What if your GP recognized the picky eating problem?
Today’s blog is going to be a little departure from usual. Please do not tune out and think this is not going to be relevant for me. On the contrary, I feel this is relevant for pretty much every parent of a picky eater. And, if it is not specifically important for you, it is something that will be affecting someone you know.
I would love to fill you in on some of the motivations behind what I do and what I’m discovering as I spend countless hours a week immersed in work and research around fussy eating.
Currently, I’m working towards qualification as a psychologist. Studying while working and looking after a family is definitely not for the faint-hearted – especially at my age But, it is also enormously rewarding and I LOVE learning, pushing myself and discovering new things.
Part of the reason I am back at Uni is to be able to better serve the families I work with. Understanding more about the psychological aspects of feeding and eating is a great way to offer better insight and support.
However, as important is the other part of my life’s mission. My goal is to ensure every child can approach food from a place of safety and joy, not fear. Although that involves working with families, it is also about changing the way we – as a society – talk about, support, and treat eating challenges.
Currently there is very limited support for parents who need help with their child’s eating challenges. More, there is little validation that their child even has an issue and worse, parents are often made to feel as though they are at fault for creating the problem.
Eating challenges are not viewed in the same way as other childhood issues like difficulty walking, talking, or reading. As a society we are very quick to point fingers and very slow to offer help.
One step in resolving picky eating problems
As we are sooooo far away from where we need to be, this is not going to be a quick nor easy fix. However, like anything it is important to start somewhere, and every step/action takes us closer to where we need to be.
Although there is so much to be done, I am always excited when there is a concrete action I can take which may make a difference.
As part of my Uni qualification I have been asked to prepare a policy brief. A policy brief is a document which details a social or policy problem and then lays out a solution. I have chosen to focus on the lack of understanding of fussy eating among GP’s/Paediatrician’s in NZ. Although focused on NZ, the same problems are encountered in most countries.
A group of psychologists from Auckland University researched and published a report about medical professional’s understandings of picky eating in children and found that in general GP’s did not have a comprehensive understanding of the problems faced by fussy eating.
GPs themselves also requested more information, so they were better informed. Let’s repeat that – the doctors interviewed understood they did not have enough information and were asking to be better educated and informed!
If you’d like to read the report click here: https://www.tandfonline.com/doi/full/10.1080/2050571X.2021.1926620
GPs also stated that there needed to be better established pathways for referrals. Doctors realized that even if they were able to recognize eating challenges they were not equipped to work with families and needed to refer them on. But to where?
Step one is therefore ensuring that GPs are able to identify when there is a problem and step 2 is to ensure that there is somewhere to refer families to.
Step one is what I will be focusing my policy brief around. Step two is as, if not more important, but is a far more complex solution. Fixing one part of the problem is a good start. There is also a reason for tackling this step first.
Step one – providing information for GPs
If GPs can recognize when a child has an eating challenge:
1. They validate parent’s concerns. I speak to parents every week who have been told to relax, stop worrying, it’s just a phase, or a whole raft of other phrases that play down the challenges their children (and so too the wider family) face.
When you are told repeatedly that either there is not really a problem or that your child will grow out of their restrictive eating, it is enormously difficult. It also means that many parents do not look for additional support so now instead of having a 4, year old, stuck on 10 foods, they have a 14, year old, eating only 5.
If parents know that something is going wrong early and are supported in this, they are able to take action.
Current international feeding advice flies in the face of many of the things we have been told. For example, if you have a child who is 10 months old and who is not able to eat dinner food, then there could be a problem. It may be minor, but fixing it early prevents the ongoing issues that so many parents contend with.
2. The problems are acknowledged and entered into the medical records. If every GP is able to recognize when fussy eating is more than a normal toddler phase, they would soon see the magnitude of the problem.
They would also then start to focus on Step 2. A GP’s role is to identify problems and then find a resolution for parents. If they identify the problem, what then?
Part of resolving Step 2 is to have vested interests from all sides saying “hang on, we have this big problem but no solution”.
3. Medical professionals may be able to help wider family too. Part of the report from Auckland Uni talks about how the stress and challenges for parents are not being acknowledged and that solutions should be aimed at the whole family.
The article concludes: “Picky eating is no longer seen as only benign, and interventions that increase dietary variety and flexibility should be accessible to whānau (wider family) across the country”.
My policy brief will therefore discuss the lack of understanding of picky eating by medical professionals and the importance of addressing this gap in knowledge.
The solution to a lack of awareness of picky eating
My solution is also super simple. On the first of October 2021 a new feeding diagnosis was added to the ICD-10 called pediatric feeding disorder (PFD).
The ICD, (International Classification of Diseases) is the globally utilized diagnostic tool for epidemiology, health, and clinical management for the World Health Organisation (WHO). The WHO operates within the United Nations system.
PFD is a far better fit for many children than the also relatively new diagnosis of ARFID (Avoidant Restrictive Food Intake Disorder) as this a psychiatric disorder. Being a psychiatric problem means it is classified as an eating disorder alongside anorexia and bulimia nervosa.
However, PFD is a FEEDING disorder not an eating disorder which is a very different diagnosis. You can read a basic overview about it here:
For my solution, I will take the main components of PFD which is classified over four domains:
1. Medical factors – anything from neurodevelopment challenges (like ASD), to other problems preventing competent eating.
2. Nutritional factors – where a child has a restricted quality, quantity and/or variety of food and beverages consumed (sound familiar?).
3. Feeding skills factors – for example oral sensory functioning which can limit the acceptance and tolerance of textures, flavours, temperature, and appearance (again, this is the experience of most families that I work with). Or gagging or requiring food to be prepared in a non-age-appropriate form.
4. Psycho-social factors – problem feeding behaviours. Stress and distress in the child and/or caregiver (this one is probably self-explanatory!).
Taking these 4 domains I propose a simple check box analysis that can be accessed by medical professionals, and which enables them to quickly evaluate whether there is an eating challenge.
Should this questionnaire come from the Ministry of Health, it can be a standard form that is available to any medical professional who wants to do a quick analysis of whether there is a problem beyond a ‘phase’.
At the moment it is all hypothetical, as it’s being prepared for an internal assessment for my Uni. However, the more research I do, and the more I think about it, the more it seems like an amazing, cost effective and ABSOLUTELY ESSENTIAL resource. It is such a simple solution to a problem that affects countless parents.
Naturally, if this were to go on every medical database around the country, the form would be created in conjunction with specialists in each of the domains but I am convinced the concept has legs!
I would love your thoughts, ideas, and suggestions.
Judith, MA Cantab, is an AOTA accredited picky eating advisor and internationally certified nutritional therapist. She works with 100+ families every year resolving fussy eating and returning pleasure and joy to the meal table.
She is also mum to two boys and the author of Creating Confident Eaters and Winner Winner I Eat Dinner. Her dream is that every child is able to approach food from a place of safety and joy, not fear.
Learn more about Judith here: https://theconfidenteater.com/about/