Don’t start with the food, says specialist Catherine Jeans.
Restrictive eating can develop as a result of a sensory aversion to food, a fear of eating, or a lack of interest in food (not recognising when you’re hungry). It can also develop following a period of poor health, from surgery, from a difficulty with swallowing, or from vomiting after food poisoning. A person with restrictive eating may be diagnosed with ARFID (Avoidant Restrictive Food Intake Disorder), and it’s important to remember that this is different to other eating disorders in that it is not influenced by body image. ARFID can also usually be diagnosed from a much earlier age. Not all children with ARFID are autistic, but there is a high co-occurrence rate of ARFID and autism and also PDA.
When supporting a restrictive eater, the long term goal is to help them increase the diversity and quantity of foods they eat. However, no amount of encouragement, coercion or bribery is likely to work. Some liken it to asking them to eat a plate of worms. The first step is to work with some of the potential underlying causes of restrictive eating, from nervous system challenges to any nutritional deficiencies that may be exacerbating sensory aversion to food.
Nervous system support around food. Given how distressing it can be for someone with restrictive eating to be faced with food, one of the first steps is to try to calm the nervous system around the eating experience. For example, before meal times, try getting ready for eating with an activity the individual finds calming, such as going for a walk outside, listening to their favourite music, doing some age-appropriate yoga or reading a book together. You could try to encourage deeper breathing by teaching them to blow ping pong balls with straws, or other activities to engage the proprioceptive system, such as bouncing, climbing, or walking like an animal on all fours. At meal times, consider what may help that individual to feel calmer. Distraction can also be helpful. Whilst it would be ideal to have everyone sitting at a table together to eat, this doesn’t work for everyone. Using a distraction such as drawing, favourite toy or even an ipad can be a game-changer for a restrictive eater.
Engaging with food without eating. One of the underlying contributors to restrictive eating might be a heightened neophobic (fear of new things) or disgust response, which for non-restrictive eaters usually diminish by around the age of five. For restrictive eaters, these natural responses that helped to keep our ancestors safe, may persist for many years. Therefore, it can be helpful to support children and adults to feel more comfortable around food, without any pressure to try or taste it. Engaging in non-eating activities may start with messy play, perhaps with dry foods initially if someone is sensitive to texture. This may progress to helping to cook or bake for someone else, drawing with foods, squishing mashed potato or playing with spaghetti swamps. These activities should be done away from meal times, to avoid any impact on already accepted foods.
Allowing access to accepted foods. Restrictive eaters must be allowed access to their accepted or safe foods although it may be useful to find another word to use other than safe, as this could reinforce the idea that other foods are unsafe. It is vital that restrictive eaters do not have their accepted foods removed from their diet, as this could potentially be dangerous for their health. They have to eat, and it’s crucial not to do anything that could prejudice their acceptance of these foods, even if they are unhealthier foods. Don’t try to hide or sneak other foods in, but instead encourage acceptance initially through sensory exploring away from meal times. Then over time you can gradually start to introduce new foods in a systematic way, on a separate plate.
Nutritional deficiencies. A common side-effect of restrictive eating is nutrient deficiency. This can cause a downward spiral of further restrictive eating, as some nutrients, such as zinc, are vital for supporting the brain and a balanced nervous system. Zinc is vital for our sense of taste, appetite, digestive health and also for production of key neurotransmitters such as dopamine (for focus) and GABA (our off-switch and calming neurotransmitter). Supplementing can be a challenge for restrictive eaters, as they may struggle to take supplements.
Author: Catherine Jeans
Catherine Jeans
Catherine Jeans is a registered nutritional therapy practitioner and director of The Family Nutrition Expert. She specialises in supporting restrictive eaters and neurodivergent families.
Website: thefamilynutritionexpert.com
Instagram: @catherine_jeans
