Food refusal is not “bad behaviour”. Food refusal is communication.
Children may not always be able to verbalise why they don’t want to eat something, beyond saying “I don’t like it!” What might they be telling us by refusing foods or running away from the table?
As part of my PhD research, I interviewed children aged 6 - 10 years to find out about their experiences of mealtimes and their thoughts about what us adults call “fussy eating”. While there are papers upon papers providing parents' perspectives, very little research has tried to understand the child's side of the story. What did children tell me?
What was striking was the strong physical sensations and emotional reactions some children described in response to disliked foods.
Children said things like cheese on a pizza “is like some kind of shield...the smell just puts me away”. Another described how a disliked food "makes me move around when I don’t want, it controls my body”. Children described being “scared how it tastes” sometimes to the extent that they “think that they might die” if they eat vegetables. One child said that children “don’t know what they’re eating...they could be eating poison or something”. And sometimes, their reason for rejecting foods was simply “I’m not hungry”.
The interesting thing here is that the majority of these children were typical eaters who ate a wide variety of foods. What must eating be like for children with eating challenges?
Feeding specialists Katja Rowell and Jenny McGlothlin (in their book “Helping your child with extreme picky eating”) write about food refusal from the child’s point of view. Some of the challenges they discuss include medical challenges, oral motor challenges, sensory processing difficulties, fears and anxieties. Children who refuse to eat may be telling us:
“It hurts! It doesn’t feel good!”
“I can’t - it’s difficult to chew!”,
“I’m uncomfortable, I don’t like how this feels/tastes/looks/sounds”
“I want to do it my way”
Again, the message is that children are not just being naughty - eating is genuinely difficult - and can be scary!
What other messages could children be communicating? In a recent paper published in the Journal of Nutrition Education and Behavior, Jo Cormack and colleagues write about the three basic needs required for psychological growth according to Self-determination Theory. These three needs are
- the need for autonomy
- the need to feel competent
- the need for relatedness
Jo Cormack and colleagues apply these needs to the context of feeding. When a child is not eating, are they communicating that their basic psychological needs are not being met? Perhaps they are saying
“I need you to let me do this myself”
“I need more autonomy about what goes in my mouth”
“These foods are too difficult for me!” or on the flip side “These foods are too easy and not challenging enough!”
"Mealtimes are too stressful"
“I want company!” and “I need you to sit and eat with me!”.
Eating is complex, and unpicking the factors that are driving children’s eating challenges is tricky. A feeding assessment can help to work out what a child is telling us, and how we can support them to cope with mealtimes and enjoy eating to the best of their ability.
Wolstenholme, H. (2020). A qualitative investigation of family perceptions, experiences and management of childhood fussy eating behaviours (Doctoral dissertation, NUI Galway).
Rowell, K., & McGlothlin, J. (2015). Helping your child with extreme picky eating: A step-by-step guide for overcoming selective eating, food aversion, and feeding disorders. New Harbinger Publications.
Cormack, J., Rowell, K., & Postăvaru, G. I. (2020). Self-Determination Theory as a Theoretical Framework for a Responsive Approach to Child Feeding. Journal of Nutrition Education and Behavior.