Module 6 Healthy Eating

You, your child and healthy eating

Managing your child’s special eating needs can be stressful. Whether your child is on a special diet to manage their condition or they choose to self-restrict, including the special diet within the rest of the family is difficult. Siblings can be resentful of the attention their brother or sister receives and then may start their own issues.

Sometimes issues escalate and families find themselves navigating the healthcare system as their child’s diet and health has become more of an issue. Parents have had to modify their role in providing food and nurturing the child and this can result in feelings of being devalued or even threatened as the health care team takes on a bigger part of the decision making around food for your child. Many also report doubting their skill and capacity and can be defensive, angry, in denial or fearful.

And on top of this, as your child grows they need to learn to self manage their diet! The responsibility can be overwhelming . It is valuable to seek professional help from your health care providers and support groups who have a wealth of lived experiences to share. Try to avoid being perfect, no one is and it just sets the bar too high. Recognise stressful times and experiences and try to reflect on those at a quiet time to plan a different approach- brainstorm with others.

What sort of behaviours do we see in children at mealtimes that causes the stress?

All children will use food and meals at times to push your buttons. From the child’s point of view refusing to eat something might be for a variety of reasons

Fear of change/ new foods
Too many distractions
Part of normal development
Eating to avoid doing something else
Pressure from peers
Pressure from parents
Not enough variety
Refusing food to get attention
Refusing food to gain power

Where do you start?

Firstly, you need to decide how important is this meal. Is your child going to become physically unwell by not eating? Is their growth and nutrition a major concern or are they in general good health? A dietitian will help you determine suitable strategies to use if the answers to these questions are a 'yes'. If food refusal or limited food intake is a general pattern some of these suggestions might be worth considering – not every suggestion will suit every family though!

Children vary in how they eat- some are very enthusiastic eaters and others don’t seem to care for food very much. Some eat slowly and some more quickly.

Most children will have some particular preferences. Some are even “super tasters” who find tastes of some foods like cauliflower and broccoli very strong. Remember as adults as we all have preferences for specific foods ourselves. It is ok to have a small number of dislikes but not an entire food group!

Consider the eating environment. Make sure your child is comfortable at the table and can easily reach their plate. They should sit well supported with feet not dangling, and not need to reach up to table. Some high chairs have a tray that can be fully removed and the chair pushed up to the table or use a booster cushion on a kitchen chair.

Eat together as often as possible, children learn about foods and eating and are more willing to try new foods if they are watching their “ trusted adults” enjoy the foods as well.

Avoid distractions at mealtimes like TV, toys, computers or phones. This decreases the value of the meal and the parent’s attention on the child as well. Mealtimes are more than food. They are an opportunity to learn to hold conversations, manners and social skills.

Have realistic expectations. Don’t expect large intakes straight away when your child has just started a new food. A young child’s attention span is short, 15-20 minutes is usually enough, no longer than 30 minutes should be spent at most meals. Mess is normal. Young children like to play with food to explore the textures with their hands. Wait until the meal is finished before you start cleaning up. Choose a place to eat which has an easy to clean floor.

Keep offering foods - 10-15 presentations of a new food are needed before it might be accepted within the ‘normal’ foods. It takes a long time to get used to foods so if you do not serve them then you are saying you do not expect it to be eaten.

What can parents do?

Remain positive, calm and consistent
Don’t get cross about rejected foods, step back and avoid confrontations over food. Pressuring and coercing to eat a particular food is more likely to promote a dislike of those foods!
Don’t talk about your fussy eater in front of them - they will believe the message too. Put a positive spin on things “...likes trying new foods”
Be responsible for making healthy foods available to your child. Aim for a variety of foods every day
Eat together as much as possible. Even if you usually eat dinner later than your children, allow children to join in and graze with you before bed and eventually the time will stretch out as they get older so you can all eat the same meal together
Don’t prepare different meals for each person. Serve meals family style so everyone can help themselves. Some children loves the power a “no” causes and you can’t sustain producing different dishes every night. Limiting foods offered to ones that you know they like deprives them of the chance to try new foods that they might also enjoy!
Don’t focus on what they are not eating, instead enjoy what you eat and the exposure will encourage them to eventually try it
Offer one or two foods that you know your child likes as part of the family meal. For instance a new casserole recipe served with rice, or always have some bread on the table. Most young children will at least eat that and so will become familiar with new foods whilst being able to prevent hunger on old favourites
Remember tastes change so retry new foods regularly. Be aware of textures too. Some children with sensory issues are very aware of texture of foods and especially reluctant to eat foods of mixed texture such as yoghurt with pieces of fruit mixed in
Watch out for large quantities of drinks especially milk and juice around meal times, one glass of juice a day is plenty
If you are aiming to change things, just work on one behaviour at a time.

Your new approach needs to be tried many times before it will work, remember you need to be consistent and that things might get worse before they get better. Consistency is the key!

Other factors to consider:

Division of responsibility

The parent has the responsibility to:

Maintain indirect controls on feeding such as having set meal and snack times
Choosing and buying food
Making and presenting meals and snacks
Deciding where these will be served
Presenting food in a way a child can manage
Allowing ways of eating a child can manage
Making family meals pleasant and setting limits on behaviour
Keep the child safe- watch out for choking risk foods and behaviour

The child has the responsibility to:

Decide what to eat
Choose how much to eat

Pressure on eating more than they want leads to issues long term, including overriding hunger and satiety. Pick your battles, is it worth fighting about the last green bean when they have tasted corn for the first time?

Encourage children to use all their senses to develop their own confidence in their choices and tastes:

Sight — check out the colour, shape, and size. Colour is important—red foods are often preferable according to research!
Smell — what scents can you detect, does it remind you of something else?
Touch — how does it feel on the fingers, lips and tongue
Taste — lick to taste-is it sweet, savoury, bitter, salty? Temperature alters the taste intensity so cold foods are preferable for some children. Also some foods are ‘irritating ‘ to children such as strong spices and fizz in drinks
Listen — to the sound it makes as you bite (try on the back teeth first with a little bit) to avoid flooding the mouth with new tastes if your child is very sensitive - its ok to take it out again if you don’t like it- this reassures the child they are in control).

Planning your meals:

there are many guides about how much to offer- these are some basic guidelines for children who don’t have specific dietary restrictions to manage a medical condition. Here are some common and useful hints:

Include a bread or cereal at breakfast with milk or other dairy and offer fruit in some way
Encourage at least 2 fresh foods per day as fruit or raw vegetables
Offer a cooked vegetable at least one meal per day
Offer dairy foods twice more during the day (as yoghurt, milk or cheese)
Make sure lunch and tea have some carbohydrate base like rice, pasta or potato for energy
Include meat at least once per day – a very small serve is needed for children (about the size of their palm)
Restrict high fat and high sugar foods
Watch drinks and snacks close to meal times.

Here are some websites that might give you more ideas or food for thought.

Remember if you are making changes to how and what you feed your family you will need some support to get through this stage. See if you can enlist your partner, parents and friends as allies and sounding boards.

Goal setting – see if you can set a goal for this week and next in relation to this content. Write your ideas down and select the change that will most likely be successful. Then, build up from there. You can do it!

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