ask the Expert panel comes from a worried mum whose son has an extremely limited diet. She asks how she can get her son to try new foods. Dr Gillian Harris and Dr Elizabeth Shea share their advice
My seven year old son has a really limited diet and I have got to the point where I’m really worried and don’t know what to do. He eats cheese, plain pasta and bread. He also eats chicken and things like sausages and bacon. The only fruit he will eat are grapes and strawberries – but that’s it. He also refuses to eat any vegetables at all. He doesn’t like any sauces or foods that are mixed together – like casseroles, or even something like shepherd’s pie where the meat is minced with veg or in a sauce.
He used to eat most things as a baby but I started noticing him refusing more foods around the age of 3.
A typical dinner for him is pasta with grated cheese on top, or sausages with plain pasta.
I feel like I’ve tried everything but now have got to the point where I’ve given up and just offer him what I know he’ll eat. I am really worried he is not getting the proper nutrition and that it will affect his health. What advice can you give me to help him try new foods and increase the amount of different foods he will try?
My other children ( 5 year old daughter and 20 month old son) are what I call good eaters – they eat most foods.
Dr Gillian Harris and Dr Elizabeth Shea reply:
Your son sounds as though he is showing features of a pattern of eating that we call ‘avoidant and restrictive food intake disorder’ or ‘ARFID’ for short. This eating behaviour is usually evident from late infancy and is very resistant to change.
Children with this pattern of eating choose (and reject) foods based on their sensory properties. This means that foods have to look ‘right’ (including being in the right packaging), be the right texture and smell and taste okay before they are accepted.
Many children with this pattern of eating choose ‘safe’ and predictable foods such as beige dry carbohydrates e.g. cereals, bread, biscuits, plain pasta, or foods that are soft or smooth and either melt or dissolve in the mouth, e.g. soft crisps, fromage frais or chocolate. They also dislike foods mixed together, with a sauce, or anything that has ‘bits’ in. This is because they like to see exactly what they are eating. They also dislike foods with difficult textures such as vegetables and fruit, so it is very good that your son will eat some grapes and strawberries!
In addition to extreme or hyper sensory sensitivity, children with ARFID become very extremely anxious if asked to eat anything outside of their safe range. This is called neophobia (literally fear of the new) and is a stage that all children go through usually around the age of 2 years.
When children reach this stage they reject new or unfamiliar foods or even foods that look different to the way they are usually presented. Most children grow out of this stage and learn from watching others which foods are safe and ok to eat. Children with ARFID get stuck in this stage and can show anxiety and disgust to any food that is different to their usual range (think of how you would feel if asked to eat a slug sandwich). This includes even tiny changes to the appearance of a food such as the toast being the ‘wrong’ shade of brown! These children can get very anxious at mealtimes or in eating situations outside of home, such as school or on holiday. Parents can also get extremely worried about their child’s eating and often report that mealtimes have become a battle.
You are not alone in thinking that you have tried everything or in your worries about nutrition or your son’s health. The first piece of good news is that this eating problem occurs because of inherent (born with) characteristics and not because of what parents have done or not done. The second piece of good news is that the majority of children with ARFID grow well, get the right nutrition and are healthy despite a relatively limited diet. A community dietitian can re-assure you that your son is getting the vitamins and minerals he needs, or suggest a supplement if necessary.
Lastly, your son at the age of 7 is reaching the age where it is easier to expand a child’s diet.
How to expand your son’s diet
So how do we go about doing this? You might be surprised to learn that you are already doing the first and most important intervention which is to allow him to have his safe and preferred foods without any pressure to eat anything new. If we do this then the majority of children will grow as expected (for a useful guide on how to measure children and understand growth see www.infantandtoddlerforum.org).
What else will help you to increase his range of foods? Here are some ‘Do’s’:
- Do reduce anxiety at mealtimes by allowing him to have his preferred foods. This will also help him have a good appetite.
- Do ‘desensitise’ him to the look, feel, smell and taste of new foods. This builds a tolerance to new foods. For younger children this can be done with messy play and for older ones being around other people eating the food(s), but without any pressure to eat it themselves, can help.
- Do expand his categories of accepted foods. Begin with introducing foods that are very similar to foods he already eats, e.g. a new brand of flavour of a preferred food.
- Do help him relax. The use of relaxation techniques can help children from the age of 8 upwards try a new food.
Most parents of a child with ARFID report they have made some mistakes along the way. Here are a few ‘Don’ts’:
- Don’t over-encourage him to try something new. This is a form of pressure and leads to further anxiety, food refusal and possible weight loss.
- Don’t mix or hide a new food or unfamiliar food in a familiar and accepted one. Children with sensory hyper-sensitivity will spot even a tiny change and reject the food. You also run the risk of ‘contaminating’ it for the future!
- Don’t let him go a long time without eating or drinking. Children with ARFID don’t appear to notice hunger and often do not spontaneously eat. This means they are at risk of dehydration or becoming ill if we do not offer them their preferred foods.
- Don’t worry about ‘healthy’ eating. Children with ARFID are rarely at risk of obesity. In fact they are the children most likely to need higher calorie foods or snacks, particularly at school where many of them do not eat well.
Lastly, remember not to worry too much, the more relaxed you can be about your son’s eating the easier it will be to help him move on over time. Good luck!
Dr Gillian Harris and Dr Elizabeth Shea run workshops and therapy for children who are food averse and have very restrictive diets at the Birmingham Food Refusal Service. Read more about Dr Harris and Dr Shea