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This podcast episode is the first of a two part series on the psychology on how to reduce your picky eater’s anxiety.
I interviewed Dr Sarah Mundy, a Consultant Clinical Psychologist, who has worked with children and families for 20 years. She has recently written a parenting handbook and a series of interactive children’s picture books to help with those tricky times we all experience in early childhood – one of which focuses upon healthy eating. Much of her work is with children who have been adopted.
In this podcast episode she shares brilliant tips on how to reduce picky eater anxiety.
What is a picky eater?
‘Picky/fussy’ eaters are usually defined as children who consume an inadequate variety of foods through rejection of a substantial amount of foods that are familiar (as well as those that are unfamiliar) to them.
In the podcast version of this blog post, Dr Sarah Mundy explains that she primarily draws on the attachment theory, to help fussy eaters develop their relationship with food. The goal is to improve their emotional and behavioural wellbeing.
She often works with children who have experienced early adversity, many of whom have a particularly complicated relationship with food.
How should you help a picky eater manage their anxiety at meals?
Dr Sarah Mundy is interested in helping families learn to connect over mealtimes, rather than being pulled into battles (as is so often the case!) and for children to develop a more healthy relationship with food minus the picky eater anxiety.
This ultimately leads to more enjoyable mealtimes and a better diet.
She aims to take a systemic approach, moving away from just managing behaviours to considering feelings and relationships within the whole family.
What are the barriers that parents face with their fussy eaters that lead to anxiety rather than food freedom?
Dr Sarah Mundy explains that there are lots of evidence on what we need to do to support children to eat healthily.
She agrees on including them in the process from start to finish, helping them experience different textures and learning about food in a playful way, and giving them lots of chances to try an undesired food without giving up prematurely.
But, we may know what we need to do as parents but often it’s hard to put this into practice.
As she works mainly with children and parents together, she can see how influential parents are in shaping their children’s behaviour, often unconsciously.
Research suggests that the key to learning is through parents – for example, a parent’s fruit and vegetable consumption is the strongest predictor of a preschoolers intake of these foods.
Our behaviour and relationship with food as parents really matters – children whose parents indicated greater attempts to control their child’s diets reported higher intakes of both healthy and unhealthy snack foods.
In addition, those children whose parents indicated a greater use of food as a means to control their child’s behaviour reported higher levels of body dissatisfaction (Brown & Ogden, 2004).
Particularly in the pre school years, you are your primary model to your child – they develop expectations of the world based upon what they have experienced with you.
So, if you have a complex relationship with food yourself, or you find it hard to enjoy it and worry a great deal about eating, you probably will find it hard not to control how much your child eats. This will make it much harder for children to develop a positive relationship with food.
What we know is that restrictive feeding practices are associated with overeating and poorer self-regulation of energy intakes in preschool aged children – they eat depending upon how they are directed to.
For example, using food as a reward for good behaviour increases a child’s preferences of these foods (and we don’t often dangle carrots as an incentive).
Also, if we make too much of a positive fuss of children for eating healthily then this can actually result in them avoiding these foods.
Feeding behaviours in family is caught up with our general approach to parenting.
The more authoritarian we are (high demands, pressure to eat, coercion, greater restrictions, punishments, alongside low responsiveness to a child’s needs or behaviours) relates to fewer fruits and vegetables being eaten by children.
Whereas an authoritative approach (strategy that seeks to set reasonable rules and guidelines that are in the best interests of the child, responsive to child’s needs.
The rules provide structure while still allowing room for the child to explore, test, and begin the process of learning what constitutes acceptable behaviour).
Not surprisingly this is associated with eating more healthy foods. (see Savage for a good review of parental influence on eating behaviour, 2007 – from conception to adolescence).
It’s really helpful to think about how eating was managed in our home when we were children, and what we have taken from that – and how helpful it is.
As parents, we can also make the mistakes that we know best – in fact a child has an innate ability to self-regulate their energy intake BUT, this is affected by our approach.
For example, if we offer large portions, use controlling or restricting practices or put too much pressure on this can undermine the self-regulation.
Parents need to think about whether are pressurising their children too much, whether their expectations are too high. If we feel too over controlled it is harder to recognise feelings of hunger and fullness.
It’s important to remember that it’s innate for children to reject bitter foods, and will take time to change learn a new association with it.
How we react (not just verbally – our non-verbal communication has to be congruent with what we are saying) will shape their eating habits.
What the research is saying is that we need to respond to children’s hunger and satiety cues – but this is a departure from traditional feeding practices which focus on promoting children’s food intake whether they are hungry or not!
Does a parent’s own perceptions and beliefs around food and nutrition influence their child?
Children are like sponges and will mimic your eating choices, patterns and behaviours.
When parents demonstrate that restricting food and being unhappy with their body is normal, children will quickly follow suit.
2013 research from Duke Medicine and the Duke Global Health Institute show kids whose mums encouraged them to exercise and eat well, and model those healthy behaviours themselves, are more likely to be active and healthy eaters. This is a reminder to parents that their children are watching and learning from their behaviours, both good and bad.
The difficulty is that a lot of parents think they are being healthy by going on a restrictive diet when they are really teaching their children how to restrict food in the short term and not be able to keep it up in the long term.
A feast/famine relationship with food are then established as the norm.
The role of a parent is certainly a bumpy ride and there isn’t a rulebook, so you tend to teach what you were taught.
If you have an unhappy relationship with food and your body, it is important that you recognise this and find ways to help you to change this.
Not only will you be healthier and happier, but your children will have a better chance of never getting on the diet bandwagon in the first place. So, you really do need to think about your own relationship with food.
It’s also interesting how our own relationship more broadly with our children, affects their eating habits.
For example, a lack of trusting and reliable relationships within the family relates to unhealthy eating behaviours.
Certainly, in Dr Sarah Mundy’s work, she has seen children experiencing huge difficulties with food.
Fussy eating has been a default way of coping with difficult feelings and behaviours (rather than through the attachment relationship which children need) and has resulted in children having an extremely negative relationship with food, the need to use it as a form of control and/or a need to check it is available.
Eating behaviours can move away from the need for nutrition to a way to soothe and regulate deep emotional pain, or get one’s relational needs met.
Tips on how to handle picky eaters with high anxiety at the table.
It’s probably worth thinking about how you manage when you are anxious.
Dr Sarah Mundy for example focuses upon coping with her feelings rather than eating!
So the key to any mealtime is to try to take a positive and relaxed approach. It’s important to think about what is making your child anxious, and how much of that is coming from you.
Parenting is all about child reading – what are they communicating, why are they anxious, what is scary about new foods, what are you communicating to them about their behaviour?
Dr Sarah Mundy recommends the PACE approach – being playful and accepting and empathic, as well as curious why they are struggling with a particular food. Remember a food is not necessarily essential because your child hates it! (Katherine Whitehorn, journalist).
Also, remember that we have different preferences for food and naturally avoid bitter tastes (as they were associated with poison!).
It’s not surprising your child may struggle and we need to remember it’s natural rather than a naughty thing. Formula fed babies experience less variety of tastes in infancy so it might be that they take longer to learn new tastes.
We often give up too quickly, rather than trying an undesired food in different forms (until they either like it or you give up!). I often fall into the trap of thinking my child doesn’t like something only to see he has eaten it – which he wouldn’t if I had given the message that I expected him not to (and therefore help increase his anxiety about something being wrong with it!).
Role modeling whereby you are eating the desired foods, and providing gentle encouragement is fine, in fact we overcome anxiety by learning something is safe, and not avoiding it. But this is gradual.
You can praise them for trying or even smelling, and find other ways to talk about foods (interactive books have been helpful – my children’s picture book – please eat up, no it’s yuck, is developed just for this – to create a more positive association with food and learn about children’s perceptions of eating and what they need to make things easier) that have become a sticking point outside mealtimes.
The more familiar we are with something and the more of a positive association we have with it, the more we are likely to try it.
Try not to catch their anxiety or push yours onto theirs (emotions are physiologically contagious).
Really think about how important it is in the moment for them to eat that piece of food. You may be surprised by how your child tries something when the pressure is reduced.
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