First Do No Harm

So you have a restricted eater. You have written out your list of "safe foods". Now what?

The first step is actually to stop and regroup.

"A child needs to build trust: when children trust food and those feeding them they have a strong foundation for eating in the future." Thrive by Spectrum Paediatrics

The first step is to rotate the safe foods to ensure no further foods are dropped. Introducing new foods straight away will trigger anxiety. Anxiety and stress set off our fight or flight response (brain thinks: Danger! Danger!) and appetite is suppressed. Stressed child = no eating. (Keep this in mind also when your child becomes sick or really tired- appetite will be again suppressed.)

Eating the same food over and over again and then refusing to ever eat it (ever again) is known as 'food jagging'. Food jagging results in a loss of safe foods. The first goal is to maintain the safe foods that your child currently has.

On a piece of paper write out an entire week and try to fill in all meal and snack times with current possible safe foods.

The following is an example of how you could arrange a meal schedule for a child who is only eating:

• Smith's potato chips: plain and salt and vinegar

• Honey-soy chips

• Popcorn

• Pretzels

• Apple

• Strawberries and blueberries

• Dried mango

• Plain pasta with cheese & frozen peas

• Chicken nuggets

• Hot chips

• Toasted cheese sandwich

• Peanut butter sandwich

• Milkshakes, yoghurt

• Cakes/Muffins/biscuits/ pancakes

• take away: plain cheese pizza no sauce

It may look something like this:

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Breakfast	Coco Pops	Toast	Weetbix	Coco Pops	Yoghurt & apple pieces	Pancakes with Nutella & berries	Toast
Morning Tea	Smith's potato chips plain; grapes	Popcorn, apple, muffin	Honey-soy chips; dried mango	Pretzels; grapes, yoghurt	Smith's potato chips plain; grapes	Popcorn; muffin
Lunch	Chicken nuggets; hot chips	Cheese toasted sandwich	Plain pasta with cheese & frozen peas	Pancake; grated cheese	Plain pasta with cheese & frozen peas	Cheese toasted sandwich; dried mango
Afternoon Tea	Toast with peanut butter	Smith's potato chips salt & vinegar	Biscuit, apple	Muffin; berries	Toast with peanut butter	Biscuit; apple
Dinner	Plain pasta with cheese & frozen peas	Chicken nuggets with hot chips	Peanut butter on toast; yoghurt	Chicken nuggets with hot chips	Take away: plain cheese pizza no sauce	Chicken nuggets with hot chips
Tea/Dessert	Ice cream; hot chocolate	Milkshake	Ice cream; hot chocolate	Milkshake	Ice cream	Milkshake

The aim (where possible) is to include 1 x carbohydrate, 1x protein and 1 x fruit OR vegetable at every meal and snack. This may not be possible with your current list of safe foods without repeating the same foods. Or it may not be possible because your child is missing an entire food group (e.g. fruits and vegetables). That's okay. Our goal is to maintain the current list of safe foods for now.

Years ago I was given a copy of the book, French Kids Eat Everything (incidentally the inspiration for the title of this blog). This book filled me with immediate inspiration to set the table every night with a table cloth and cutlery, light a candle and get everyone eating together.

That first night felt like a colossal failure. No one ate anything different, everyone complained about sitting together, and I was left completely exhausted from the additional prep required.

Looking back now, I can see that the foundations were actually solid.

Making mealtimes social. Reducing pressure. Sharing food together as a family.

These are all important first steps in supporting children with feeding challenges.

In feeding therapy, we often talk about creating a family meal—a predictable opportunity for children to be around food, connect with others, and build trust without pressure. (I'll write more about family meals in a future post.)

What I didn't understand at the time was that feeding challenges are rarely just about food.

For many children there are sensory processing differences influencing what feels safe and manageable to eat. For others, gastrointestinal discomfort, muscle motility changes, anxiety, or oral motor coordination difficulties may all be playing a role.

Sometimes a child isn't refusing food.

Sometimes their body is telling us that eating feels genuinely painful.

This is why feeding intervention is rarely a quick fix.

Anything to do with feeding can take time—sometimes a really long time!

Progress often looks smaller than we expect:

• sitting at the table for a few extra minutes

• tolerating a new food on the table

• accepting a different brand of a safe food (think Smith's chips vs Kettle Chips)

• touching a food that was previously avoided

  
  

These may seem like tiny steps, but they matter and progress your child along the hierarchy of food exposure. (What is the hierarchy of food exposure I hear you ask? We will get to that!)

Every small step represents a child feeling a little safer around food than they did before.

And that is worth celebrating.

While you're considering whether your child may benefit from assessment of sensory processing differences, oral motor skills, or other factors impacting eating, you can also begin thinking about gently expanding the foods already on their safe list. (We will explore how to do this in a later blog post!)

Remember: First do no harm. When it comes to feeding, safety is usually where progress begins.