In my clinic, I typically see toddlers, nursery-aged and early-school age (KS1) children with behavioural, learned or sensory issues resulting in food refusal. Children who are growing well are usually meeting their nutritional needs for energy, but may be lacking in other key nutrients eg. calcium, iron, essential fats or vitamins. In general, aversive experiences in infancy related to the mouth, throat or feeding can be linked to food refusal later on. Examples include repeated reflux, respiratory difficulties, food allergies, tummy pain or force-feeding of any kind. Children with sensory processing differences may experience food very differently and have difficulty accepting a range of foods. Limited early feeding experience, as described in feeding difficulties in infancy, will likely contribute to feeding difficulties in childhood, particularly food refusal. An early feeding history can be a helpful way to understand what has happened in the past, and find ways to work with and improve the present.
Meeting Nutritional Needs
- The first nutritional need for all children is for energy (calories); from grains like wheat, oats, rice; roots like potato, squashes etc. and fats and oils from plants and animals like butter or oils, and fats contained in foods like meat, fish, eggs, nuts, seeds and dairy foods
- Proteins from meat, fish, eggs, pulses, nuts for building and repairing muscles and all other cells are needed daily. Without enough energy, protein will be used for energy, and not for its primary purpose of growth and repair
- Calcium and Vitamin D are essential for growing bones, provided mainly from dairy foods, plant milks, tofu, nuts and seeds and fortified white flour and hard water
- Vitamin D is a hormone-like substance, produced in the body from the sun’s rays on the skin, and not found in any significant amounts in foods except oily fish. All children in the UK need a daily supplement of at least 10ug
- Iron from eggs, red meat, green leafy vegetables, dried fruits, wholegrain, fortified cereals, nuts and pulses is needed for making haemoglobin, an oxygen carrying substance found in red blood cells that carries oxygenate the muscles, body and brain. It’s necessary for vitality, appetite and concentration
- Essential fats of the Omega 3 family necessary for many aspects of immune function, are found in a wide range of foods including oily fish, egg yolk, walnuts, flax, chia seeds
- Other nutrients such as iodine are essential for metabolic regulation and thyroid function. B vitamins and magnesium for production of energy. Vitamins A, C, and E to protect cells and zinc to boost immunity and growth
Behaviour and Learning about food and eating
For children, it’s not just about what they eat, but how they eat, and in what ways they can learn positively about food and eating. Parents are learning too! Not least about how best to support their child to enjoy a wide range of foods to meet their nutritional needs. The question becomes: how do young children enjoy eating and learn to regulate their eating behaviours? Eating should be social, enjoyable and stimulating for children but as many parents know, it can be a challenging task! Being present at mealtimes means children experience various social interactions, copy or try new ways of eating, and acquire familiarity of how food looks, smells, feels and tastes. Over time, this all helps to expand the repertoire of foods tried, accepted and enjoyed. Giving praise in whatever small way, is a great way to build good habits at the table and enjoy the experience of eating with others.