Why won’t my child eat?

Do you worry that your child is not getting enough?​

Have you heard people say that a child will eat if they’re hungry enough? That surely they won’t starve themselves? But what happens when a child actually does ‘starve’ themselves to the point that growth becomes affected?
Many people believe that eating is a instinctual process and that a child will eat no matter what. Actually, instincts (reflexes) do help a young infant find the breast up to about 3 months of age. However, after this, eating becomes largely a learned behaviour. 
Just as a child can learn to eat, they can learn to not eat.

Kay A Toomey (2010) states that research shows that learning about food happens through two main ways:

The first is when a connection is made in time between one natural stimulus and another neutral stimulus. For example, if a child (or anyone) experiences pain or discomfort, they will try to avoid it. This a natural event. But if the pain or discomfort get associated with something such as food or eating, then they may learn to avoid the eating situation even though it’s not directly the cause of the pain. Painful gastro-oesophageal reflux can be an example of this.
The second way we learn is through reinforcement (imitating or praise) and punishment (such as yelling, forcing food to be eaten).
Punishment around eating can be a negative experience resulting in physical appetite suppression. Further negative associations in time, can ultimately lead to complete avoidance of the feeding situation and mealtime battles. Overall, this can be a very hard, unpleasant and unhappy way to to do things. 

Sometimes parents fall into negative feeding struggles when children won’t eat well. It makes sense that parents can start to worry and feel like they have to make their children eat. In their mind, if they don’t, well, their child’s wellbeing is at risk and that is overwhelming and scary! Parents in this situation often just want their child to be okay. And so we can also start to see confusion around feeding roles and responsibilities, where the parent feels they need to decide how much the child should eat. For more on Division of Responsibility take a look at Ellyn Satter’s work here.
A child that won’t eat, is likely to be finding the eating experience challenging and has learned to not eat.

To work out what is going on for a child that won’t eat, it is more helpful to look at how the child learned to not eat. 
Is it that they have a number of food allergies and their reactions caused them extreme discomfort or scary anaphylaxis? Or did they see a family member scrunch up their face with refusal when a particular food was offered, in turn teaching them to approach that food with caution? Might they be constipated and experiencing poor appetite? Or have they not had many opportunities to learn how to eat through social modelling because they eat separate to the rest of the family? There may be many many scenarios. We can accidentally teach children not to eat, without intention or awareness.
When children (in particular small children) won’t eat in a problematic way, they are communicating something about eating is hard or doesn’t feel good. 

Children also learn to eat (or not to eat) by reinforcement. We can use positive reinforcement to encourage positive learning and eating behaviour. This can be in the form of imitating, natural praise or social modelling with step by step details on how to eat. It can even be the body’s natural feeling of satiety (feeling comfortably full) after eating or the pleasure of eating. 

We can accidentally reinforce undesirable feeding behaviours by using things such as distractions, rewards or bribes.
How can we get our children to eat well?

Expressing your concerns to your health care professional with an interest in feeding and childhood nutrition can really help! You may gain more understanding of what is normal eating behaviour and development (which will vary a lot!) and identify possible interactions or situations that may be contributing to your child’s eating experience.
All learning around eating needs much patience and time to allow the gradual learning of feeding skills and gaining feeding confidence. With practice and positive reinforcement a child can learn to eat. Some feeding issues can be complex requiring professionally support or therapy, and a home environment that supports the learning of eating.
Learning is the key factor.
Ines Astudillo

Paediatric Dietitian, APD

Toomey, K (2010). When Children Won’t Eat: Understanding the “Why’s” and How to Help.

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