I recently blogged on one of the childhood eating disorders (incidentally not yet recognized as such in the DSM system) called selective eating. I got a deluge of parental comment and interest, which I would like to try and address here.
What exactly is selective eating?
Selective eating (SE) is a condition present since earliest childhood where a child eats only a very narrow range of foods and refuses all others and yet where his or her linear growth is normal. Such children are not amenable to persuasion; neither bribes, punishments, “gold stars” nor being left at the table “until they finish their food” helps in the slightest. Parents of selective eaters report regularly having tried all these things and more -- often to appease grandparents or other well meaning relatives -- to no avail. These children would literally prefer to starve than eat food outside their range. And while I am not aware of any good epidemiology, our experience has been that selective eating runs in families and is often seen in males. Although SE is not fatal nor necessarily accompanied by other psychological difficulties, it does cause a lot of parental anguish and by extension, childhood misery.
To add to the parental unease, almost invariably the chosen foods are things like chicken nuggets from a certain place, chocolate milk of a certain brand, Cheetos or other junk food chips, and similar “low nutrition” items. My God, the parents think, how can a person thrive on such a horrible diet? And yet they do. Humans appear to have survived and thrived on the planet because we are biologically resilient.
Selective eaters may also “burn out” on certain foods they formerly favored and find new (equally appalling) substitutes, but they usually enter adulthood able to eat only a very narrow range, becoming that husband (or less commonly, wife) who only eats “white things, plain and unembellished”—no green vegetables, only corn, no fruit, etc. And they function perfectly well. And I do mean well. Warren Buffett is one such highly successful selective eater.
Parental response to my earlier blog has followed several themes: “thank you for explaining how parents do not cause this”, “we have suffered along with our child with SE” , “other people’s comments drive us crazy” and “but I want my child to be normal… how can this change?”
Here’s Peter, for example: “…. My son has suffered from highly selective eating (only 5 things - all crispy and beige in colour, all carbs) from the age of 1. He's now 10 and it's no better. He's been "brand conscious" from the age of 1. It's caused a lot of stress. We have been to 7 different institutions…..We've wasted hours and hours of time on bogus appointments, and pulled him out of school for much of these. There are virtually no reading materials on this subject, and people couldn't give a damn to help. The rest (teachers, family members, etc) stand on the sidelines full of criticism, disbelieving facial expressions, and unhelpful suggestions. But the fact is, we've tried everything we can think of as parents, and nothing works. Our son would rather starve than branch out. So, optionless, we have pretty much given up. It was a great comfort to finally find this blog and the postings under it as it confirms that, in doing no more, we are actually doing the only thing open to us....and that's OK. Good luck all.”
And “G’s Mom” says: “This [blog] made me cry. In a good way. Someone who actually understands. My 9 year old eats 25 things x 6 years. We have been in psychotherapy previously and OT currently. He has SPD and dyspraxia and is making great strides in all areas - except eating.?This is exactly what I want to tell people. It is SO hard to explain to someone with a typical eater who says "my child is pick too" or "my kids eat what is served or they go to bed hungry". These people have NO idea. ?Everyday I pray that he will expand his palate. Until then, will take heart that he is healthy.?Thank you.”
And then, despite what I felt was a fairly clear message that SE is astonishingly harmless physically, as long as the child was growing well and not failing to thrive, and cannot be changed or treated by any methods I am aware of, comes the comment: “This sounds like my 7 year old daughter to a T. What do you suggest as "treatment"? Basically, how do we deal with this as parents?”
This instinctive desire for normalcy drives a lot of suffering. And while we are prepared to accept deviation from the mean in some things (e.g. “smarter than average”, “more talented than others”, “higher income than average”) we seem to agonize over eating behavior that is “not normal” or “not what the average child does”. When parents struggle to accept this hard-wired deviation from omnivory, the affected child picks up the message that “there’s something wrong with me”. This can be a big problem. In fact, one of our family therapists (Heather Mirasol) suggested that I advise parents who are struggling with this diagnosis so engage in a few sessions of family therapy (without the patient) in order to explore their feelings about this diagnosis in their child, the feelings of helplessness it engenders, and learn techniques for acceptance. Learning to accept differences in people is something we struggle with globally as a society, whether these are racial differences, socio-economic differences, or differences in (dis)abilities. Parents of children with SE will have to serve as a support to each other, for there are fewer people who understand. Insisting that “there must be some treatment that works” despite all clinical experience to the contrary, just makes life harder for a child. In my experience, you cannot "treat" selective eating and, as it is not broken, you don't need to fix it. I know this is hard to accept, but sometimes we must focus on the normal growth and let go of the rest.
My friends and readers: doctors, therapists, neighbors, grandparents, please release these parents from their sense of failure, complement them on their good job raising a child who is growing well, and let their children get on with the real tasks of childhood: having fun, learning new things, making friends and finding themselves in the world.
And if you are the parent of a child with SE yourself, I hope you can gain the strength and courage to change the things that can be changed, accept the things you cannot change and the wisdom to know the difference. It wasn’t called the serenity prayer for nothing.