Building a positive relationship with food and your body

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Parents and Carers – Avoidant Restrictive Food Intake Disorder

Session 3

What can I do to help

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NOT helpful things to do

Hiding foods they don’t like – they will find out and will impact
their trust in you

Letting them go hungry – they will enjoy not having to eat and this will impact
even more their lack of hunger

Pressure to eat or finishing on time – it will increase anxiety and it will not make them eat faster

Not giving their preferred food - They won’t start eating other foods if you limit the amount of preferred foods

Having the idea of “good” and “bad” food – food is food and if they are only managing a few foods, this is ok for now

What can I do to help my child?

Understanding that eating can be a difficult process as it includes all our senses

Understanding and think about the 32 steps to eating

Managing my own anxiety, so I am better able to handle challenging situations

To try and have a curious approach about the difficulties my child is experiencing
(i.e. “I can see you find eating at the table difficult, what do you think might be happening? What can we do to support you?”)

Support Feeding At Home

Putting pressure on them can increase their adrenaline, which can suppress their appetite and make them less likely to eat. Try to remain calm and positive at mealtimes.

This is to help you remain as relaxed as possible and keep anxiety low

Daily routine for feeding: try to stick to consistent times each day and if needed, create a meal plan together so your child knows what to expect
Mealtime routines: prepare (i.e. “lunch will be ready in 5 minutes”). You might need to have some calming activity: wash hands together, sing song, blow bubbles, sit at the table, clean up, wash hands, finish. Consider also using stress balls, tangle toys, weight blankets, anything that calm/help your child

Avoid negative comments (avoid words like ‘no’, ‘don’t’, and
‘naughty’.

e.g. throwing, refusing, gagging. Telling a child off
or making a fuss often increases that behaviour.

Instead try a sticker chart or something fun after the meal, like a favourite book. Make sure the goals you choose for your child are achievable for them.

Do not force feed them

To 30/45 minutes and snack times to 15 /20minutes

Make sure he/she has support under their feet, behind their back and they do not slip down too far in the seat – use non-slip mats if needed under feet and bottom.

Eat together as a family. Talk about the food in a positive way – make sure the food is the focus, not the child. You might want to use table cards as a
way of having conversations during meals that are not related to food only. We know that eating at the table can be extremely difficult for some children, so try changing sits at the table to avoid overwhelming situations

As well as new or less preferred foods – consider different plates or outside of their “safe area”

Enjoy eating and exploring your food – talk about the colours, textures, shapes, smells and sounds of the food. Encourage your child to think about these things too. Children learn by watching and copying.

For anything good they do, even if this is just touching or tasting a new
food. Some children don’t like to be praised, so avoid it.

Getting food on their hands and face is good for their learning. Clean up at the end. If your child is getting distressed during the meal, provide a napkin or small towel to wipe their hands.

Remember that is a new food and it might take few days/weeks for them to get used to it.

Remember that it is an exercise and your child is not expected to eat the food, it is about engaging and desensitizing them

Strategies for treatment

There are different strategies to support individuals with ARFID It is important to discuss with the clinician that is working with your family

However, we know that there are important things to consider in all treatments:

Family approach is often recommended
Keep a routine
Having a timetable
Motivation work
Working on emotions – food related and not only food related
Understand that the eating can’t be fixed but is a work in progress

How to approach it?

It works on a systematic desensitization hierarchy of skills/behaviours necessary for children to progress with eating various textures, and with growing at an appropriate rate for them

One step at the time, without overwhelming the them

SYSTEMATIC DESENSITIZATION

Experience feared stimuli in a small hierarchy

Allowed to 'move away' from exposure

Patient controlled

Goal = to maintain a competing response in the face of increasing incremental exposure

FLOODING

Experience feared stimuli at full exposure

Held in the exposure with scape being prevented

Therapist controlled

Goal = to have peak fear response with no undesirable

Consequence during repeated full exposures

Food chaining – other ideas

FRIES TO CARROTS

Learning to eat new colour

French fries

Sweet potato fries new colour

Butternut squash fries same shape & colour

Steamed carrots new texture

Roasted carrots same shape & colour

Roasted b.squash new shape

Food Chaining involves gradually and systematically diversifying the foods a person will eat.

For example:
You begin with a food that is currently accepted. You then consider what can be tolerated in relation to change i.e. colour, brand, texture, shape.You then identify a new food to try based on what can be tolerated. This new food is then introduced. This then restarts the process.

POTATO CHIPS TO BANANA

Learning to eat new colour

Potato chips

Plantain chips

Banana chips

Banana

Frozen banana slices

Freeze-dried banana

VEGGIE STRAWS TO GREEN BEANS

Veggie sticks

Green only

Snap pea crisps

Green beans

Raw green beans

Freeze-dried green beans

@Feedingpickyeaters

CHICKEN TO FISH

Learning to enjoy more protien

Fave nuggets

Fish sticks

Baked white fish

Fried white fish

Fish patty

Messy Play

- The child does not have to eat the foods presented to them

- It is about exploring food with the child

- It is about sharing an experience with the child, not to the child.

- Regularly reassure the child that they are “ok”

- It is about getting messy – wash hands at the end

Use different food characteristic,
for example:

- Large dry foods

- Medium dry foods

- Fine dry foods

- Wet drinks

- Sticky foods

6 Steps to Eating

Visual

What does it look like?

- What is the colour?

- What size is it?

- What is the appearance?

Touch

What does it feel like?

- Is it wet or dry?

- Does it feel cold or hot?

- Does it feel bumpy or rough?

Smell

What does it smell like?

- Is it weak or strong smell?

- Is it a nice smell?

Taste

What does it taste like?

- Does it have a strong taste?

- Is it sweet or salty?

- Is it spicy?

Texture/Sound

What is the texture like?
What sound makes in your mouth?

- Does it feel loud when you chew it?

- Is it crunchy?

- Does it get soft quickly?
*Not expected to eat, it is ok to spit it out

Swallow

Any other sensation?

- Any other sensation?

*Smell mouthful is ok and gradually increase quantity

- Emphasise that they are not expected to eat the food!!!
- Outside of mealtimes
- To try and stick to a routine – so they know what to expect
- To use different place to practice

Other strategies

Fade in - adding small amounts of food they don't like into food the like
Add some spice – ketchup, curry, salt, honey, sugar
Food chain –– try similar foods i.e. veggie chips with same format to potato chips
Change presentation – salted x unsalted
Deconstruct – break the food i.e. pizza – try with a piece of bread add tomato sauce add cheese…

THEY NEED TO AGREE WITH THESE STRATEGIES!

Other things to consider

We know that routine works well for most children, especially for those with ARFID
Think about a visual timetable and possibly a visual meal plan
Think about offering 2/3 options (maximum per day, so they also engage on this)
Taking them to shopping and letting them chose some new foods
Having a separate cupboard can be helpful sometimes
Reward system – can be helpful with some children
Distractions at meal times – can be helpful in some cases, but ideally is a working in progress to remove this so children can be present whilst they are eating

To use a hunger chart, to help them track and understand their hunger signals
Have your child be part of the meal where possible – helping to prepare, setting the table, or just bringing their own plate to the table
Encourage them to serve others food, even if they are not serving themselves
If possible, have a ‘learning plate’ in front of your child. They can serve a small amount of food on to this plate. There is no pressure for them to eat this food, but they can look/smell/touch/play with this food.
Have meals together as a family where possible, even if you are eating different things. This gives the child opportunities to be around different foods.
Have a familiar routine around mealtimes – wash hands, set table, eat food etc.
Make sure your child is sitting in a comfortable chair (feet on the floor).