SAN FRANCISCO – Three adults and one child sat at the child-sized table set with brightly colored plates, forks, and glasses. Sitting before each diner was a very hungry baby doll. The diners fished through a clear box brimming with all shapes and sizes of plastic food to select items to feed their dolls.
Irene Chatoor, MD, vice chair of the Department of Psychiatry and Behavioral Sciences at Children’s National Health System, who played host at the pretend dinner party, subtly worked questions into the conversation to tease out the girl’s own food anxieties. “Do you like corn? Do you think your baby doll would like corn?”
The 6-year-old balanced an ear of corn atop her baby doll’s outstretched arms and nodded. Next came a mound of green peas. A wedge of pizza. A stem of grapes. A scoop of ice cream perched atop a sugar cone. The girl’s baby doll tried a lot and found each food delicious.
Dr. Chatoor, who employs such role-playing meals to ease the food anxieties of her pint-sized patients and their worried parents, then wove in knowledge of the child’s own concerns. “You don’t like peas? I’m going to see if I can get my baby doll to try the peas,” she says. The baby doll says “OK. Very green. I don’t know if I’m going to like it.”
As it turns out, Dr. Chatoor’s baby doll finds the peas very tasty. She praises the boy doll for being “brave” in overcoming his food fears and asks for the girl’s help selecting stickers to reward all four baby dolls for overcoming their fears.
Over the course of her career, Dr. Chatoor has specialized in helping children work through their food anxieties and encouraging parents to set aside dedicated time for family meals, expertise she will share with peers at the American Academy of Pediatrics 2016 National Conference
. Time-strapped parents often sip coffee as breakfast in the car, inhale lunch, and prepare a separate dinner for their children eschewing their own dinner until the kids are in bed.
Feeding the children becomes a major task, and youngsters don’t have an opportunity to see their parents eat. Parents don’t realize how important modeling healthy eating is for their children. About 25 percent of parents report that one of their children is a “picky eater,” which can mean that the child refuses to eat certain vegetables or may refuse whole food groups, such as vegetables, fruits, or meats. “It’s important for the parents to not overreact and to model eating a variety of foods without pressuring the youngster to eat everything they put on the child’s plate,” she says.
“I also want to help pediatricians to differentiate between toddlers who ‘no-no-NO’ to the few foods they don’t like – which is OK – and children whose food selection is quite limited. They need to be aware of red flags, like a child who spits out food, gags, or grimaces in response to certain foods or refuses to eat other foods that may look similar or that have the same texture as the aversive foods.
These are signs of sensory food aversions. “Children who need to be referred are so selective in their food choices that they refuse all vegetables, all fruit, all meat; they are afraid to try new foods; and they are not getting the vitamins and minerals they need for proper development,” she adds. “These children really need help to overcome their fears.”
Their limited diet not only may lead to nutritional problems, but also may have emotional consequences, according to a 2015 article published in Pediatrics for which Dr. Chatoor was senior author. Severe dietary restrictions can stand in the way of social activities, such as sleepovers, parties, and overnight camp.
Parents also frequently fret that their children aren’t eating enough. Sometimes, their expectations for how much the child should eat are unrealistic. Some children have small appetites and would rather play and talk than eat. They do not gain weight and fail to grow at the expected rate.
This makes parents increasingly anxious, and they often try all kinds of distractions to get their child to eat. Dr. Chatoor has described this feeding disorder as infantile anorexia. Interestingly, research has shown that families who eat together at regular times help their children to outgrow their feeding problems.
AAP 2016 presentations:
Saturday, October 22, 2016
• F1069- “Food Refusal: From Picky Eating to Feeding Disorders”
9:30 a.m. to 10:15 a.m.
Sunday, October 23, 2016
• F2012- “Food Refusal: From Picky Eating to Feeding Disorders”
7:30 a.m. to 8:15 a.m.
Contact: Diedtra Henderson | Children’s National Health System | c: 443-610-9826/o: 202-476-4500 | email@example.com ###