WITH FEEDING PROBLEMS IN CHILDREN
The purpose of this information
booklet is to provide suggestions to parents on how to manage problems with
feeding and difficult behaviour at the dinner table. The advice in the guide is
based on the assumption that the child is physically well. Any suspicion that
his or her difficulties are caused by a physical problem, should lead you to
seek advice from your family doctor.
What do we mean by feeding problems?
This term covers a wide range of
behaviours such as: -
Refusal to eat or eating very
Picky eaters, faddiness, eating a
very limited range of foods
Refusal to sit at the table, leaving
the table during a meal
Throwing tantrums at the table,
crying, throwing food or other objects
big a problem is it?
have shown that this is a common problem. A large scale study of 5 year-olds
showed that over one third were described by their parents as having mild or
moderate appetite or eating problems, Two thirds of these were considered to be
faddy eaters, while the rest were thought not to eat enough. In another study of
causes the problem?
are a variety of explanations but often a feeding / eating problem arises out of
difficulties in relationships in general. Feeding problems are often linked with
general behaviour problems such as temper tantrums, as well as more specific
behaviour problems such as sleep difficulties, soiling and breath holding.
often create problems at mealtimes by failing to establish a routine and this
can lead to the child not knowing how to behave appropriately. Although
mealtimes are a private affair, how many times have you been in someone else’s
house or in a restaurant or café and seen a parent chasing after a child
holding a chicken nugget. The parent’s aim is to feed the child regardless of
what he or she is doing; the child is basically doing what they want. In some
households this can often be the normal way of eating.
should be thought of as any other behaviour. It has to be taught and the child
must learn. Often there are too many distractions such as television or family
arguments. Parents may also not realise how much the child’s appetite matches
the helpings on the plate. There is nothing more off putting than having to eat
a huge pile of food knowing that you are going to be told off if you do not
“clear your plate”.
many instances the child’s behaviour is linked to attention seeking. It is a
natural desire for parent to feed their child. For mothers this starts at birth
and helps establish the maternal bond. When a child starts to refuse to eat food
or develops a fad, this leads to the parent spending more time thinking and
talking about the problem. Soon it becomes the major topic of conversation in
the household. When the child does not eat the beautifully prepared food that is
given, there is likely to be some conflict. The child is shouted at, threats are
made, and all the time the child is gaining attention. When the other parent or
relative comes into the house, the first question is often “ Did Johnny eat
his dinner tonight?” Grandparents will phone in the evening to find out if
Susan ate her dinner. So who is in control of the situation? Who is the centre of attention?
parents are able to list the foods that they know that their child will eat.
They can also give a list of foods that their child used to eat but no longer
like. In many cases where the child is displaying a feeding problem there is
little weight loss. For some reason the child is not losing weight and is
growing normally. This suggests that the child’s calorific intake is adequate,
so what are they eating. Often this is due to the child eating snacks or “junk
food”. When the parent gives the child a meal and they refuse to eat it. The
parent may do one of several things: -
child what else they would like to eat and make it.
food away and sends the child from the table but will make something else later.
child “If you eat one more nugget then you’ll get a bar of chocolate!”
child to have a snack later on, such as crisps, Pringles, biscuits, sweets,
fizzy juice, and milk.
all the parent feels guilty and worries that their child may starve. Who is in control here?
Assessment of feeding problems
Keeping a food diary
If you think your child may have feeding problems then the first step is to record what he or she eats over the course of a day, or if possible a week. This should include details of the amount and type of food eaten, including all snacks and drinks, as well as time and place. This helps to identify how much “junk food” accounts for your child’s daily calorific intake.
Ask yourself some basic questions
you have rules about mealtime behaviour? What do you expect from your child at
you clear about these rules? Is the child clear about the rules?
you and your partner agree and follow these rules?
your child sit at a table to eat?
your child eat at the same time each night?
mealtime rules are often broken?
do you do if your child breaks these rules? What is the consequence of rule
breaking? Do all adults in the house apply these rules consistently?
happens if the child follows the rules? Is there a positive outcome?
where, with whom does your child not present feeding problems?
you take your child out for a meal and know that they would sit at the table and
you lose your temper at mealtimes?
you shout at your child at mealtimes?
Do mealtimes end up with arguments?
The child’s appetite
Children have a very different appetite from adults. Adults are used to having three meals a day, but this is not necessarily the best for young children. Most young children require four or five small meals a day, morning, mid-morning, noon, mid-afternoon and evening. The amount of food is also very important and parents must be aware that children do not have the same appetite as them. There is nothing more off-putting than facing a mountain of food on a plate. It is much better to give the child a modest portion and the opportunity to come back for more if needed.
You must also consider the amount of fluid that the child is taking. Some children may not be hungry because they have been drinking milk or juice before their meal. It is not surprising that they then do not eat their meal.
Children require help in establishing setting
cues associated with eating. This is a symbol or indicator that helps the child
recognise that feeding / eating is required. This is the starting point for
mealtime rules to apply. Setting cues may be only eating a table at meal times,
having a special place mat or cutlery. If the child has a specific place to sit
and eat then they are less likely to argue over where they want to go and there
is likely to be fewer distractions. They are also less likely to drop food on
the living room carpet.
Most of the time we respond to negative
behaviours, so the child does something wrong and we comment or react to it.
When we think of positive reinforcement we have to responds to desirable
behaviours and reward them. This can be quite hard to do as we are used to
responding to negative behaviours and ignoring good behaviours.
How often do we praise a child for sitting at a
table for a few minutes? A good slogan to help think about this is
“Catch the child in good mealtime
behaviour rather than always in bad behaviour”
To have most effect, reinforcers
(rewards) such as treats, praise and encouragement should follow as closely as
possible upon a child’s performance of the particular desired mealtime
behaviour. So if the child sits at the table then he is immediately praised. If
he eats some food then he is praised.
There is little doubt that attention,
whether positive or negative, can be a very powerful reinforcer for children’s
behaviour. Inappropriate eating habits in children who are able to feed
themselves are often the result of the child mastering a technique in which they
control mealtimes. If the child sits sulking at the table refusing to eat, the
way that the parent responds is critical to the outcome. Frequently parents’
reprimands or attempts to clean up the mess on the table or clean up the child
can simply reinforce the behaviour. The skill is knowing when to ignore the
negative behaviour and asking yourself “If I respond to this what will be the
consequence for me and my child?”
Examples of ABC Analysis
A useful way of looking at behaviour
problems is using the A-B-C method.
stands for Antecedents (what caused the tantrum?)
stands for Behaviour (what actually happened?)
stands for Consequence (What was the outcome?)
If you can identify the events that
led to the tantrum then you can avoid the negative behaviour, which means there
will be no unpleasant consequences!
Time-out is a response to attention
seeking behaviours that cannot be ignored. It involves removing the child from
the rewarding situation related to the problem behaviour to a specific “time
out” location for a defined period of time.
Alternatively the source of the provocation may be removed, for example
the food that the child was throwing.
The rules of time-out are simple but
must be applied correctly
Remember – Hunger is a natural consequence of not eating, so use it to
your advantage. Explain to your children “if you don’t eat your lunch by the
time the timer rings, then I’ll take away your plate and there won’t be any
snacks until dinner!”
Strategies to help your child eat
Offer a limited choice
If your child is a faddy eater then
you could consider offering a choice of 2 meals. They can either choose what
everyone else is having or they can choose one type of nutritious food. The
choice must be made well before each meal so that you are not forced into last
minute preparations. By offering the child an alternative, you are giving them a
way out of a conflict, so everyone wins. A limited choice introduces the idea of
compromise and shows that you are willing to give them some control, but not all
If your child has a limited diet then
try to introduce new foods with those that you know he or she likes. Give
smaller portions but with a range of foods, for example a sausage, some potato
shapes, some peas and a carrot.
Reward good eating and table manners
Watch your child eating and praise
appropriate behaviours. If he or she is using their cutlery properly then praise
them. Give positive feedback to the child so that they know that they are doing
well. If there are other children at the table then use a technique called
proximity narration. This involves the parent commenting on what positive
behaviours the other child is doing. For example, “ Jack is using his knife
and fork well!” “ Katy is eating all her peas”. This method reinforces the
positive behaviours and allows those children who are eating well to be receive
Have time-limited meals
It is often the case that poor eaters
will drag mealtimes out by eating slowly, complaining at every mouthful and
playing with their food. This is not acceptable and results in tempers being
frayed and the food being spoilt. Instead of allowing this to continue, set a
reasonable amount of time, say 20 minutes and let the children know how long
they have. You could even use a kitchen timer and when the bell rings then their
plates will be removed.
A start chart or sticker chart can be
a useful aid to rewarding good eating behaviour. If a child eats all their meal
or sits well at the table then a star or sticker can be given. These can be
added up for a treat. Remember, children find it difficult to plan far ahead so
the reward cannot be days away. It is best to reward that day or the next.Summary
Feeding and eating problems in young
children are quite common and a normal aspect of learning. It is important that
parents thinks about how they manage meal times and the rules that they set and
apply. In most instances the child is receiving more attention for displaying
inappropriate and unacceptable behaviours at meal times. By clarifying the rules
and boundaries that we set and also by applying these consistently then it is
possible to overcome these feeding /
Chartered Educational Psychologist