Do you have a resistant eater?

I have a million things going on right now between packing up our house, making plans for London and all the soccer games, swim practices, etc. It is definitely not the time to be writing a blog post. But I've been wondering if our experience could possibly help someone else and I want to get it written out before we move to London and my posts turn to other things. This is going to be long.

Luke crying at 2 years old because I gave him a peanut butter with 1/3 less sugar than normal. I had to scrape it off his tongue in order for him to stop crying. Foreshadowing at its best. 

Luke has always been a resistant eater (remember this post?!). Even as an infant he did not nurse well. When he turned 1, he wouldn't drink whole milk and eventually I had to give him Pediasure on a daily basis. He did okay with pureed foods and a few other finger foods but by 2.5 years old he settled on a handful of foods and those foods largely remained the same until he was 6 years old. Foods like peanut butter, toast, dry cereal, crackers and certain varieties of chicken nuggets. Other moms would notice his picky behaviors and tell me stories about phases that their own children went through. But for some reason those stories never resonated with me. I always knew in the back of my mind that this wasn't a phase. It was not going to go away on its own. I knew that unlike kids who are just picky, Luke would rather starve than eat a new or unfamiliar food. Period.

This certainly isn't the worst problem a child could have, but this affected our family in several ways. I'm not going to go into all the frustrating stories, but it was hard to deal with day after day and we often worried about Luke's health and well being. Over the years, I tried many different ways of trying to help him expand his diet. At times I tried to be more strict and offer rewards, other times I tried to just relax and let him choose what he wanted to eat. Nothing worked and every approach had significant drawbacks. One thing that I never felt comfortable with was letting him starve until he ate what we wanted. I received that advice from some parents while they quoted the adage that "kids won't starve themselves". But my child could go without food longer than I was comfortable with. I think there are cases where this isn't very good advice.

I knew when my 6 year old constantly came home from school fatigued and starving because he wouldn't eat anything during the day, that this was more than normal pickiness and it wasn't going to change on its own. I read some blogs online like this post. Luke is not autistic but the description of a "resistant eater" resonated with me. He was always very analytical of his food, noticing if it had black spots or strange bumps that made it a bit imperfect. His food choices had slowly narrowed over time, never increasing to include new foods. If pressed to try a new food, he would gag and be unable to swallow. I didn't know where I would find an "eating therapist" in my area and it seemed like the places I contacted were better suited for children who had suffered a mouth trauma or had an eating disorder like anorexia. Plus the waiting lists were ridiculous.

Finally, (and this must have been revelation because I have no idea how I came to this conclusion) I decided that Luke was very similar to someone who had OCD or anxiety (his anxiety is about food) and whatever therapy would work for them, would work for Luke. I was somewhat familiar with Cognitive Behavioral Therapy (I have a BS in Psychology) but I knew that I could not be the one to help him through it. We had too much baggage between us after all these years of food wars. He needed someone outside his comfort zone who would have a clean slate. Through the recommendation of a therapist friend, I contacted the Anxiety and OCD Treatment Center of Ann Arbor. Luke began seeing a therapist once a week in January. I should mention that Luke doesn't have an official diagnosis for any kind of disease or condition. He does not take any medication. I'm not really interested in labeling, diagnosing or trying to figure out why he had this problem though I have several hypotheses. For whatever reason, trying new foods is something that scared him and therapy helped him overcome that fear.

After getting to know each other a little, the therapist explained to Luke that his mind was playing tricks on him. She told him that it happens to people all the time and gave him several examples of things that people were afraid of. Luke thought some of these were really funny. She told him that his brain was telling him to be afraid of new foods but that he didn't need to be afraid and they were going to show his brain that new foods aren't scary. Luke is very logical so this explanation really worked for him. During every session, Luke and the therapist would play games. The therapist recognized that Luke is competitive and likes to win. Eventually she would stop him before his turn and tell him that he could not take his turn until he ate a small (I mean, very small) bite of a new food. She would set a timer and he had one minute to either eat the food or relinquish his turn. We started out with things that were very similar to what he was already eating. A new type of cracker or chip for instance. Slowly, each we week we ventured into more unfamiliar foods.

In the beginning the major foods we worked on were apples, carrots, and cheese. I can't tell you how SLOW this process began. In one of the early sessions, Luke gagged on the smallest bite apple every time his turn came around for almost the entire hour. He could not swallow it. The therapist would calmly tell him that it was a good effort but he needed to swallow the food in order to have his turn. As soon as he successfully got it down, she immediately rewarded him with a small M&M. Sometimes she would promise him a few M&Ms if he was really struggling. At the end of the session he could pick out a small prize.

The therapist was not opposed to negotiating with Luke. Sometimes she would tell him that he only needed to try a new food once or twice the whole session if he really didn't like it. Or if Luke felt a piece a food was too big, she was not opposed to cutting it smaller once or twice. If they ever reached an impasse, she always presented him with new options or choices so he had some degree of control and things could move along. In a way, it was therapy for me to see how she dealt with his arguing techniques and balanced the line between setting rules and being flexible. It was good for me to model her approach.

At home, in between sessions, we would continue to work on the foods introduced in the previous session on a daily basis. This was the hard part. At first there was a lot of resistance and negotiating. I had to work a lot on staying calm and unemotional. The timer really helped with this. It gave us a cutoff where we could just move on if things weren't going well. Sometimes we would have a hard time getting a game started so I usually had to start off with very tiny pieces or foods that were relatively easy for him. Once he was invested in the game, I would begin bringing in harder foods. I always tried to give him choices so he felt like he had some control. The reward system we had in place was key. In the beginning I knew the strongest motivator for him would be treats. This meant that he could never have treats other than after eating practice.

The beginning. Apples, cheese and carrots.

Slowly, after a few months, he began mastering apples and cheese (he still doesn't really like carrots) and once these foods became a bit easier, I made sure that he ate them everyday. He still would not eat them without a reward but instead of giving him a treat every time, I started making it a qualifier for other activities, E.g. "Before you eat dinner, you need to eat some apple" or " Before you can watch that show, you need to eat some cheese". At first this was a pain and I hated doing it to be honest. Sometimes, when he wouldn't eat, it felt more like I was being punished. But we stuck with it and eventually it got better.

The next step was to get rid of some of his old favorite foods and make the newer foods "the new normal". This part was also difficult. I didn't necessarily get rid of his old favorites all together. But now, instead of making him toast with PB for dinner, I would put apples and cheese on the table for dinner (in addition to whatever we were having as a family). I also ventured into other foods like cheese sandwiches and cheese quesadillas. Luckily, after a month or so he really started liking cheese so this became much easier. As foods became easier I would bring new foods for the therapist to introduce. Slowly our list of foods grew.

(a little clip from a therapy session)

We have now been going to therapy for almost 6 months. Here is a current list of foods that Luke can choose from. Some of these food are easy for him and some he doesn't like yet but will still

try. I keep the list handy so that whenever he wants a privilege like having a treat or watching a show, I can quickly think of something for him to eat beforehand. He has become so used to this now that there usually isn't any argument. However, he still likes to play games in order to eat a majority of these foods and generally his serving sizes are quite small. But I'm very happy with the progress. I'm getting a little weary of playing games all the time (and my other kids get jealous so I usually have to work everyone into the game). I won't lie, it is exhausting. But it is so much better than the situation we had before that I can never complain. It has been 100% worth all the effort. Slowly, he is not needing any reinforcement for a few of these foods which is very promising. Tonight he asked me if he could have some yogurt because he liked it. I wanted to fall on the floor and cry tears of joy (I did on the inside) but on the outside I pretended it was totally normal and got him some yogurt from the fridge. It was the first time he has eaten yogurt without playing a game or needing some kind of reward at the end. It was progress.

Perhaps most importantly are the changes I've seen in Luke. He seems so much lighter and happier. Part of this is because he is rarely starving and literally his body just feels better. He also doesn't feel as scared to try new foods and it is like an entire world has opened up to him. I expect that Luke is going to be somewhat picky for the rest of his life and I'm okay with that. I'm not expecting to go eat sushi with him someday. But I'm so happy that he is more willing to try things and doesn't carry this anxiety around anymore. I expect I'll be playing eating games for years to come but at least we have a method that works.

If there is anyone else in a similar situation and food "pickiness" is becoming extreme to the point where it is greatly affecting the quality of your family life, I would definitely suggest finding a therapist who specializes in behavioral cognitive therapy. It is a simple method, but it works and having a third party who held us all accountable and kept us moving forward was invaluable. If Luke ever complained about what we were doing I could tell him that "Dr. Amy" was the boss and he would have to take it up with her. It was nice to have someone else in charge (at least in his mind).

I normally don't like to blog about the things my children struggle with out of respect for them, but I thought this might be helpful to someone. I'm really proud of Luke. He is a great kid and is so creative and fun. I'm glad he is learning that he can overcome hard things at such a young age. I have never met anyone in person who has been in this situation, but if there are people out there I am more than happy to talk to you more about it if you just leave a comment.