Wholesome Child : Wholesome Child full
23 22 ➋ SENSORY ISSUES Children with sensory issues may get upset by things like the tags in their clothes, loud noises such as the vacuum cleaner and certain smells or bright lights. One of the main sensory issues that leads to fussy eating is called oral defensiveness. A child with oral defensiveness shows unusual sensitivity to taste, smell, and texture. Common signs that a child may be oral defensive is that they will easily gag, may not transition off purees onto finger foods, avoid messy tactile play (finger paints, sandpits, messy food), fuss when it’s time to brush their teeth or wash their face as it creates an uncomfortable sensation, have repetitive diets and be picky about foods, and dislike eating in unfamiliar places such as friend’s homes or restaurants. Sensory issues are very prevalent in children who have autism spectrum disorders and most of these children will need to seek help from experts such as occupational therapists, who specialise in this area. At the same time these children benefit from working with a trained nutritionist or dietitian to ensure the foods they are trying to integrate are beneficial. ➌ ORAL MOTOR DELAYS These can begin with the inability to suck and swallow and include the inability to chew properly due to weak muscles. Many of these children are undiagnosed and for them it is easier to eat white bread, pasta, chocolate and foods that dissolve in the mouth and do not require excessive chewing. Hard vegetables and foods such as meat are avoided as they require skills these children do not possess. These children will need to be treated. Common signs that a baby or child may have oral motor delays is an inability to latch at the breast or suck at the bottle, an inability to bring their bottom lip down to suck food off a spoon, struggling to pick up food and bring it to the mouth, an inability to chew solid food without choking, frequently gagging because their gag reflex has not moved to the back of their tongue and every time they eat they feel like they are going to gag, choke or vomit. Older children may not have the ability to move food around their mouth using their tongues. Other signs your baby or child may have an oral motor issue: • drooling. • gagging frequently on food. • spitting up during and after meals. • coughing and gagging while eating. • difficulty chewing, difficulty keeping food in mouth during meals. • refusal of foods, pocketing food and negative behaviours around mealtime. • changes in voice during and after eating. • recurring respiratory infections/pneumonia. • poor weight gain/growth. ➍ LOW MUSCLETONE Children can be born with low muscle tone (hypotonic) or have low muscle tone due to a specific diagnosis such as Down syndrome, or they can acquire low muscle tone through ‘nutrient deprivation’ or ‘cellular malnutrition’. Children with low muscle tone: • have reduced stamina. • can have difficulty with maintaining positions like sitting for meals, hence the importance of correct highchairs and seating. • become fatigued by chewing food. • have trouble using their hands to self-feed. • have trouble pushing with constipation due to muscle weakness. nutritional causes of fussy eating Common causes of fussy eating include zinc deficiencies, cravings for sugar or salt, as well as stressful mealtimes. Below are the main causes that I see in my practice: 1. Introducing sugary foods too early on. If children are exposed to sugar too early, they will alter their sweet taste receptors. Research has also shown that sugar is highly addictive, and has a drug-like response in many children – the more a child eats it, the more he or she wants to eat it to feel the euphoric feelings associated with sweet foods. For fussy eaters, it’s really important to balance their blood sugar levels and curb their cravings. (See more about the effects of too much sugar in children and how to manage it in the Reduce Sugar chapter). 2. Introducing too many commercially prepared foods. As a parent, you can’t compete with processed foods that not only contain sugar and salt (two of the most highly addictive tastes that can interfere with children getting used to natural foods) but also contain flavour enhancers, • If you are reading this with an older fussy child and wishing you had known this beforehand, then you are like many other parents. The most important thing you can do now is to continue to persevere in exposing your child to healthy food choices. As children grow up, and especially as they enter into their teens, their cognition takes over. It is far easier to speak to an older girl and explain that a healthy diet will make her skin glow, her hair shine and her body strong for sports, and for boys, if they are into sport, explaining to them (or better yet, getting their coach or another male they respect and admire to speak to them) about the importance of eating nutritious foods. Fussy eaters vs Problem feeders Most children will go through fussy patches and there are many ways to ensure that this does not evolve into myriad unwanted behaviours. However, there is a small percentage of children who will require intervention as a result of physiological or psychological reasons for their ongoing food refusal such as oral motor delays, sensory issues, gastrointestinal disturbances or anxiety food-related disorders. These children may fall into the category of what is called ‘problem feeders’, and the sooner their issues are identified and treated, the more willing they will be to try new foods. Underlying causes of fussy eating A combination of occupational therapy (OT ), speech pathology, nutritional therapy and medical supervision is often required to address the following conditions: ➊ DIGESTIVE ISSUES There is a wide range of digestive disorders that can interfere with a child’s ability to eat and enjoy their meals. This can range from hernias, constipation, reflux and coeliac disease to food allergies or intolerances and much more. The main thing to be aware of is that if your child is suffering from a gastrointestinal problem, it’s likely they will not want to eat. The two most common issues I see in clinic are: • Reflux. Most of the fussy eaters I see suffered from reflux as babies. These children have been wired to expect eating to be associated with pain and do not have a genuine love of food. For these children, it’s essential to look for food allergies and eliminate any foods from the diet that may still be causing pain. Part of the treatment can be ongoing management for reflux, or healing the gut with nutritional supplements and probiotics to ensure the digestive tract is functioning well and nutrients are being absorbed. • Constipation. This is a huge factor that can cause fussy eating and loss of appetite. If the bowels aren’t being cleared daily then the appetite is more than likely switched off. One of the first things we do when treating children with eating difficulties is to heal their guts with probiotics and ensure they are evacuating all the contents of their bowels. Children with severe cases of constipation may initially need to be treated using a prescription laxative under medical supervision, however as a nutritional therapist it’s my aim to get them onto natural alternatives to support the body. wholesome child fussy eating A FUSSY EATER... A PROBLEM FEEDER... eats a decreased range of foods but will eat at least 30 types of foods. eats less than 20 types of foods. will eat the same peanut butter sandwich every day for months, then go off it and refuse to eat it. However, a few weeks later he/she will happily eat it again. will demand a peanut butter sandwich every day for months, then tire of it and refuse to eat it again, even months later. can tolerate new foods on their plate, touch new foods, may even (after lots of encouragement) taste a new food even if it’s not swallowed. will have a meltdown if a new food is placed on their plate; some children will refuse to sit at the table if certain foods are present even if only on other family member’s plates. will eat foods from all the different food texture groups (eg crunchy, soft, hard). will completely omit certain textures from their diet. during mealtimes will be happy to sit with family as long as they are eating a food/meal they like. This will most likely be different to the rest of the family’s meal but may include some components of the family meal (eg will eat corn or a meatball with no sauce). will refuse to eat all components of the family’s meal and demand a completely different meal to the family the majority of the time. with lots of repetition, encouragement and positive reinforcement from parents may slowly add new foods to their limited diet. will refuse to taste new food no matter how much encouragement they receive. Consider this... Research now shows that the most influential factor in determining children’s taste preferences despite their genetic make-up (up to 85%) is due to the foods they are exposed to early on in life.