Health

Saturday 23 August 2014

David Coleman: How can I get my son to eat normally again?

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My problem lies with my younger son aged 21 months and his eating habits, or lack of! He had been a great eater up until a couple of months ago and now will no longer eat a dinner and the majority of food types.

Thankfully he is not underweight – in fact he is a little tubby.

He will eat his breakfast, which is normally porridge or Weetabix and a yogurt. This is the best time of the day; however, throughout the rest of the day he will only eat dry crackers, fruit pots or sweets and crisps or spaghetti hoops. That is it, nothing else! He is not teething and it is going on too long now to be a phase. I try him every day, twice a day with his dinner but he looks in the bowl to see what's in it and then says "No".

If I try and force it, he will hold it in his mouth for as long as it takes. My other son, aged four, is a fantastic eater, and we try to eat together as a family probably four times a week.

Mealtimes are becoming a real struggle now and I dread feeding him every day. I am praying that you can offer me some advice, as I do not want to stress my little baby out.

David replies:It is always frightening when our children seem to lose their appetites. We fear they aren't going to get the nutrition that they need. It is this fear that they will 'fade away to nothing' that then drives us to try anything to persuade or force them to eat.

I am sure you have tried many of the old favourites like creating the spoonfuls of food to be airplanes needing a landing runway in his mouth.

Or perhaps you've tried distracting him with stories or toys while you try to slip some food into his mouth.

There are many variations on these 'tricks' to try to get children to eat more than they want to. In my opinion, however, that is all that they remain – 'tricks'.

You know that your son has not dropped weight, so his recent restricted choice of foodstuffs hasn't led him to 'fade away'.

Take this as a reassuring sign that your son is doing okay and that you can safely listen to the messages he is giving you.

By holding food in his mouth, without swallowing, he is giving you the clearest message he can that he doesn't need or want that food at that time.

I think it will really help you and him if you listen to that message.

I believe that when children don't eat it is because they are either full, or they don't want a particular type of food.

We are very tolerant of adults choosing the food they eat, however, we are very reluctant to allow children to choose.

We still try to override a child's own intuitive choices.

Many babies and toddlers will change their eating patterns, very radically, between about 12 and 24 months of age. This is, typically, because a huge part of their physical growth slows down.

I think they inherently know that they don't need the same volume of food to give them the energy they need to continue to grow at their new, slower, rate.

So they eat less volume. Most parents are not expecting this and so do, indeed, panic at this apparent 'food strike' that their baby or toddler exhibits.

Ironically, by then engaging in all the 'trick' tactics to get more into them, we can end up creating such negative association with food that children learn to hate the food or the mealtimes.

I think it is great that you try to eat as a family regularly during the week.

Let this become a primarily social occasion, and take the focus off the food that gets eaten.

Do bring your son to the table, but don't put pressure on him to eat.

It is quite likely that your son will continue to have enough balance in his diet, when spread out over time, even if he isn't getting a balance in every meal. So, as long as you have healthy, varied, snacks available to him throughout the day, it won't matter that he doesn't have any big meal, or dinner.

At his age too, you can take the pressure off yourself to feed him and let him have more opportunities to feed himself with the range of foods he gets offered.

Many children are grazers, snacking through the day like this.

When we can relax a bit, in the knowledge that this is okay, it takes pressure off all of us. You are right. Food should be about enjoyment, and not a source of stress.

* * * *

We think our teen has ODD but he won't go for counselling

My husband and I have two kids. The older, a boy, will be 15 in June. He has always been difficult.

From the age of about two or three he was defiant, but we put it down to the "terrible twos". We hoped the tantrums would lessen but instead they increased. Just getting him to do the simplest of things would prove difficult or even impossible.

We have often questioned our abilities as parents in the way we were handling things and have been, with him, to many therapists over the years. When he was 12 there was a particularly difficult situation in which he got aggressive with me, resulting in me needing stitches over my eye.

At that point a child psychiatrist put him on medication to lessen his anger and impulsivity. His outbursts have lessened in frequency and intensity but when they do happen they are frightening as he is now 5ft 10in and 14 stone! At home he spends all his time on video games and avoiding us as much as possible.

He has never been formally diagnosed with ODD (Oppositional Defiant Disorder) but it does seem to describe him. Is this even a legitimate disorder? We are always looking for ways to help him but he is refusing to attend counselling. What can we do?

I can only imagine that life has been extremely trying for your family. When a child, or in this case a teenager, acts out so much it just causes untold stress and heartache to everyone else. Nobody in the family can ignore what is happening or hide from it.

Yes, ODD or Oppositional Defiant Disorder is a real disorder. I don't know enough about the physiology or neurobiology of it to say definitively what the specific causes are.

In my experience of working with children, teenagers and their families, ODD is most often the result of a combination of a child's temperament and the way parents find over the years, to try to deal with that temperament.

It is common, for example, to get into a very negative pattern of responding to children from when they are small. For instance, if we start responding to toddler tantrums and defiance with punishment and our own anger, we may exacerbate the frequency and duration of those tantrums.

If this then becomes a habit, or pattern, of child defiance or frustration followed by parental strictness and punishment, it will solidify a child's sense of anger, injustice and the need to "fight their own corner". In this way a "vicious circle" can become established.

So, for example, very strict and punitive approaches to parenting, coinciding with a child's own inherent determination, independence, impulsivity or lack of attention can often lead to spiralling negative behaviour from the child and growing frustration and helplessness amongst parents who run out of ways to try to "make" their child behave.

It is great that you and your husband have been willing to think about your strategies for responding to your son. I can imagine you have had to be very flexible and try different approaches.

It sounds like, despite your efforts, your son has remained stuck in his habitual ways of interacting. Perhaps this has occurred to the point at which you now feel powerless to help him make any changes.

I do think it might be helpful to think of his attitude and behaviour as his strategies for dealing with the world and keeping it predictable.

So, by its nature, then his oppositional and argumentative behaviour, is self-reinforcing for him. Changing from this may even be anxiety provoking for him as he won't know what to expect from his interactions with peers or other adults.

However, a relentlessly understanding and empathic approach from you, to him, may help him to see how much you care about him. It may also show him that he doesn't have to be belligerent, obstinate or vengeful. Instead you role-model a completely different way of interacting to the one that he relies upon.

It would be great if, at his age, he'd accept that counselling or therapy may be really helpful for him and might reduce his frustration. However, he is also of an age where it is impossible to force him to go. Moreover the benefits of him attending anyone will be negligible if he isn't an active and willing participant.

So, it is vital for you to continue to attend courses, services or support groups locally that will give you the social and emotional support you need to keep living with your son.

I read and enjoyed 'The Explosive Child' by Dr Ross Greene and I think you may find it very relevant and helpful for the issues you face with your son.

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