Tag Archives: ARFID

Tiny victories in selective eating

I know you’re all dying to know how the new dinner thing is going. Did we finally crack it? Or did I just crack, again?

I cannot tell a lie, at least not here on the blog, so I have to admit that once again we fell at about the second fence and it all came to pieces as soon as I blogged about how great I was and how we were finally on the right track. Of course it did. Will I never learn to keep my big trap (fingers) shut (still)?

BUT.

There’s a but. (Not a butt. Stop giggling there in the back row.) Reading the book and finding the blog were good, but joining a Facebook group for parents of selective eaters has really opened my eyes and given me a healthy dose of perspective on what we’re facing, how bad it is in the grand scheme of things, and what’s important.

There are parents in the group who have fussy toddlers, in a totally normal and age-appropriate way, babies and little kids who are exercising their newly found power by refusing food, or demanding only certain foods, or not eating things they’ve always eaten in the past. There are parents of kids like mine, who are picky and selective and have limited diets by their own choosing and who won’t “eat when they’re hungry enough” no matter how much you assume that’ll be the case.

And there are parents of children who are traumatized around food because they had such terrible reflux that their oesophagus was burned by acid, or who lack the muscle tone to swallow efficiently, or who have been badgered and bullied and terrorized so that they shut down around food, or who survive only thanks to liquid diet supplements, or whose parents celebrate when they eat a teaspoonful of solid food for the first time in a week, or who spent years on a feeding tube and have to learn how to eat from scratch.

Compared to these parents, I feel pretty lucky. My child has no allergies, no physical difficulty eating, is perfectly healthy despite his limited diet, and continues to grow apace.

It also brings home what an odd relationship we in the Western world have with food. Food is energy, food makes us grow, food is vital for life. And yet we insist on categorizing food into “good” and “bad.” Often we need to do something like this for ourselves because we have so much choice, such a bounty of sugar and salt and smooth and crunchy and deep-fried and processed that we’ve lost sight of the basics. But for these kids, food is food, and all food is good. A lot of it is about trusting that when offered a variety of foods, humans will, if they don’t have reasons to do otherwise, choose a selection that is healthful and eat as much as, but not more than, they need.

So by offering a bunch of different things at once, we can help our children trust themselves, and show them that we trust them. That’s the key to the Division of Responsibility (DOR) method.

It’s hard to do it perfectly: I clearly haven’t figured out how to do it at all. I have niggling issues with timing and fear of waste and how to balance one child’s needs and wants against the other’s. But here’s what’s changed for me in the past few weeks:

  • I am more understanding of Dash’s feelings. I don’t dismiss his food concerns as “illogical” or “ridiculous” even if they seem that way to me. I’m meeting him where he is, not trying to coerce him into coming over to my way of thinking.
  • I am more likely to keep foods he likes in the house, because they’re his safe foods, even if they don’t seem particularly “good” to me. Things like tortilla chips or Sun Chips or plain bagels. I resisted this for so long, partly because I have no self-control around Sun Chips, but mostly because at some level apparently I still felt that if he was hungry enough he’d eat “better” foods. That’s not true, and has clearly not ever been true for him. I’m learning to let go of that notion and have food in the house that he’s happy to eat.

Basically, I’m being nicer to Dash: less impatient, more understanding. It’s nice to be nice to him; I think deep down inside I felt like I wasn’t supposed to be nice about food, but this is better. (It’s interesting the things I continue to discover about me, not about him, as we go deeper into this.)

So, for instance, when we were away this weekend I promised to always remember to ask while ordering his french fries whether there’s seasoning on them, and if they can please not do that. Before, we’ve not said anything and sometimes fries will come out with pepper on them, or – heaven forfend! – a sprinkling of parsley flakes – and then there’s a row because I don’t like making a fuss and sending things back, and to me it’s silly to refuse to eat them over this tiny thing. But to him it’s a huge thing. And if we order them without seasoning up front, there’s no waste and no awkwardness and it’s perfectly easy for the restaurant too. Win-win, but something I’ve been so resistant to for no good reason except that it felt like pandering to the fussy child and I thought I shouldn’t do that.

I’m more able now to treat what might seem like tiny achievements as what they really are – big deals in the world of selective eating. This weekend he tried and liked two new foods! They were crinkle-cut fries and kettle corn, which might not sound like a great discovery to most of us, but let’s celebrate our victories where we find them. Taking an existing “safe food” – in this case, straight fries and plain salted popcorn – and expanding that to a variation in shape or flavour – is called food chaining, and it’s how a selective eater can start to expand their horizons while feeling secure and unthreatened.

So let’s call this a win. Just not the one I thought it was going to be.

Dash with food.

Happy with crinkle-cut chips and chocolate milk. An excellent lunch.

The food is not the point

I started reading the picky-eater book with a very defensive attitude. It had been recommended, and I felt ready to maybe tackle this thing again, but I didn’t want to. At every page turn I saw obstacles and roadblocks, reasons why I couldn’t do this, why it would never work for us. My inner monologue went something like this:

– But we can’t do that. He won’t even sit at the table.

– I don’t want to feed everyone together. I can’t get all that food ready at the same time.

– Think of the washing-up! All those serving plates! And we can’t fit all the food on the table in dishes as well as each person’s plate. We’d have to eat in the other room, where the table is covered in homework and filing, and where you have to walk a mile around the counter to bring everything there.

– How can I get us to sit down together? B comes home at 6 and the kids are yelling for dinner from about 4:30 on.

– This will never work. I don’t even see why I would want it to. What’s so great about sitting at the table? Sure, there are studies that say families that eat together every night have kids who are better behaved, more academically successful, more wonderful in every way… but my kids are pretty good already. Kinda. Why would I give myself all these headaches just to be “good”?

/Heaves giant sigh of put-upon-ness./

On the other hand, I have been starting to feel lately that, well, sometimes living here is like sharing a flat with short ungrateful people who never do their share of the cleaning up. What’s the point, really? When do we get to be a family, if we’re just the people who live in the same house as them and bring them to the places they need to be?

And I’m really sick of people announcing that they’re hungry, again, right when it’s bedtime or time to start their homework, or just when I’ve put away everything from dinner. All the separate dinners.

So maybe – just maybe – something wasn’t working so well after all. Maybe it was worth trying to make a change.

As I said yesterday, I really liked the fact that the authors said you can start a bit at a time. Going all-out with a totally new way of doing things is great sometimes, but I feel like that would be doomed to failure, for us. But small steps, when it’s easy-ish; I can maybe do that.

And the more I read the more I understood that what I’ve to aim for isn’t for Dash to be an adventurous eater. It’s not even, necessarily, for him to branch out much. It’s for us to all sit around the table and have a pleasant time. At the moment, that’s a big enough end-game to hope for, and also makes it seem a little more possible that this isn’t all a wild flight of fancy. Eating at the table is a social skill that both my kids lack right now, much as I pretend they don’t – and maybe it’s within my power to change that.

So I started out very small. I’d noticed that when Mabel goes to her friend’s house after school they have a snack at the table. I asked her how she’d feel about doing that at home. I figured if she was on board that would be a start, and maybe Dash would join in if there was no cooked food in the room with us at the time. She said it would be okay, she supposed. She sounded a little bit, secretly, happy about the prospect, even.

We had a snack at the table, served family style, sort of, as much as you can with apple slices and pretzels. Just me and her, and her brother for half a second before he flitted off. Since then we’ve had dinner at the table twice, the girl and her two parents and no brother, and snack at the table a couple more times. Dash says he can’t eat a sandwich at the table. It feels too weird. He runs away from french toast. He’s like a skittish kitten around humans for the first time. Maybe we’ll try pancakes over the weekend, because he likes those. (Not waffles. Won’t touch a waffle even though he knows the batter is practically identical.)

But the thing is, I think I get it. Mabel really likes it. I like it. It’s nice sitting at the dinner table having a conversation. It’s nice having Mabel there. It would be fun to have Dash there too, because he’s entertaining company. The food is not the point. I’m starting to understand.

 

The Picky-Eating Book – what you want to know

Well, I finished reading the book and I’m all fired up with renewed enthusiasm. I’m going to outline the basic plan from it in this post, and then I’ll write another post about what I’m thinking and planning and doing and how it’s going so far. (Very early days. But that’s why I have a “Best Intentions” tag.)

This is the book: Helping your Child with Picky Eating, by Katja Rowell and Jenny McGlothlin.Helping Your Child with Extreme Picky Eating - cover of book

When I showed it to Dash he spotted the flaw in the title’s phrasing immediately, and said he didn’t need any help with picky eating. Indeed: he’s an expert. But I read it anyway. And it was good.

This book is entirely complementary to everything Ellyn Satter wrote in How to Get Your Kid to Eat (and, I’m sure, her other books; that’s the one I’ve read). It takes Satter’s principles of Division of Responsibility (DOR) and draws them out to show you how to work it for an extremely picky eater, or a child who has physical problems that make it hard for them to eat, or even a child who’s been fed by a tube and is transitioning to solids. (And I thought I had it bad.)

Division of Responsibility, if you’re not familiar with it and didn’t just follow that link, means that you are responsible for where and when eating takes place, and what food is offered. The child is responsible for what and how much they eat.

The whole premise of the plan is that you get your child to the table, and once they’re there you take all the pressure off. You make the table a pleasant place to be, not one where they’re bugged and hounded and stressed about what they should and shouldn’t eat. You put a bunch of food on the table and everyone takes what they want and nobody talks about who’s eating what or how much. And your child always has at least one or two of their “safe” foods available, so they don’t have to go outside their comfort zone until they’re ready to.

The first part of the book basically lays to rest most parents’ fears and guilt about their child’s eating. It’s not your fault, it’s not something you did, and we can help you fix this without pressure or anxiety or making your kid cry. It talks about how if the dinner table is a place associated with stress and fear, your child is very unlikely to want to eat or to enjoy their food.

There are a few key points to the plan:

  • You schedule “eating opportunities” at regular intervals, following the same principles for snacks as for meals (and maybe offering something more nutritious then than you might have thought of; chicken nuggets, anyone?) So if they don’t eat much at dinner, they know there’ll be another chance for food in a little while.
  • You serve meals and snacks “family style”, meaning that you put everything on the table and each person helps themselves, or is helped if they can’t manage.
  • You put one or two of your child’s safe foods on the table, always available. If they eat nothing but bread rolls for days on end, say nothing.
  • You put the dessert on the table too. They can eat it whenever they want. No bribery, no “do this to get this.” It’s food, just like everything else.
  • You don’t encourage anyone to eat anything. You don’t say “Mmm, try some of this,” or “Just take a bite,” or “You need to eat some protein” or “That’s not enough to fill you up.” Just don’t. You can talk about how you like your food, and you can ask them not to “yuck someone else’s yum” – that is, not to say something on the table doesn’t look good, but mostly you’re there to enjoy a pleasant time with family. The food is not the focus.

The book goes on to show how you can plan meals that everyone will eat (at least some part of), and offers suggestions for ways to manage if you don’t have time for cooking or don’t want to cook much yourself. It also gives lots of advice for parents of children who have physical difficulties eating, and discusses types of therapy that might be useful and how to approach these. They also talk about how to deal with eating out of the home – at a restaurant, with other family members, or with friends.

My favourite part was near the end, when they said you don’t have to do this all at once. It’s not an approach that’s doomed to failure if you don’t go cold turkey on your old, bad ways and turn over a new leaf that never turns back. It accepts that maybe you can only commit to one step at a time, and that things might backslide for a while, but that you can keep going and this will become your new normal and it will work. I also really like that this is a plan for the whole family, not just something you’re doing for (or with, or especially to) the picky eater in your life.

Sounds good, eh? Come back for the next post to see what’s happening in real life.

Far-from-beige cauliflower and a discovery

I made Cauliflower with Romesco Sauce for dinner and it was so delicious that I’m going to give you the whole recipe, since I didn’t do it exactly the way the recipe I used told me to. I got this from Jill at Proper Fud, but I don’t think she ever blogged it, so here I am filling that gap.

First, put on some fancy wild rice mix to cook. Don’t boil it till it’s crunchy like I did. Or just use regular rice, whatever.
Then turn on the oven to 400 F and make the sauce while that heats up.

The sauce is exactly as given in the recipe:

  • ½ tsp sweet smoked paprika
  • 1 roasted red pepper (from a jar)
  • 40g fresh breadcrumbs
  • ½ garlic clove
  • 40g ground almonds
  • 1tbsp red wine vinegar
  • 50ml water

Sorry, Americans, for the metric. You’ll have to weigh stuff. (I love my digital scales. So handy.)

Whizz all that up in your food processor. I use the mini-blender attachment of my Braun Multimix that they don’t make any more so you can’t buy one – it’s just the right size and so much easier on the washing up than the big processor. First I ground the almonds in it, then added the bread to make the breadcrumbs, and then put in everything else and gave it a good blend. I end up with quite a dollop-y sauce, but if you wanted it more pour-y you could just add a bit more water, I’m sure.

Your oven is probably hot enough by now. Get a cauliflower and break it into florets. Spread them on an oiled baking sheet and sprinkle a teaspoon more of the smoked paprika over them, and a drizzle of oil. Into the oven with it.

After 20-25 mins the cauliflower will be roasted and a little charred around the edges. Try not to burn the rice like I did. Serve the cauliflower on the rice with dollops of sauce on top. The sauce really brings this whole thing to the next level and makes it a totally delicious dinner. A glass of wine  brings out even more facets of flavours, if you like that sort of thing.


Oh, and a discovery. Dash’s testing results came back with some helpful recommendations for all sorts of things, including his eating situation. The doctor mentioned a book called Helping Your Child With Extreme Picky Eating. I was sceptical because I’ve done all that, read the books – they just make me depressed and guilty – but I looked it up on Amazon anyway and checked out the reviews. One mentioned a website, so I took a look:
https://mealtimehostage.com/.

About 30 seconds later, all sorts of lightbulbs were going off in my brain. The website talks about Selective Eating Disorder, which is now called ARFID, and is an official thing people have. Here are some excerpts from the site.

Selective eating disorder was officially added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders in May 2013, and renamed Avoidant/Restrictive Food Intake Disorder (ARFID).

Avoidant Restrictive Food Intake Disorder (ARFID) is food refusal due to highly selective intake, lack of interest in eating, or fear of the unpleasant effects of eating without concerns of body image or weight.

“A selective eater will NOT “eat when they get hungry.” If you implement a technique designed to “wait them out” or “exert your parental control,” if you alter one of their 10-20 foods, you risk having that food drop out of their food list forever.

Children and adults with ARFID experience strong disgust reactions to the sight, smell and even the mere thought of eating unfamiliar food, which can create significant distress for eating in social settings.

Patients with ARFID are […] more likely to have a co-morbid anxiety disorder, learning disorder, or cognitive impairment […].

Therapy that focuses exclusively on the eating fails to consider the eating disturbance in its wider context as a relationship between the individual eating the food and the person who provides it.

DING DING DING!!! All the boxes, checked. All the Dash’s-eating things, making sense. I have joined the FB group and ordered the book. I read this entry and all the things I do, that are mostly for a quiet life and just because I hate causing, or suffering, angst, were suddenly validated and turn out to be okay.

So that’s a thing, and maybe it will lead to some developments. No cauliflower for him. Not yet.