Behaviour doesn't necessarily imply negativity or that your child is misbehaving. The term behavior is a noun that refers to the way in which someone acts or conducts themselves, especially towards others. Both you and your child exhibit certain behaviors in specific situations, contexts, environments, and around certain people. We have all encountered children who exhibit positive behavior at nursery but demonstrate behaviors that could be considered negative towards their caregivers.
While there are numerous natural reasons for food refusal, there is a significant issue that often goes overlooked. In my experience, this issue is the primary cause of most cases of food refusal, and that is... Control.
Lack of control
Children often feel a lack of control. Establishing routines and boundaries can sometimes help a child comprehend the daily events, which in turn aids them in feeling in control. Predictability in their life can bring about a sense of calmness and connection. Alterations to routines and boundaries, particularly without sufficient warning, can lead a child to feel out of control, often without an outlet for those feelings. Adults can find ways to cope, but children may not always have that option. While adults can express their feelings by shouting or retreating, society often does not tolerate such behavior from children. Allowing a child some control is acceptable - you are their whole world. If a child feels out of control, they will seek attachment and connection from those who love and care for them.
In the context of eating
Control can significantly contribute to food refusal because it is often unpredictable. We change the meal at each mealtime. Generally, individuals without food issues enjoy the variety, but for some children, this can be overwhelming, and predictability holds more importance.
Aside from food, meal times offer an excellent opportunity for seeking attachment if a child feels disconnected from their caregivers. As you are aware, meal times can be intense and emotional. When your child refuses to eat, it can lead you to hyper-focus on them for both positive and negative reasons. Children who seek attachment do not mind if you are happy or upset, as long as you are focused on them.
Clinical story
Allow me to share an anecdote about a referral I received for a child about to start school. I hope this story can benefit some of you. A 4-year-old child came to the clinic with their mother and younger sister. As far as we could determine, there were no physical difficulties or organic reasons for their refusal to eat, but they only consumed certain foods if fed by their mother. The mother brought a variety of foods with different levels of difficulty to the clinic; she was highly motivated to improve her child's eating habits. While seated at the table, the child requested to be fed by their mother. Although I do not claim to possess any special abilities, I decided to encourage the child to try eating on their own. With a bit of encouragement and setting a boundary, they reluctantly attempted to eat by themselves, much to their mother's surprise.
We needed to understand why they were willing to eat for me but not for themselves or their parent.
In this instance, it was about control. I asked the mother more detailed questions about their life at that time, their family dynamics, and their work pressures. The mother mentioned that this child was the eldest of four siblings. Juggling so much at a young age, hats off to her!
We both agreed that being the eldest of four at the age of four could be both fun and challenging. We speculated that this child may have been seeking attachment from their mother in the only way they knew how, and the only time that was significant enough for the mother to stop what she was doing and focus on them was during mealtime.
What did we do?
We did not focus solely on mealtime. The therapeutic approach for this child involved the parents finding opportunities throughout the day to spend quality time with their eldest child to foster a stronger attachment. This could range from playing with their favorite toy together to involving them in caring for their siblings. The key aspects were empowerment and doing activities together.
Interestingly, as the child felt more attached, they became more open to feeding themselves and trying different foods. While this required its own intervention - such as messy food play (which you can learn more about in my online course), they made natural progress when we stepped back from the table.
How can you assist your child who refuses to eat?
Remember: Control is acceptable - your child's world revolves around you. You can provide this by setting fixed boundaries or offering controlled choices. A fixed boundary involves you, as the caregiver, selecting 2 or 3 options that align with your expectations, allowing the child to make a choice from those options and thus feel in control.
For instance: If your child is refusing fruits but needs to eat them for health reasons, you can choose 2 fruits they prefer the most (or dislike the least), such as strawberries or bananas.
You could say: "We need to consume fruit to stay healthy, would you like strawberries or bananas?"
Common phrases heard at mealtimes like 'I don't like it' or 'I don't want any more' when the child has not eaten enough should be responded to in a manner that encourages further eating.
You might say: 'I understand you may not like it, but we need to eat it to have energy for more playtime. How much can you eat?' The challenge lies in respecting the child's response. Whether they say 2 or 10, respond with 'that's amazing.'
Control through fixed boundaries / controlled choices
Control is acceptable - your child's world revolves around you. The table may seem daunting, fear of the unknown can make them feel out of control, and they may feel trapped without knowing where to turn, resorting to seeking help - attachment seeking.
Advice - if they don't want it or don't like it, say 'I understand you may not like it, but we need to eat it to stay healthy.' Ask them how much they can eat and respect their response; many children suggest a substantial amount.
This won't be a one size fits all approach and if these things don't help, it may be that your child's eating challenges are more deep routed or require further investigations from a speech therapy Feeding Specialist or Dysphagia Therapist to rule out other underlying causes.
Please do not hesitate to get in touch if you have any queries or would like some guidance through this challenging time.
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