Food Anxiety in Children
Are mealtimes starting to feel like routine meltdowns? Is your child’s picky eating causing daily distress? Do you find yourself engaging in power struggles with your child when it comes to eating that makes you feel defeated as a parent? If you answered yes to any of these questions you can be reassured that you are not alone. This is an incredibly common experience for almost all parents. In fact, research suggests a broad but significant approximation that between 14 to 50 percent of preschool-age children exhibit severe picky eating and 7 to 27 percent of older children.**
Your child’s relationship with food evolves over time as they develop. Most parents can recall memories of their infant’s first encounter with trying solid food for the first time. This milestone sets a precedent for your child’s earliest experience of building awareness of preferred and non-preferred foods. As they grow and mature, they continue to be introduced to new foods. For many children, this experience can feel scary. Food anxiety is conceptualized as the manifestation of a heightened fear response elicited by the presentation of food that is often associated with severely selective eating, strong food aversion, fear, and emotional distress during meal times.
Food Anxiety vs. Picky Eating
Picky eating during early childhood can be a rather developmentally appropriate experience, especially during toddlerhood. It is not uncommon for young children to experience these habits and eventually grow out of them over the course of time with continued exposure. However, it is critical to distinguish the root of why your child is engaging in food refusal or experiencing food anxiety because it provides clarity for the most optimal way to intervene. Common underlying factors that may contribute to the development of food anxiety include:
Food aversion: strong dislike for particular foods
Food phobias: Common food phobias in children include neophobia, the fear of trying new foods, and phagophobia, the fear of swallowing
Sensory-related sensitivities: smell, taste, and texture of foods trigger visceral responses
Oral motor skill developmental delays: challenges with biting, chewing, swallowing, or manipulating foods
Power and control: children may utilize eating as a way to exert power and control if they are feeling insufficient in their ability to do this during other times. Some children desire to exert their autonomy over what they choose to eat and feel constricted when they sense a lack of control over this.
Generally, children classified as picky eaters often exhibit behavioral challenges during eating such as non-compliance, refusal, and upset. Uniquely, children with food anxiety experience these behavioral symptoms in addition to prolonged and severe emotional distress and fear.
If their symptoms go unmanaged the anxiety may even manifest into an anxiety-based feeding disorder. Avoidant/restrictive food intake disorder (ARFID) is an eating disorder classified in the DSM-5 manual that is defined as, “an eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs.”* Children diagnosed with ARFID have severe food anxiety and aversion that limits their food consumption to the extent that it impacts their physical health, mental health, and development. Symptoms of ARFID include extreme nutrition deficiencies, weight loss or stunted growth, and compromised physical health.* AFRID is unique to other eating disorders in that it does not involve fixated or distorted thinking related to body shape or size. AFRID can be diagnosed at any age, however, it is most commonly assessed for beginning at age six or seven due to the nature of picky eating being more developmentally expected during early childhood.
The prevalence of ARFID is higher among children diagnosed with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and anxiety.*** Children who have experienced neglect are also more at risk of experiencing food anxiety that may develop into a disorder.***
Signs Your Child May Have Food Anxiety
Children who have food anxiety experience adverse thoughts, feelings, and behaviors related to eating. If your child regularly exhibits a combination of these symptoms when presented with food it may be an indicator that they have food anxiety.
Expressing fearfulness when eating, talking about food, or being presented with food
Limited amount of accepted foods (less than 20 accepted foods indicates a poor range)
Refusal and avoidance to eat foods based on their texture, color, or taste
Ruminating thoughts related to something bad happening if they eat certain foods such as being unable to swallow or the food causing illness
Feeling a lack of control and a sense of powerlessness over their worries related to foods
Meal times trigger negative emotions such as anger, sadness, worry, and disgust
Frequent dysregulation, heightened distress, and emotional meltdowns when presented with food
Food refusal, avoidance, and consistent noncompliance with eating
Physiological symptoms including complaints of stomach aches, rapid heartbeat, fast breathing, and sweating
Visceral reactions including nausea, gagging, or vomiting when eating
Intolerance to having non-preferred foods placed on their plate
How to Help Your Child with Food Anxiety
Navigating how to help your child with food anxiety can feel overwhelming for parents, especially when it feels like you have tried everything without consistent success. The following recommendations are helpful tips to support your child through their journey of managing their food anxiety so that eating can feel more desirable and less stressful.
Talk openly with your child about their relationship with food and express genuine curiosity. Showing interest in learning about your child’s interpretation of food can help uncover the reasons why they are so fearful. For example, when given the opportunity to share, a young toddler may reveal that they don’t want to eat broccoli because they’re scared it will make them turn green. To work through food anxiety for this child, exploring what is real vs. pretend to help alleviate the fear and re-establish their sense of safety with food would be helpful. They may need to be invited to experiment with food, for example bravely taking a small bite of broccoli and noticing that they did not in fact turn a different color. Eventually, with time and repeated exposure, the child can begin to trust that their anxious thought is not a real or rational thought.
Reframing the narrative of eating by helping your child view food as a way to unlock their superpowers. Nearly all children want to grow bigger, faster, stronger, and more powerful much like the superheroes who they admire. Parents can educate their children on the benefits of eating. Teaching them that what they put into their body contributes to their growth, health, and strength can help empower them. Helping your child understand that they have control over their body’s development can make them more intrinsically motivated to eat better. This can be a helpful way to support your child in re-establishing a more positive narrative about their relationship with food.
Encourage sensory exploration of food. Historically we’ve been taught not to play with our food however, it can actually be an extremely helpful tool for children battling food anxiety. As an exposure intervention, parents can slowly introduce their child to non-preferred foods to help them feel less scared in small steps. These steps should involve sensory play, such as touching, smelling, licking, or even creating artwork with food to allow them to explore it.
Positively reinforce each step, big or small. It is important to provide positive praise for each step that involves your child encountering new or non-preferred foods. This can help reinforce their willingness to continue to be presented with it. Creating a visual scale with your child that lists 10 steps of exploring a new food, such as smelling it, eating half of it, or having it on their plate, can be a helpful tool.
Make food fun. Inviting your child into the kitchen, grocery store, or garden can help build excitement with food. This can help mealtime feel like more of a connection and less of a chore. Children can also incorporate themes of food into their play. Encouraging them to use their imagination in a play kitchen or create a restaurant of their own can help them build a more positive schema of food.
Create food challenges. Introducing a variety of new foods or non-preferred foods at once can overwhelm your child. Instead, focus on identifying one food and focusing on that as their food challenge to practice being exposed to. To make tracking their progress fun, it may be helpful to incorporate a visual food tracker.
Remember that brain development impacts decision-making. Limit choices of what foods are available. The prefrontal cortex is one of the primary regions of the brain that is responsible for decision-making. Neuroscientists estimate that this region of the brain is not fully developed until approximately age 25.**** This helps provide a neurological explanation for why decision-making for children presents as such a difficult challenge. So, how does this relate to your child’s eating habits? Meal times are routine times of their day that require decision-making. The more that children have to choose from, the harder their decision-making process becomes. To meet them where they are in their brain development, parents can help reduce their overwhelm by reducing the number of choices they have to make when they eat. If unhealthy foods are less accessible on their plate or in the pantry, children will be more inclined to be open to trying healthier foods. Try offering multiple foods on your child’s plate, most ideally one from each food group. If tolerable, their plate should have preferred foods and at least one non-preferred food that they are working on trying. If they refuse completely, parents may opt into allowing for one alternative choice, for example, stating that your child can have an applesauce instead of carrots today. Practice this with caution as allowing too much negotiating can lead to power struggles.
Visit the pediatrician. It’s important to inform your child’s doctor if they are struggling with eating. Physical assessments can help rule out medical factors such as gastrointestinal issues, acid reflux, or allergies that may also contribute to your child’s eating habits. Doctors may also help keep a close eye on your child’s physical health and monitor whether their eating is negatively impacting their growth.
When to Seek Help
The battle of helping your child cope with food anxiety and re-establishing a positive relationship with food doesn’t have to be fought alone. Making the decision to partner with a mental health professional can be a crucial step in creating positive change for not only your child but also for your entire family’s wellbeing. Heritage Counseling and Consulting has licensed therapists who specialize in working with children and are skilled at utilizing play therapy and cognitive behavioral therapy to guide the treatment of food anxiety. To begin your journey with helping your child heal we warmly invite you to schedule a consultation at Heritage Counseling by calling 214-363-2345.
Sources:
*American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Washington, DC:
Author.
**https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725687/
*** https://childmind.org/article/what-is-arfid/
**** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129331/
