Food For Kids Podcast episode 4: Is this fussy eating normal? With Emma Shafqat

Joanne Roach (00:13)

Hello and welcome to the Food for Kids podcast. I'm Joanne from the Foodies. Today's episode, I think, is going to be helpful for a lot of parents because I'm talking to the fabulous Emma from Dietitian with a Difference about fussy eating. Emma's a pediatric dietitian with many years experience in the NHS. She focuses primarily on fussy eating and allergy issues. She puts out loads of great content on Instagram to help to reduce mealtime stress for families and to give parents like tips on how to introduce children to foods in a way that feels gradual and safe for anxious eaters. She's a mom herself who has lived through fussy eating and allergy issues with her own little girl and she's incredibly realistic, practical and kind. In this interview we're talking about how to know if your child's fussiness is just a quote unquote normal level of developmental hesitancy around new foods or whether you should consider asking for advice from a professional. I think a lot of us worry that we're either making a mountain out of a molehill or on the other hand, writing off actual eating issues as just a stage. So Emma's very helpful in this interview and flagging up what to look for and how to understand where your child's coming from. I hope you enjoy it. Here's the interview.

Joanne (01:28)

Okay, so i'm here with the Emma who's a children's dietitian "Dietitian With A Difference". And I think a lot of parents that listen to the show are really worried about their child being a fussy eater or a picky eater and I know that, like most kids are picky some time to some degree. But how do you go about knowing whether or not your child is " normal fussy eating" or whether it's a problem that you should seek help with?

Emma (01:53)

So that can be hard to define as such. But I think one of the main things that we look for is the number of foods that they're eating. So we tend to say if they're eating around about 30 foods, then they're probably just more of a fussy eater. If they're very restrictive, and they're eating less and less foods, they're cutting food groups out. So they might cut out protein, so meats, know, fish, beans, anything else like that, might cut out that group, but they might start cutting out all fruit and vegetables. And the more and more restrictive it gets, the more and more I'd be concerned about nutrient deficiencies. And what's very common is particularly like iron deficiency and zinc deficiency can be quite common in these children. And the thing with the iron deficiency is often the more deficient your child gets in iron the less they actually eat. So it actually affects their appetite more.

Joanne

Oh wow.

Emma

And then also the other thing as well that they also, lot of these children tend to be very constipated as well, because again, if they cut out a lot of food groups and not having much fibre, not having any fruit and vegetables, they can end up quite constipated. And that again, in its own right, can make them even more restrictive with eating, because they feel so full, they're in a lot of pain with the tummy, they then don't want to eat. So I would say if your child's starting to really cut out food groups, and also there can be a lot of sensory issues as well. So again, if your child's almost got like a fear of food and it's more underlying than just, you know, they just don't like this broccoli or they just don't like this, but they actually like a really fearful of the food and they really can't cope with this. Like it's almost like sensory overload. They don't want to touch the food. They don't want to smell the food. They don't want to be in the kitchen when you're cooking. Then I would definitely speak to someone. Potentially start with your GP, see if you can be referred to a dietitian.

Occupational therapists work really well as well with a lot of sensory issues and I know in my trust and I've worked with a lot of OTs who help a lot of children with sensory processing around foods as well. So I would definitely say my first point of call would be to the doctor and ask for a referral to a dietitian and start the process off that way.

Joanne (03:59)

Okay, and presumably if you're going to go and ask for help like it's quite helpful for you to have like noted down some of the things so note down what foods they are and aren't eating and what symptoms they're having in terms of like you say constipation or stomach ache.

Emma (04:11)

Definitely. Start by making a list of all the food that they will eat. So what we call like safe foods. Also probably make a list of foods that they used to eat and they potentially started cutting out just so you can see a bit more of a pattern as well. Okay, there is some there is an eating disorder actually called ARFID which is a new was only recently sort of recognized in like 2013. And that's for children with very extreme restrictive sort of eating. So it's really important that you do speak to a GP if you are concerned with your child displaying any of those sort of restrictive eating signs. It does have to be diagnosed by a pediatrician ARFID so don't just self-diagnose it, do speak to the medical profession But there are rising cases of children with ARFID that we're seeing.

Joanne (04:54)

Okay, so, so if a child comes to you either through your NHS work or as a private client, and they are fitting this bill of being, very restrictive eating rather than, dealing with ordinary family fussiness. What, what do you then do with a family like how do you help your families and what do you advise them.

Emma (05:13)

So first of all, we do a full sort of medical background, understand what foods they are having, what sort of, foods are safe foods, what nutrients are they getting? Are they actually getting all the foods in the different food groups? Okay, maybe there's not much variety, but they are having, you know, some protein, some dairy, some, you know, carbohydrate. They are covering most of the food groups, which is a really good place to start. And then we'd look at those sort of strategies to try and reintroduce new foods. I mean, I tend to normally start with looking at what's going on in the family. Sometimes it's useful to get little videos of what meal times are actually like. Sometimes it can be that the meal times are just really, really stressful. And actually there's been a lot of pressure on the child to eat and parents have, know, at their wit's end have gone like, you know, down that very pressurized route of saying, you must eat everything on this plate. You're not leaving this table. You know, not to blame anyone. I think, you know, we've all gone through those stages as well. We just think "Just eat something!"

So just look at trying to make meal times fun again. So if they eat their safe foods for a bit, then that's fine. Always produce their safe foods. Never don't have an option where there's nothing that they're gonna eat on that plate. Cause that's just gonna cause more anxiety. And actually you're better off starting with just having those safe foods available to start with and looking at making mealtimes more fun again. And then I would say also we look at getting away from the tables as well. So getting away and doing things like messy play especially with the younger children So we're just touching and playing with food, feeding the Teddies, even feeding the parents and just making foods sort of fun so that they can explore it.

Because there are basically 32 steps to eating and only the last few steps are actually eating the food. So sometimes you need to go through all of those stages first before your child's actually going to start even attempting to put that food in the mouth, and just trying to reduce the anxiety associated with meals as well. And even like things like running around and burning some of that anxiety off before they even have to get to the table.

And I think also there's no quick fix. Like I'd love to give people like a magic wand and just say like, right, just do this and your child will eat everything and it will all be fine. Because sometimes it's not. And sometimes it takes a long time. And sometimes those changes are really, really tiny, especially with children with ARFID or like, you know, extreme sorts of fussy eater, change isn't going to happen overnight. And it's going to be a very small change. I always say to parents, write down any small changes. So like, even if you're starting with just changing the colour of the plate or changing the cup that they drink with, that is still a change. Like it can be that small. And you know, your end goal might be massive and you might want them to eat broccoli or whatever you want them to achieve. But you're not going to get there without these tiny, tiny little steps all the way through. So I think it's patience as well. And trying to block out some of that, you know, from family, why does your child not eat? What are you doing wrong? Because you're not doing anything wrong. So it's taking it at their pace as well. And in the meantime as well, the other thing is just making sure their diet is really balanced. So even if they're not having all of those food groups, so at the moment, maybe we're going to look at some better multivitamins or some that contain iron and some that contain omega-3 because they're not getting any of those nutrients in their diet at the moment. So let's cover all of that off, make sure they're getting enough protein, everything that they need. And then we'll work on introducing, new strategies and new foods and that sort of side, but let's just make sure, focus on making sure their diet is balanced and they're getting the nutrients that they need.

Joanne (08:40)

Okay, so just providing that kind of reassurance to the parent because what the parents worried about is two things isn't it one is: is my child in danger of harm now with what they're not eating? and secondly is: are they always going to be this way? and am I going to be able to help them to have a healthy relationship with food as they get older. And it's really difficult to work on the second one if you're so scared about the first one that like they have to eat this meal right now, whereas if if they're getting expert help and some supplementation, you can at least put that to bed and go like “I know that their body's getting what it needs this week. So this week I can afford to work on the long-term relationship things”.

Emma (09:15)

Yeah, and we do get some like some of like faltering growth, so they've lost quite a lot of weight, and they're not, you know, proportional for their height and weight And then we do prescribe what we call like oral nutritional supplements So again, these are supplement drinks that have got like all the vitamins and minerals and protein, and all the calories that they might need So we can provide all that support as well, so that you don't have to worry.

Joanne (09:35)

That's really good to know and presumably like here we're talking about children that have reached that threshold of having very restricted eating. But presumably most of those things still apply to ordinary family situations where a child just started being more fussy about food. This kind of like taking the anxiety out and building familiarity away from table and obviously you know that's a lot of what we do with The Foodies is building that familiarity away from the from the table and.

Emma (09:46)

Yeah, it does.

Joanne (10:00)

But presumably that's all the same sort of advice you would give to somebody if you just were having a cup of coffee with somebody said my kids becoming a bit picky would be the same sort of things.

Emma (10:08)

Yeah, definitely. So I mean, in terms of advice, yeah, I think, again, it's just making meal times fun again, I always say things like having theme nights, getting a child involved in cooking, getting them involved in baking, all of those sort of things. So doesn't have to be about eating the food, it can be about just getting them involved with food being in the kitchen. And even if to start with, they don't want to help you with the cooking, least getting them involved in laying the table even like I call it like what we call food rehearsals. So, you know, maybe they can be in charge of turning some music on and pouring water for everyone. Okay. Well, maybe their job next week can be that they serve everyone at the table, depending obviously on their age. So you can get them involved with food without actually them having to eat it to start with. So there's lots of ways you can make food fun again for them. So it's not, you know, not this really stressful thing.

And at the table just don't talk about food like you don't need to talk about what broccoli does or why it's good for you.

If I was to say to you now, right, I want you to sit an exam on a topic you've never even looked at. You have to pass it. And now I want you to eat roast dinner as well. You're not going to feel like eating it. Like you don't want to eat if you feel anxious. So why is your child going to eat if they feel anxious? They're not. So you have to take that anxiety away from them and then know that they've got food that they're going to eat. So they're not hungry. And then try that new food maybe not even when they're hungry or even at the table.

Joanne (11:33)

Yeah.

I mean, there's some mechanism, isn't there? I probably butcher this, but is it the parasympathetic and the sympathetic nervous system? Is it like that actually when we're in that kind of anxiety state, our bodies deliberately shut down our digestion in order to enable us to escape whatever's making us anxious. Yeah. yeah, what you're saying is kind of, makes sense really that why would we want to eat when our body's telling us we're in danger? It wouldn't, would it?

Emma (11:57)

No, it's the last thing we want to do. So you have to think about ways to reduce that anxiety for your child. And there's lots of strategies as well as like things like just before meals you know, preparing your child for meals. I don't just say like they're in the middle of, you know, playing their favorite game or they're, you know, coloring or something like that. So right now food's ready. Get on that table this minute, you know, actually prepare them like 15 minute warning before where, okay, now in 15 minutes, tea is going to be served. So let's prepare, let's get our hands washed, help me with this table, you know, get them in the right mindset for eating as well.

Joanne (12:31)

yeah that's interesting I'd really thought of it that way around but yeah that all those little rituals. About getting the table ready and getting ready to eat are telling your brains that it's time to eat and not time to do whatever they were doing five minutes ago.

Emma (12:43)

Yeah, and I think sometimes, you know, with we're so stressed and we're like, come on, get to the table now, your food's ready, I've served it, you know, and there's not that time for them to prepare.

Joanne (12:52)

Yeah. And also I suppose when we're cooking the food, we're doing all of that preparing because we're thinking about the food. Yeah. We were sort of preparing our own system for eating. Whereas if they're literally on Minecraft, their brain is not thinking about food in any way, shape or form, is it?

Emma (13:09)

No, definitely not. I think, you know, eating is not just about putting the food in the mouth. It's very sensory based. I mean, you know, if you've got a cold or you can't taste anything, you don't really feel like eating a lot either. Again, it's all sensory and it's all the senses that are involved in eating as well.

Joanne Roach (13:29)

So that's some really helpful advice there about what you should be looking out for as to whether or not you need to go and get some help to boost your child's nutrition while you're working with them. And just some general strategies that you can do whether you need help from a dietitian or not. And as regards to the sensory issues that Emma touched on several times during that interview, we are going to do some episodes coming up that are more focused on those sensory issues. So look out for those.

Joanne Roach (13:52)

If you'd like to get more of Emma's tips and practical advice, she's called Dietitian with a Difference, more or less everywhere on social. And I'll put some of her links in the show notes. At the time of this going out, which should be the 9th of June, she's got a free masterclass on tomorrow night, Tuesday the 10th of June, which is all about tips to get your child to eat the same family meal as everyone else. So if you hear this in time, go to her website and sign up for that. If you listen to this after the masterclass. She does run different ones pretty regularly. So if you follow her on Instagram, you'll be able to catch the next one. So thanks for listening today. I'll see you on Thursday when it's a solo episode. I'm going to run through five family meal ideas that are simple and fairly child-friendly that use some of the seasonal produce that I listed last week. There's three main courses, a dessert and a snack idea and links to them too. So I hope to see you then. In the meantime, happy eating.

0.00 Introduction to Emma Shafqat

1.24  When is fussy eating a cause for concern?

4.54 What does a dietitian do when a family comes to them?

9.35 Advice for all families with a fussy eater

13.24 Summary and outro

Key Takeaways:

If a child is eating much less than 30 foods, you might want to ask for help.
Restrictive eating can lead to nutrient deficiencies, and iron deficiency can decrease appetite.
Constipation is common in fussy eaters due to lack of fiber.
Sensory issues can cause fear of food in children.
Taking notes of what foods a child eats can help when you then start seeking help.
ARFID is a recognized eating disorder that requires professional diagnosis.
Making mealtimes fun can reduce pressure on children.
Small changes in a child's eating habits are significant.
Patience is key when addressing fussy eating.