Children who are raised within an institutional setting may have some feeding/food issues.  I will try and summarize the issues that we have seen and some possible explanations behind the questions: “why do they do this?” and “how should we respond?”

1. Inability to wait for food:  this is probably the most common behavior we see and is characterized by crying and screaming when they see food being prepared (or a bottle) but they don’t yet have the food in their mouth.

WHY:  This probably relates to several feeding experiences within the baby homes.  First, the children typically do not see food being prepared.  It is prepared in another room and brought to them.  Therefore, when they see that you have food, but they do not they are frantic because they have no way of knowing that the food is for them.  This also may have to do with sheer numbers.  Perhaps in the baby home the baby screaming or crying the loudest was fed first (to quiet them!)

HOW:  The best way to handle this is to give the baby or child something to eat while you are preparing their real meal.  One mother of a toddler actually saved a meal from yesterday’s dinner to heat up quickly and give to her toddler while she made dinner for the day.  The toddler still sat and ate the “real meal” with the family at dinner; she just did not eat as much of the “second meal.”  The child will learn to be able to wait once they realize that the food really is meant for them!

2. Excessive eating: this is characterized by eating large quantities of food; seeming to never be full; never turning down food when offered; becoming upset if they see others eating when they are not.

WHY: This probably related to 2 things: first the children are fed by a schedule, not necessarily when they are hungry and second, they are not consistently fed to satisfaction.  This can actually cause the brain to not really “register” feelings of fullness when it does occur.

HOW:  The best way to handle this is to NOT RESTRICT FOOD INTAKE!!  Many parents erroneously think that their child will become obese or end up with a food disorder if they allow them to eat so much.  Quite the opposite is true.  The more you restrict, the more the child will think that they need the food.  In order to really get the sensation of fullness, the feeling may need to be exaggerated.  Some children may even eat so much that they throw up!  This is really OK.  Their brain needs to get the “signal” that they are full.  Offer the child healthy food that they can eat anytime (bowls of cut carrots, celery sticks, strawberries, grapes…believe me, no one ever got fat eating unlimited quantities of these foods!  It may take a month or 5 months, but eventually, you will see that the child will turn food away, will say that they are full and will be able to tolerate watching others eat even when they are not.  Their portions will begin to look like a typical toddler/child instead of adult-size portions.

3. Inability to chew/texture issues: this is characterized by the child literally swallowing foods without chewing and or spitting out or “gagging” on any foods with texture.

WHY:  This probably relates to the lack of variety in the child’s diet along with the hurried manner in which they are fed in the Baby Homes.  Typically, they are fed at a very quick pace and the care givers use big spoons (the child has no time to chew before the next spoonful is being shoved into their mouth!)  Many baby homes will continue to use bottles when a child should be eating more table foods (it is once again quicker).

HOW:  Resist the temptation to accept their restrictions as this will only reinforce their intolerance to textures.  Parents need to continue to offer the child a variety of textures over time to increase their tolerance.  If they do not accept it one day, try the same food a few days later in very small portions. Some children continue to resist any food with texture and they will continue to gag even after several months.  In this case, you may need clinical intervention in the form of an occupational therapist who specializes in feeding issues.  There could be oral sensitivities relating to sensory issues.

4. Extremely picky eater: characterized by children who refuse to eat or try foods; generally will only eat certain foods; typically this is more common in an older child (toddler age and older).

WHY:  Life in the Baby Home is very structured with meal times being at set times.  The variety of foods within the orphanage is limited as well.  Ironically, some parents report literally seeing a child eat a certain item in the Baby Home, only to flat out reject this item at home. Some people think that maybe this food “reminds” them of the baby home and of an unpleasant time.  I tend to think it’s more about the child trying to adjust to all of the changes happening in their life. This may also relate to the age that we tend to see this behavior.  It generally comes at the age of emerging independence and their desire to control situations is heightened.  They are also trying to figure out “what are the rules here?”

HOW:  If the issue is one of control, give the child several food choices (all acceptable to you of course!) and let them have their choice.  In the beginning, try and tailor the choices to what you know they like (or what you saw them eating in the Baby Home).  Make it clear that once they pick, they cannot take a bite and then decide that they don’t want it!  Be very firm, but very calm in dealing with food issues.   If you sense that the issue is simply one of not liking the taste of something (due to lack of exposure/experience) than offer different foods in small doses and small increments (almost as if you were trying new foods with an infant).  A child may reject a food one week and try it the next (studies show that children need to be offered a food 7 times before being willing to try it!!)  Parents can make a game out of trying new foods…passing around something and everyone taking a bite…making silly faces afterward (of extreme pleasure or extreme disgust).  Try not to take it all too seriously.  If a child who has control issues sees that this is a way to “push your buttons”, they will use it and they will win the battle!