Thursday, Jun 21, 2018
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‘Spoiled' is not the only reason kids won't eat

DETROIT — Go ahead: Play with your food. Mash it, squish it, and build castles and faces with it.

Leave those fingers sticky. Ooey-gooey pudding feels fun on your face.

And here's the important part: It won't hurt.

When it comes to working with children with severe eating issues — the kind that can trigger a panic attack at the mere sight of the wrong-colored or wrong-textured morsel — what Mom told you at the dinner table might backfire.

“What I tell parents is: ‘Whatever you've been doing, do the exact opposite,' ” said Donald Deering, a behavior-modification coach at St. Joseph Mercy Oakland, Mich., hospital.

Deering and other therapists work with children whose eating is so restrictive, it threatens their ability to thrive.

As a preschooler, Andrew Crawford's reaction to anything beyond pureed baby food was instant: “He'd almost have a full panic attack, he'd start sweating, he'd start crying, he'd take a bite then gag, and even vomit,” said his mother, Amy Crawford, a nurse at Detroit's Henry Ford Hospital.

Parents would tell her, “He'll eat when he gets hungry.” Crawford wanted to scream: “No, he won't.”

It was as if Andrew never hungered. He never fussed for food.

“You’d almost forget to feed him if you were out,” Crawford said. Andrew grew. His parents pleaded and threatened.

“We’d take away toys ... but he’d rather have his toys gone than eat a grilled cheese. We’d say: ‘Sit in your room for a half-hour or just take a bite.’ He’d just sit in his room for a half-hour,” she said.

With husband Jon and daughter Olivia, 7, the dinner table in their Allen Park, Mich., home became a place of routine frustration, even panic, as the toddler refused to eat.

“It was all-consuming,” Crawford said.

• To be clear: Kids like Andrew, now 4 , are neither mildly picky nor spoiled.

Consider a girl whose parents allow her frosted flakes every morning, even though toast and yogurt are choices too. During a visit with Grandma, the absence of frosted flakes triggers a tantrum because it’s the first time she doesn’t get her way.

A problem eater is different, said Deborah Bruns, an associate professor at Southern Illinois University, Carbondale, who has written about feeding challenges and young children.

“These are kids who will only eat frosted flakes from Kellogg’s, not the other stuff from the store, and it has to be in the blue bowl, and with a yellow spoon, or whatever,” she said.

For many kids, the cause is a sensory processing disorder. To understand, think about the act of eating an apple.

Messages from our senses smash together with every bite we take — the apple’s bright, shiny surface, its smell, and feel as it crosses our lips, the crunch of its skin and the soft squish of its insides, the tingle and taste of its juice.

All of these messages inform a complex interplay of systemic feedback and fine motor controls and as we place it in our mouths, move it around, bite, chew, and swallow.

Nine-year-old Kristian Andresen, who is autistic, sometimes struggles with carrying out the fine movements needed to bite and swallow.

“He’ll put a grape in his mouth, but it sits there. He’s not sure what to do with it,” said his mother, Lisa, a stay-at-home mom of two in Commerce Township, Mich.

That can make eating really scary, and it adds to the stress of trying to take in and interpret a deluge of stimuli.

“You and I can take in all kind of stimulus and can adapt to it. We can go to New York and it might be a bit overwhelming at first, but we’d adapt pretty quickly,” St. Joseph’s Deering says.

For a child with a sensory disorder, “it’s like a New York City in their living room. It’s just too much.”

There are other causes behind eating issues.

Severe food allergies have trained some children to see food as dangerous.

Consider a bad bout of food poisoning you’ve had: There’s a good chance you haven’t touched that kind of food since. That’s mild.

Karen Polisei, an occupational therapist within Beaumont Hospitals’ Center for Children’s Rehabilitation, recently worked with a 2-year-old. He was pleasant and playful away from food.

But acid reflux had repeatedly burned his esophagus. His body’s message: Food is pain.

By the time he came to Beaumont, “He’d throw a tantrum even getting near a kitchen or a high chair. He would not eat a thing. ... That’s not a bratty child. He associated food with a miserable experience,” Polisei said.

For other children, Down syndrome, cerebral palsy, and other conditions interfere with normal skeletal-muscle control necessary for eating.

And all these issues often overlap.

Therapy generally involves the ever-so-slow reintroduction of foods. For kids with the most adverse reactions, that might mean simply bringing the food into the room.

“The goal is not necessarily to eat those foods [immediately] but to increase their level of interaction with them,” said Dave Uchalik, an occupational therapist at the Abilities Center, a division of the Detroit Institute for Children.

Over several sessions, the food is moved closer to the child — on the table, on the plate, into tiny hands.

Ultimately, therapists help the child move the food to their mouth. The child will kiss it. Lick it. Bite it and spit it out, before ultimately chewing and swallowing — a long process that sometimes means two steps forward with one back.

These days, Andrew’s parents hope to tempt him with the kinds of foods he’ll face at school when he starts next year.

“I’d like him to eat a typical lunch food, even chicken nuggets ,or a hot dog, or a jelly sandwich,” Amy Crawford said.

But she, too, has learned the lessons of therapy at Beaumont: Be patient. Celebrate tiny victories.

“Today, he ate silver-dollar pancakes cut up in quarters,” she said. “A week ago, he would take an hour to eat a single silver-dollar pancake. Today, he ate four, just like that. That’s incredible progress.”

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