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Opinion: fussy eaters aren’t necessarily whingers

“No child will ever starve themselves.”

How many times have I heard other health professionals say that when talking about a very fussy child? Many parents, quite rightly, don’t believe this. They have also been told that the best way to get a very fussy child to eat is just to sit them in front of a plate of the dinner of choice and leave them to eat it. The child will eventually give in.

I have heard one health professional suggest that if the food isn’t eaten straight away then it should be served up again the next day, for breakfast. But very fussy eating is not to do with the child being stubborn or flexing their ‘no’ muscles, wherever they are. Extreme fussy eating is caused by sensory hypersensitivity (an over-reaction to sensory input), which leads in turn to a disgust response towards any foods that do not fit the safe foods profile for that child. These safe foods are usually beige dry carbohydrates, such as bread, biscuits, cereals, with the addition of yoghurts and, sometimes, chocolate. All of these foods are easy to recognise and have simple textures which are easy to process in terms of sensory input.

All children tend to get more fussy at around two years, when they refuse both new foods and foods that they used to eat quite happily before. This is called the fear of the new (neophobia), but really it is a fear of the different. If the food doesn’t look exactly right, then it will be refused. A broken biscuit, toasted bread that is the wrong colour, a mixed dish that this time has green herbs sprinkled on top: all will be refused. These new foods do not match the internal idea of what a safe-to-eat food should look like, and so it triggers a disgust response. Gradually, as most children get older, they begin to understand that foods can look slightly different and yet still taste the same. Then they will extend their range of foods.

Some children, though, are fussier than others. This is largely an inherited trait. Although it is true that the more tastes and textures that an infant experiences in the first year, then the more foods they are likely to accept in later childhood, this does not mean that all infants who have been offered a wide range of foods will turn out to be good eaters. Some children just really struggle with food textures and feel little enjoyment in eating; consequently, their appetite is not good. However, if they are given the foods that they are happy with, they will grow well. If they are given foods that they find disgusting they will refuse to eat at all.

At last, though, this eating behaviour has been recognised as a diagnosable eating disorder, called Avoidant and Restrictive Food Intake Disorder (ARFID). Children with this disorder will eat very few foods (10 – counting everything eaten – would be good), they get anxious around new foods and quite often cannot be at the same table as others eating because of the smell of the food. Parents who have  a child like this: don’t force – it will make things worse – and please don’t leave them to starve.

Dr Gillian Harris is a consultant clinical psychologist at the Birmingham Food Refusal Service and at the University of Birmingham, in the United Kingdom.

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