from Winter 2013 Adoptalk
Used with permission by Mary Boo.
By Katja Rowell, M.D. © 2013 Dr. Katja Rowell is a family doctor turned childhood feeding specialist. Her mission is to bring peace and joy to the family table. She consults with parents, is a blogger, mom, family cook, and sought-after speaker. Her book Love Me, Feed Me: The Adoptive Parent’s Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More distills the support she provides clients. (Published in 2012 and available on Amazon.com.)
The information in this article is educational. It is not meant to replace careful evaluation and treatment by medical, nutritional, or mental health professionals.
Whether a child is 15 days or 15 years old, feeding and nurturing through shared meals is a critical way to deepen attachment. Dr. Bruce Perry, of the Child Trauma Academy, refers to ideal bonding opportunities as repetitive, relationship-building, patternbased, and involving the senses— which describes the family meal experience perfectly. But the family table is not always an easy place for adopted and foster children. Indeed, one mom said that her fantasies of pleasant family meals were met “with a slap in the face” when her two children, adopted from Russia, struggled with food anxieties and sensory issues. Unfortunately, conflict around food and eating habits are more common for foster and adopted children due to their past experiences. When conflict defines interactions around food, those bonding opportunities are lost, and trust and attachment can suffer as well.
“We had a 15-year-old boy in foster care with a history of runaway episodes,” Amy recalls. “He was gone for about 30 hours. When he came back, I decided there was no point being upset, so just told him we’d been scared, made sure he was safe and healthy, and quickly threw a box of mac-n-cheese on the stove to get him some comfort food. That floored him, because it turns out that he’d been denied food in his home after his running. I think it ended up bonding him to us much more than anything else could have.”
Parents want to raise children who are healthy and happy. Many try to instill healthy eating habits by enforcing nutrition rules or portion control. But when raising children who have experienced food insecurity, healing the anxiety around food is key to helping children grow up to be competent eaters who can self-regulate and learn to eat a variety of foods.
Food Insecurity Leads to Survival Behaviors
When children are not fed reliably, do not get enough food, or have to compete for enough, they become anxious. When food-insecure children do have access to food, they often don’t understand or trust that it is coming again in adequate amounts. Food insecurity and unsupportive feeding deeply color the initial relationship a child has with food. It can take weeks, months, and even years of reliable feeding for that trust to build and for children to believe they will be fed.
Some children who have been food insecure demonstrate hoarding behaviors. These survival strategies may manifest themselves in the following:
- Eating quickly
- Gobbling or stuffing food
- Stealing or hiding food
- Eating large quantities, even to the point of vomiting
- Becoming upset if someone eats off their plate
- Getting upset if food is limited or taken away
- Getting upset or eating faster if asked to slow down
- Eating only familiar and “safe” foods
- Keeping food in the mouth for hours, known as “pocketing,” which may be behavioral or a sign of an oral-motor problem (or both)
Healing Food Anxieties
Deciding whether to stash or not to stash. Many resources on hoarding advise allowing the child to have snacks in his backpack or carry food in a pocket, or even have containers of food in the bedroom. Anneliese, mother of two boys, one adopted, one biological, recalls that the main feeding advice she got from her social worker was to let her son carry around baggies of carrots all day: “I just didn’t think that was going to help.” Other experts advise parents to avoid the stash and serve regular meals and snacks. The reality is, it is not an either-or or one-size-fits-all answer.
Parents may decide to offer a stash, or not, and see how things go. The stash may help at first, and the child simply loses interest with time. Consider 18- month-old Marcus, who did not want to let go of his biscuit. He certainly can be allowed to hang on to the biscuit for a while, and maybe even have one in his pocket. Follow his lead. If he throws a tantrum when it’s taken away, allow him to carry it. But the parent also has to be absolutely reliable about regularly providing food. Parents may need to offer food more frequently at first, perhaps every hour or so.
Three-year-old Arielle, adopted at 11 months, was on calorie restriction and was experiencing intense food anxiety and preoccupation. Mom let her carry food in an attempt to address her anxiety, but Arielle gobbled it up and begged for more. In this scenario, Arielle’s actions were not the hoarding behaviors seen when a child first arrives from a place of food insecurity, but were actually symptoms of a feeding relationship disruption due to her food restriction (more below). Letting her have her own stash of food to carry around didn’t work in this situation.
To facilitate bonding and food security, food should come from the parents whenever possible. When a child is allowed to get food whenever he wants, he may still feel responsible for getting his own food. It is a missed opportunity to nurture and deepen the attachment with the child. Feeding a child directly shows him that he will be taken care of and builds trust. Meeting his needs, over and over again, is the basis for attachment.
Reassuring the child with words and actions. One foster mom had a little boy she couldn’t keep out of the fridge. He would occasionally eat to the point of making himself sick. Mom didn’t want to lock the fridge to restrict his food access. Instead, she assigned him a refrigerator drawer. She stocked it with familiar food and told him that the drawer would always be full, and while he could not take food at random, this drawer was his. He checked the drawer often, with Mom’s reassurance that it was his food, and he could help choose from it for meals and snack times. Mom made certain it was never empty, and gradually he forgot about it, mostly because Mom reassured him with regularly scheduled meals and snacks.
Another preschool boy, adopted from Eastern Europe, loved cereal. He would frantically gobble as much as he could and cry when limited. His parents finally realized that when he saw an empty box, he thought there would be no more cereal, ever. They were able to reassure him, and for a while overstocked the pantry with his favorite cereals. At breakfast, he was allowed to eat as much as he wanted, but simple reassurances and a trip to look at the pantry helped him realize he would get enough. Soon he was eating about the same as his brother and was no longer anxious at meals.
Being reliable about feeding. While parents can allow a stash if it works for their child, the best way to lessen hoarding behaviors is to lessen anxiety around food.
“Sam had some hoarding issues, but it didn’t last long. We let it run its course. We chose not to have food available to the boys all day and night. I didn’t think it would reassure them. I fed them regularly and sat and ate with them. They pretty quickly learned to trust they would get fed.” — Mia, mother of two boys adopted at age five and seven
Deborah Gray, in Attaching and Adoption, wrote about “high nurture, high structure” parenting. This dovetails nicely with feeding in the Trust Model, pioneered by therapist and nutritionist Ellyn Satter. Parents provide regular meals and snacks with balanced and tasty foods, and the child decides how much to eat from what is provided.
Keeping initial hoarding from becoming entrenched food obsession.Even if a child is labeled as obese or overweight, she can still feel food insecure, and attempts to limit her intake will make her more anxious and prone to overeat. Many children who experienced food insecurity have initial behaviors that scare parents, especially if the child is bigger than average. A foster child may be obese and not regulating food intake due to food insecurity or other factors.
Research tells us that restrictive feeding tends to lead to higher weight and increased eating in the absence of hunger. I believe food restriction and efforts to control weight lead to more entrenched food obsession, with food-seeking behaviors worsening, not improving.
It is critical to address a child’s initial food anxiety with nurturing, reliable feeding, and allow the child to “overeat” while she learns to trust her cues of hunger and fullness. I believe these children’s food regulation skills are simply buried, and they can learn to tune in to hunger and fullness cues.What it boils down to is this: with reliable, pleasant, and satisfying meals and snacks, even the food insecure child will learn over time that he doesn’t have to worry about when or how much he will get to eat. Parents get to worry or think about the food, so the child doesn’t have to.
Tips to Reduce Food Anxiety
- Feed young children every two to three hours and older children every three to four hours.
- Offer food more frequently at first or if a child is healing from food obsession.
- Offer frequent reassurance: “There will always be enough food.”
- Show him the pantry, perhaps even as you end a meal, “See, there is always enough food here.”
- Plan on pleasant family meals—if you’re battling over broccoli or a therapy task, that’s not helping him feel more secure.
- Structure is critical. If you go to the park, bring a balanced and filling snack.
- Include fat, protein, and carbs. A snack might be whole-wheat crackers with cream cheese and apple slices, or cereal, milk and a banana.
- Institute Division of Respon sibility. At meals and snacks, he gets to eat as much or as little as he wants from what you provide. Even if he eats a lot initially, this sense of control will reassure him.
- Always provide at least one thing from her accepted list. She needs to feel that she can come to the table and her hunger will be fed.
- Invite the child to help you cook and meal-plan if he is old enough. You can say, “We’re having lentils for dinner. Would you like cornbread or rice with that?” Resist the urge to argue or pressure, even if he refuses food he chose.
- Let her know that she may politely spit out any food she doesn’t want to swallow into a paper napkin. Children are more likely to try a new food if they can spit it out, particular if they have a history of gagging or vomiting episodes.
- Don’t worry about enforcing manners right away. Lead by example.
- Serve foods family-style so a child can serve herself and feel more in control. This also diffuses battles that begin when a pre-plated meal is served to the child who might erupt over something on his plate. (Clients tell me this is the number one tip to lessen power struggles.)