Food refusal

Fast facts

• Most children go through a period in which they tend to refuse certain foods. This normally starts during the second year of life.
• In most cases, this behavior does not cause the child any harm, and will gradually go away.
• Parents' reaction to a child refusing food can make a big difference to their child's behavior. Putting pressure on the child to eat, or worrying about the child's refusing food, can often make matters worse.

What is food refusal?

Many young children go through a stage of refusing many types of food. Usually, this behavior is simply one stage in the normal process of figuring out food and eating. This type of food refusal will not cause any health problems, and will gradually go away.

A child refusing to eat might:

• Turn away or close their mouth at the sight of food;
• Gag or spit out food;
• Throw a tantrum, or;
• Vomit.

Things to keep in mind

Parents' behavior is very important at this stage. Some parental responses, such as forcing or bribing the child to eat, can actually make matters worse. It is important for parents to understand that if their children refuse to eat certain foods, they are most likely:

• Not hungry;
• Uncertain about the taste or smell of that food, or;
• Physically cannot handle the food they are being offered.

If your child is refusing to eat:

Do:

• Give praise for desired eating.
• Let your child play with their food and make a mess. Join in the fun.
• When possible, get your child to participate in making and serving the food. Children are much more likely to eat what they feel they have had a role in making.
• Ignore any mildly disruptive behaviors.
• Keep mealtimes regular and minimize snacks between meals.
• Make sure it is easy for your child to eat - that the seat is good for them, the food is in easy reach, and the cutlery is suitable.
• Keep the boundaries clear: parents decide what and when the family eats. The child decides how much to eat.
• Try alternatives to the food your child does not like. No one food is essential to a child's diet. There are other options containing the same nutrients.
• For babies, avoid overfeeding and try to keep your baby upright for about half an hour after feeding to reduce the risk of heartburn.
• Put the food in the fridge and try again later if they are not interested.

Don't:

• Don't worry that your child is not eating enough, or make too much of a fuss. This will likely backfire.
• Don't force them to eat, or punish them for not eating.
• Don't bribe them to eat. Children who are rewarded for eating certain foods will view those foods as less desirable than if the food itself is the reward. Don't promise dessert as a reward for eating the main meal.
• Don't let a fussy eater have too many unhealthy snacks, soft drinks or juice between mealtimes.
• Don't allow distractions (television, digital devices, books) during mealtimes.
• Don't insist on your child 'leaving a clean plate'.

And remember that:

• A healthy child will eat when hungry.
• It may take several attempts before a young child will actually eat. Offer again and again - 20 times, if necessary.
• Simply getting your child to taste the food will help them accept eating it later.
• Children are good imitators, so look at your own food choices and set a good example.

Causes

Food refusal can have many causes. As noted above, in most cases it is a normal stage of development. In a small minority of cases, food refusal is the result of something else, such as:

Food refusal related to medical conditions

• Anatomical problems, such as cleft palate, can make chewing and/or swallowing difficult;
• Problems with the esophagus or intestines, such as heartburn, can lead to discomfort after eating;
• Slow digestion - slow emptying of the stomach, or movement of the intestines (peristalsis), can lead to the child feeling bloated and full, long after the last meal;
• Growth disorders - children with growth disorders can have a smaller appetite than other children. Importantly, children with growth disorders may be eating enough to meet their own growth needs and their smaller food intake is not the cause of their growth disorder, or;
• Ingesting a foreign body.

Swallowing problems

If the swallowing is abnormal, it can lead to regurgitation or choking. Swallowing is a complex process that continues to develop throughout the first year of life, as infants learn to eat solid foods. Infants can develop swallowing difficulties if they are not fed solid, textured foods between the ages of 6-12 months, or if they have certain medical conditions, such as cerebral palsy.

Past events

In some cases, children (and adults) can develop a strong dislike for food they ate just before experiencing a nauseating experience. This can also include food eaten around the time of chemotherapy or radiotherapy, particularly food eaten in the 24 hours before treatment.

Selective feeding disorder

In a small minority of cases, a child will refuse to eat a wide variety of foods, for a long time, even when hungry, resulting in the child becoming obviously malnourished.

Children with this condition tend to have a high sensory sensitivity, meaning that they are often very sensitive to touch, sounds, textures and smells. They can be extremely fussy about food, even showing a fear of 'contamination' between food they like and food they do not like. The condition is more common in children on the autism spectrum, and children with other developmental difficulties.

This behavior usually is not affected by the tips offered above. It is a medical disorder that requires professional guidance. It is known as selective eating disorder, perseverant feeding disorder, or avoidant/restrictive food intake disorder. The signs of this type of problem often become worse at around 18 months of age. In many cases, the situation improves around age five.

A child with this disorder will be gradually introduced to certain foods so that over time they find eating them acceptable. This can take time and patience, and is best done with the help of a healthcare professional.

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