Lack of experience in the first year
The most likely reason for extreme food refusal in the early years is lack of experience and practice, which slows down learning about how to eat. Infants with limited experience of foods, flavours and textures during their first year, will often be delayed in their feeding skills, but will catch up with continued exposure and practice. Is important for parents to understand that the neo-phobic phase is a normal developmental phase when toddlers start to become more selective about their food. However when coupled with limited experience due to repeated illness, feeding difficulties or chronic poor appetite, feeding can become a stressful and worrying time for parents. Those toddlers who reach the so-called “neo-phobic phase” (from 1 year – 18 months) whilst only being used to a few tastes and textures, often find it more difficult to accept unfamiliar foods, commonly only accepting soft textures and sweeter bland tastes. The section on food refusal may be helpful here. Young children will gradually accept foods that are familiar – learning by positive experience and praise. So building up different foods, offering them often, eating together with friends or family are all helpful ways to broaden experience. Although not as severe (or prolonged) as innate characteristics, one or two chosen strategies to work with are often helpful ways to get feeding skills back on track.
Innate food refusal
Extreme food refusal as a result of innate or inborn characteristics is rare, and the extent and cause of the condition is unknown. Many more boys than girls are affected, with every school probably having at least one child affected. Children with extreme food refusal are hypersensitive to sensory information like touch, taste and smell and can be highly selective and very anxious about trying new foods. Highly selective eating a narrow range of foods does put young children at risk of growth faltering and can be an additional concern for families. Gagging can be common in those young children if they are encouraged to eat a disliked food. However, gagging does happen more frequently with young children who have lack of experience. A good route to meeting nutritional needs can be combination of well-accepted foods to meet caloric needs alongside some less familiar foods, with gentile and consistent encouragement. With-holding food, eg. no dessert if the main meal is not eaten, or minimising between meal snacks in an effort to make a child more hungry, is unlikely to result in better food intake for those children with AFRID or extreme food refusal.
The first nutritional priority for children with innate characteristics is energy (calories). Making every mouthful count will rely on fortifying foods with extra calories eg. butter, cream, oils, and nutrients. Identifying nutritional gaps and providing selected nutritional support (eg. oral supplements drinks or puddings) will support growth whilst chosen strategies can be tried and worked through. Paediatric Dietitians are considered experts in this field. Messy play, food play or preparation like stirring, mixing, handling or even planting and growing from seed can all help toddlers and young children become de-sensitised and more accepting of foods. It can be a long process, and an area I work with regularly. Further information on extreme food refusal can be found here.