Are screens with food always bad? with Emma Fitzgerald – Food For Kids Podcast episode 51

Joanne Roach (00:13)

Hello and welcome to the Food for Kids podcast. I'm Joanne from the Foodies.

On today's episode I'm talking to Emma Fitzgerald who's a paediatric feeding therapist with 16 years of NHS experience helping children with their eating and we're talking about whether it's sometimes okay to use screens to help our children with food.

Emma specialises in the assessment, diagnosis and management of paediatric feeding disorders and she works in an evidence-based but family-centred way to make eating feel safer, more enjoyable and more fulfilling for every individual child. When we have children, I think we all have an ideal of what we want our family meals to be like. We probably picture eating meals together around the table, chatting and laughing and grabbing food from bowls in the middle, and bubbling over with stories from our days at school and work. I know I did.

It's a lovely picture cobbled together usually from the best bits of our own memories either of our own families or from friends’ houses and the happiest and coolest families in the TV shows we watch.

In previous episodes with dietitians we have touched on lots of good reasons why this style of eating is a good thing to aim for if we can. That family style of eating where people can help themselves from the middle of the table really is helpful for kids to have more agency and chatting about their day and things other than the food takes the pressure off children to eat and it also enables them to communicate about stuff that's going on in their life. So when it's possible and it works, obviously that's great.

But what about when that just doesn't work for you?

What if you're a family who does lots of stuff after school because you're following the children's passions and that often means that people are eating in different shifts? What if you're a family with a smaller living situation and a dining table just isn't a possibility anyway, or at least not one big enough to have food arranged in the middle? What if sitting around the table is actually stressful for your child or indeed one of their parents and it always leads to a tense atmosphere? What if your kids always eat way less at the table because it makes them too tired or they get upset there?

Does that mean you're letting your child down if you let them eat their dinner on their lap with a TV show? Or that you're cutting corners if you give them tablet to watch while they have a quick tea so you can get out the door to dance class on time? Or are you just being lazy when you all watch TV with food together on those days where sitting at the table just feels like too much tonight?

Emma posted a great post on Instagram about her professional take on this and especially what she thinks about screens and food. So I thought she'd be perfect to ask. So here's that interview.

Joanne Roach (02:48)

Emma, you work with lot of families whose child has eating difficulties which might be physical or they might be more psychological or emotional. So I'm guessing you come across a lot of places where that kind of ideal we see on the TV of sitting around the table all together sharing food from the middle of the table doesn't necessarily work for them. What are the kind of reasons that you come across that make that not work for all situations?

Emma Fitzgerald (03:12)

So there's so many different situations where it's just not possible. I'd say actually in quite a large proportion of the children I see. The biggest proportion of children who find it really hard to come to the table are children with neurodiversity. So it might be children with autism or ADHD. A lot of them that I see as well can be undiagnosed. So it's emerging and we're not quite sure what's going on, but we're seeing these difficulties and coming to the table and eating is one of them.  So those are the huge proportion of children I see.

And the reason behind that is when they're asked to come to the table, an anxiety reaction is provoked because the range of sensory input that's required to sit at a table, the tastes, the smells, the sounds, mum's asking me to eat one more bite. I don't like the taste. I don't like the texture. Why do I have to sit here for so long? So immediately children are anxious, afraid, and the way that kind of comes out is, you know, a bit of a tantrum. And it's not that they're being picky or it's not that they're being a problem child. It's this deep rooted kind of anxiety and fear of what's going to happen when they come to the table.

For children with neurodiversity and ADHD as well, they experience all these things in such a different way that we don't even understand. And the way I like to explain it to parents and caregivers is it's a bit like a phobia. So if I asked you to come to the table and eat 10 tarantulas, you'd be like, there's no way I'm going to do that. And for children with these sensory processing difficulties, that's pretty much what it feels like. And when I say that to parents, they immediately go, my goodness, you know, if I'm asking my child to do this, this is a really big ask. And that's, you know, when the light bulb moment happens. And that's the biggest kind of proportion of children I see who do find it difficult to sit at a table.

You'll have children with sensory processing difficulties who don't actually have ADHD or autism. They just have a pure sensory processing difficulty and they'll present the exact same. And the other proportion of children I see are children who have physical disabilities where it's really difficult for them to, you know, sit upright, see what's going on at the table. And in those cases, I'd work with an occupational therapist to try getting them sitting in those family meal times in a really nice supported position so they can see what's going on. And that's where we start with those children, just getting them sitting up nicely and just seeing what's in front of them.

Joanne Roach (05:50)

Obviously we're all bombarded with messages all the time about the fact that we should be getting our kids off our screens. We know that screens aren't good all the time and it's less than ideal at the table, that we should try to eat more mindfully. But if a family is finding that the only time that their child actually eats - either eats a decent volume or is able to eat a wider range of foods without getting overwhelmed is when they have a screen, is that always bad? Or is there times when screens can be helpful?

Emma Fitzgerald (06:20)

So a lot of the children I see actually screens are really, really helpful. So when I do an initial assessment, it could be online or at home. I ask the parents, what are they doing already that helps? And a lot of the time screens, TVs are really, really helpful. So that's the thing I actually say to parents, you know, you're doing a really good job because otherwise, you know, your child's not going to want to eat a bite if they don't have the screen or the TV in front of them. So that's when it's particularly helpful, especially in my line of work for children who, you know, they're almost at the point where they're having such significant problems meeting their nutritional needs. Absolutely. That's when a screen can be really, really helpful.

And I try and capitalize on screens as well. So if children don't want to eat any food, I use the iPad to talk about food. I get them Googling food and I get them to become a food scientist. So if they're an older child, I'll ask them to research a particular type of food on the iPad and they can bring up all sorts of statistics and facts about food. And actually, the evidence base suggests that even when you're doing something like that, it's extremely helpful children who find eating and drinking difficult. you're actually doing something that's scientifically proven when you're using screens sometimes. And in those situations, they're extremely helpful.

And if a family is at crisis point where, everything is so stressful and every meal time feels like a chore and you know, that's when screens really, really do come in handy because the way I see it and the way we practice is we can wean children off the screen at a later time. What we need to do firstly is get meal times relaxed. We want them to feel safe. We want them to be happy to come to the table or wherever it is you have your meal. And if using the screen is the way we can do that, then absolutely yes, because we can work at getting rid of the screen later on. First, we want to relax and happy and safe meal times. And then what I find is once you get to that point, it's actually quite easy for children to put away their iPad because they're actually really, really happy to come to the meal in whatever shape or form that is and just engage and talk about the food and chop food up and things like that. those are all the situations where screens are really helpful and they get a really, really bad rep in the media. But yeah, there's a lot to be said for screens.

Joanne Roach (08:43)

My children are both diagnosed with autism and ADHD as adults and sometimes we would sit at the table but on very busy nights when they were tired or there was sports or whatever we used to have a family show that we would all watch together we'd have a box set over a series of weeks so it was still a family activity but it was watching TV while we ate, and we found that both of our children ate really well, for different reasons, when we did that.

Emma Fitzgerald (09:07)

And it doesn't need to look the way you think it needs to look. You know, if you think about the end goal, you want your children to be nourished, to have energy to go to school the next day, and you want them to be eating something maybe from every food group. And if that's if you meet those goals, to me, it doesn't really matter what it looks like.

There might be a little bit of concern that they might want to use start using a screen at school, but I never find that happens. They usually fall into the kind of pattern that school has and they fall into the pattern that family has. because they want to be like their friends at school. They want to be doing all the same things at the lunch table. So they don't want to look different. You might occasionally have a child like that, but I'd say it's really, really rare where those patterns extend outside of the family environment.

Joanne Roach (09:59)

For people who are in that place right now where they're using screens or distractions or picnics on the floor or any of those things in order to make sure their child is enjoying eating right now but they want to get to a place where they can go to somebody else's house or yes eat well at school or you know just thinking ahead to leaving home and being able to look after themselves… what are some suggestions to move them from mostly relying on screens or distractions to gradually being able to not do that?

Emma Fitzgerald (10:30)

Usually I like to look at the underlying reason they really want a screen. So if there's a kind an issue where they need a self soothing to feel safe, then that's what we look at. Okay, what other things can we do that make you feel safe? there might be other things other than a screen. I do a lot of parent coaching changing their style of language around food, how they approach the child with eating food because there's this traditional style we've inherited where we say, you don't leave the table until you've eaten your vegetables. That tends to really, really affect children, especially with the neurodiversity that makes them more aversive to coming to the table. So if we change the style the meal time sometimes that can help wean off the screen. So it's all about what the underlying cause is because if you treat the underlying thing that's causing the dependence on the screen, then you tend to find that you don't really need it anymore. And it can take time. There's a lot of children who I need to work on their sensory skills for quite a long time before we can bring the screen away because that's how they feel safe and that's how they self-regulate. And that's the last thing I'm ever going to take from them until I've looked at all those underlying things and made them feel safe in other ways and a bit more regulated and they don't have that fear response. definitely going to keep the screen until we've looked at those underlying reasons. So that's kind of what I'd suggest is looking at, OK, why do we need the screen?

And it's not about blame.  Often I congratulate parents for getting to the point they have and being able to actually feed their child because if they didn't have all these tools and screens, I've got a lot of children who would absolutely be in hospital if they didn't have their screen to help them eat. So I think that's, that's how I tend to approach changing screens, looking at the underlying reason it doesn't have to be a feeding therapist. It could be any professional really, who has an understanding of children's behavior, especially when it comes to kind of sensory feeding issues.

Joanne Roach (12:35)

I don't know about you but I felt incredibly reassured by that.

I know that I always felt like a total failure every time we went through a phase of hardly ever eating at the table, even if the kids were actually eating pretty good food. But between lots of evening hobbies and some fussy eating phases and people being stressed by each other's eating styles and to be honest, eating noises at various points, there were definitely times in our family when insisting on eating all together at the table would have just contributed to more disharmony or tension. Both of our kids knew how to eat at the table and when they come home now or when we visit them, we can all sit around and eat and chat just like the families on TV. But we did have lots of phases where the dinner was eaten with the communal box set and while that totally worked for us and to be honest, probably at some phases helped them to eat better, it did make me feel very guilty all the time because of that ideal image I wasn't living up to and I really wish I hadn't felt that way.

I love Emma's explanation that it's good to work first on helping children to be comfortable and feel safe eating at all, and then to work towards eating with other people. And then ultimately to aim for some family meals at the table without screens once their emotional needs and sense of safety have been taken care of. Ultimately, it's good to teach our children that they can be confident to go to other people's houses or to restaurants and to be able to have the skills to do that, but an inflexible adherence to a one size fits all, right way to eat with the family doesn't help every family or every child during all the phases of childhood.

So to go back to my introduction, if your family has meals where you're making something quick on their lap between a late hobby and the bedtime routine, or you're letting your child eat with a screen or have a picky plate, as a picnic while playing because they find sitting at the table difficult. If you're in a phase where the dynamic isn't great at the table so you want some time out to reset, or if you have a child with fussy eating who will relax and accept more foods when they're sometimes allowed to watch TV while they eat, then you're not a terrible parent, you're just working with different family priorities right now, or you have different goals for their eating which take precedence.

You're not a family on TV. You're a real family, made up of real people, with all of their needs and sensitivities and quirks and phases. And what you're doing is making sure everyone is nourished and happy in a way that works for your family. And that's the most important thing. Phases come and go, children's needs change over time and there are different chapters in your family life so you can keep reassessing and then rejigging to meet your family's needs over time.

Emma has some great posts on her Instagram feed and as well as helping with the issues she talked about in this interview, she also has a lot of expertise on physical eating issues because she has a Masters in Speech and Language Therapy and she worked as a Senior Staff Nurse so I'll put her website in the show notes too.

I hope you found that interview helpful or reassuring like I did. If you're trying your best to make eating feel safe and positive for your child so that over time they can broaden their own horizons with food then you're doing a good job. I'll be back on the next episode and hope to see you then but in the meantime be kind to yourself and happy eating!

Chapters

00:00 Introduction

02:48 When it's hard to eat at the dinner table

06:04 Is it ever ok to eat with screens?

09:59 How to transition away from screens

12:35 Summary and outro