Recognition and Response, The Challenge for Parents
By Abigail Natenshon, MA, LCSW, GCFP
The Challenge for parents: Recognition and Response
The task for parents of eating dysfunctional children is first to
recognize the problem… next, to solve it. The responsibility for proper
diagnosis rests solely with parents and caregivers. Behaviors connected
with feeding problems are diffuse… with behavioral, neurological and
emotional signs unique and variable from child to child. Pediatricians
cannot be counted on to diagnose problems whose full spectrum of
behaviors does not present itself in the medical evaluation or in
laboratory testing. Too often, these diagnoses are missed.
Compounding the problem of under-diagnosing feeding disorders because of
their complexity, the rampant existence of disordered eating in our
society today is another major decoy, throwing parents and professionals
off track. We live in a world where restrictive eating is considered to
be "healthful" eating. Persuaded by the latest fad diet of the week and
the belief that a person "can never be too rich or too thin," many
believe that skipping meals; eating "substitute" foods and meals in the
form of liquid diets or protein bars; restricting fats and sugars and/or
becoming vegetarian; or ordering salad dressing "on the side," promises
fitness, an attractive appearance and longevity. Many parents, who are
themselves disordered eaters, fail to provide their children a
consistent healthy eating lifestyle and/or exercise role modeling.
Research shows that only 50 percent of American families sit down
regularly with their children to eat dinners together.
On college campuses today, 40 to 50 percent of girls are reported to be
disordered eaters. 50% of girls in the first grade report having dieted
or restricted foods. By the time they get to the eighth grade, 80
percent of girls have been on diets, feeling virtuous and accomplished
when they can reject food and deprive themselves of nutrition. A
behavior so commonplace as to have become a norm, dieting is a dangerous
pastime. In genetically susceptible youngsters, dieting behaviors can
trigger the onset of a clinical eating disorder, the most lethal of all
the mental health disorders that kills and maims close to 15 percent of
its victims. Ironically, it is, in fact, the worst possible way to lose
weight and keep it off. It is a little known but important fact that
dieting youngsters have a greater propensity to become overweight
Recognizing signs of early childhood feeding problems
The following are signs of feeding problems according to the Colorado
Pediatric Therapy and Feeding Specialists.
(Detroit Free Press, June 11, 2002):
Ongoing poor weight gain
Gagging during meals
History of eating and breathing coordination problems (which might
cause problems with nursing)
Inability to transition to baby food purees by 10 months.
Inability to transition to baby food solids by 12 months of age.
Inability to transition from breast/bottle to a cup by 16 months of
Crying and arching the back and neck at meals.
Smell and food texture intolerance.
Parental history of an eating disorder.
People commonly believe that if children are hungry enough, they will
eat; they will not starve themselves. Though this theory may be true for
96 percent of children, it does not apply to the 4 percent of kids with
feeding problems who are, in fact, capable of inadvertently starving
themselves. For these children, food smells, textures and feeding
literally hurts, and no amount of hunger will overcome that fact.
Through their efforts to protect themselves from pain, eventually the
appetite becomes suppressed, and in time, they no longer respond
correctly to appetite as a cue to eat.
The preteen and young adult years: What these problems look like
Complicating the challenge of a feeding dysfunction diagnosis, a child
may display a whole cluster of neurological or sensory traits, some of
which occur at the lower end of a disorder's continuum, and others at
the higher end. A child could typically be in the 90th percentile in
areas such as working memory, but in the 27th percentile in
organizational abilities and visual processing or motoric functions;
this child might exhibit an academic performance that is typically
average to poor through what appears to be a lazy, sloppy, disorganized,
or unfocused work style. (Note that the child with sensory integration
disorder will typically do his homework, and then lose it on the way to
school.) Children with a non-verbal learning disorders are typically
misdiagnosed as suffering from ADHD and are likely to be medicated
improperly as such.
Schools tend not to consider an eating dysfunctional child in need of
special attention or accommodation if he or she is still managing to
pull A's and B's ("So what's the big deal?"). If through standard
psychological testing, the child does not meet all the criteria for
learning disabilities and special education funding, the schools are apt
to consider these problems merely a benign "shtick," to be disregarded.
Why is it necessary to note subsidiary problems along with the feeding
problem? Because without a proper diagnosis of feeding problems along
with the full spectrum of their related disorders, these problems cannot
be adequately and fully treated. Without an accurate diagnosis, parents
tend to get blamed for their child's quirky behaviors, and kids get
scolded and punished. It is hard to find expert professional help for
problems that may at first glance appear to be considered nothing more
than stubborn quirkiness. Despite misdiagnosis and lack of
understanding, these are neurologically based problems that are hard
wired into the central nervous system and that will not simply be
Treatments and Resources
The place to go for help with these disorders of the central nervous
system may best be a properly trained occupational therapist, rather
than a psychotherapist or medical doctor. Occupational therapists help
children develop and hone motor skills through a variety of physical
activities, such as obstacle courses, tumbling, rolling on balls and
using tools and utensils. O.T. Kathy Dovey describes this active form of
play therapy with a young child patient; "It's practice for his brain to
talk to his muscles, to get around the roadblocks that come up for him
because of this sensory integration disorder."
Aside from the importance of the O.T. as part of the child's team, there
is a place and need for a multi-disciplinary team approach to serving
the multi-dimensional, integrative needs of the eating dysfunctional
child and family. The professional team optimally also includes a
pediatrician, pediatric psychologist, speech pathologist, dietician and
physical therapist capable of assessing and meeting the needs of the
whole child beyond their own area of specialization. Once diagnosed,
children with tactile/sensory problems can and should be supported by
community resources such as the school, through educational and personal
accommodations. Examples might include use of laptop computers to
accommodate poor fine motor problems, shorter writing assignments,
longer times for test taking, or special dispensation if the child is
unable to wield a pencil sufficiently to complete an art assignment to
satisfaction, or eat in the lunch room.
The Feldenkrais Method
The Anat Baniel Method Based on the work of Dr. Moshe Feldenkrais
These mind/body holistic approaches to treatment access, reorganize and
integrate the central nervous system, creating an empowered, more
integrated perception of the self and a new repertoire of possibilities
for neurological change. The power of these experiential treatments is
in bypassing the area of the brain that relies on language alone to
facilitate learning. Thus, the technique is designed and well-suited for
children as young as new-born, a boon to the pre-mature population of
babies who may be the most prone to developing these types of feeding
For children and adults of all ages, these techniques integrate mind and
body, reduce anxiety, and increase self confidence and enhanced
well-being, while upgrading the quality of brain function. Kids access
the gentle movements through song and play, through one-on-one work with
a skilled practitioner. By
facilitating self- and body-awareness, Feldenkrais techniques promote
emotional versatility and integration. Offering a novel opportunity to
seek and discover alternative solutions, it enhances coping skills and
adept problem-solving, upgrading all aspects of physical and mental
Other Practical solutions
Just Take a Bite: Effective Answers to Food Aversions and Eating
Challenge (2004) by Lori Ernsperger and Tania Stegen-Hanson offers some
suggestions for healing afflicted children. Adults who wish to make
changes can also benefit from such techniques and practices.
Children with SID benefit from systematic desensitization programs
offering short exposures to new textures and oral sensations in
small, incremental doses. This requires the investment of time,
initiative, and creative thinking, with the goal of introducing new
foods that are similar to those the child already likes and is
The feeding team may alternately choose to reduce the demands for
varied eating and focus instead on other ways to maintain a healthy
diet… Parents are wise to utilize supplements and vitamins to
achieve maximum nutritional balance.
Children, whose systems are continually in the "alert mode" have
difficulty calming themselves; they need the right atmosphere for
eating, so that mealtimes become pleasant, fun and stress-free
social experiences. It is critical that there is no TV at mealtimes,
lots of talk, and no threatening food discussions or forcing of
Kids need to make friends with food by exploring and handling food,
in many contexts and through all of the tactile senses.
Techniques for stimulating/exercising the tongue diminish the gag
reflex. The side of the tongue, rather than the tip, is less
sensitive to strange new tastes and is the best place to introduce
A treatment technique called "food chaining" involves "chaining" off
the foods the child is willing to eat, and limiting availability to
the child's favorite and most nutritious foods. Working within this
context in small leaps, child and therapist search out increased
numbers of barely acceptable (similar) foods, which became
progressively more acceptable as the child eats more of them. As an
example, pizza is a good food to chain off; pizza could be expanded
to a grilled cheese by creating a pizza sandwich, toasting
mozzarella cheese and pizza sauce instead of a more flavorful
cheese. Or, by having hot pizza sauce served in a cup next to a
child's macaroni and cheese, he could be encouraged to dip
occasional bites of mac and cheese into the sauce, expanding his
there is a "cure," there will certainly be no quick fixes. Treatment
will invariably involve discomfort, albeit in a controlled environment.
Problems are always easier to treat early on, before they have become
too deeply rooted. Curative interventions let the individual know that
he or she is not crazy, not alone, and not so misunderstood. The
following are words of advice from a seasoned parent, "Once you start
the ball rolling, you cannot stop, not even for a day, because otherwise
the child will just slip backwards; going through the process with my
son over the last two years has so very nearly broken me lots of times,
but the rewards in the end are worth it. We can go to restaurants
together now, and we can look at life together now with a new eye
towards making adjustments and accommodating to change and towards
solving problems that arise in the natural course of daily living."
A Parent's Question
Should I wait until HE thinks his eating is a problem? Will trying some
of these behavior modification strategies turn things into a more
emotional issue? Will I do more harm than good?
Why would you assume that your young child is fully cognizant, or even
capable of making a competent decision about whether or not his eating
needs some attention? In some respects, leaving up to the child is a bit
like asking the fox to guard the hen house. He is the most unlikely
candidate to understand that change would be of benefit to him, and is
least likely to feel motivated to change because in eating the way he
does, he is maximizing his comfort, and minimizing his stress. It is
counterintuitive, and in fact, incomprehensible for most kids to choose
change once they recognize that an effective solution can (and will)
feel worse than does the problem.
As a parent motivating change, you do take the risk of magnifying
emotional ramifications of the problem, but at the same time, by so
doing you must recognize that you are shielding the child from deeper
and more far-reaching emotional problems as he grows older. There are no
easy solutions to certain problems…particularly when they involve food,
eating, and neurological function.
… Abigail Natenshon, MA, LCSW
Books and articles
1. Lask and Bryant-Waugh: Anorexia Nervosa and Related Eating Disorders
in Childhood and Adolescence. Psychology Press 2000.
2. Lask and Bryant-Waugh: Eating Disorders- A Parents Guide Psychology
3. Ernsperger and Stegen-Hanson. Just Take a Bite: Effective Answers to
Food Aversions and Eating Challenges Publisher Future Horizons, 2004
4. Marcontell, D.K., Laster, A.E., & Johnson, J. (2002).
Cognitive-behavioral treatment of food neophobia in adults, Journal of
Anxiety Disorders, 16, 341-349.
5. Nicholls, D., Christie, D., Randall, L., & Lask, B. (2001). Selective
eating: symptom, disorder or normal variant? Clinical Child Psychology
and Psychiatry, 6, 257-270.
6. Seminars: http://www.sensoryresources.com/conf_details2.asp?cid=915