"I've read so much stuff online and I'm none the wiser"

"We've tried everything - nothings helps, nothing makes things better"

"I just don't know how many more mealtimes like this we can take..."

These are real quotes from parents who felt like they had come to the end of the line in terms of finding solutions to their child's picky eating. The internet can be a fantastic source of support for parents, but there are so many articles out there, often offering conflicting advice. It can be really hard to know what to trust, and sometimes, too much information can just feel plain overwhelming.

You've had your child's weight and growth checked and it's all fine. You've ruled out physiological causes of their eating issues, like allergies or physical problems with chewing or swallowing. Everyone tells you that they will grow out of it; that it's only a phase!  - Just put the food in front of them and wait for them to eat it, because "they won't starve". 

But for some children who are extremely wary of unfamiliar foods - the ones who cling to their safe foods like a life raft in a stormy sea, and who really, truly need to know that the food they are offered is firmly within their comfort zone; these children need a bit more help. I call these children cautious eaters. 

No amount of gentle (or forceful) persuasion, bribery, creative presentation or talk about the nutritional benefits of food will convince a genuinely cautious eater to eat something that they don't feel comfortable with. In fact, research shows that trying to encourage children to eat can actually make their picky eating even worse.

Serving cautious eaters foods that they don't feel okay with in the hope that they will eventually get hungry enough to relent and eat something, can end in several terrifying days where children simply don't eat. This is deeply distressing both for them and for you. Not to mention dangerous.

It is so tough on parents when they don't know what their next move should be. We can deal with pretty much anything if we feel that we know what we need to do, and we have the support required to do it. There is nothing worse than that feeling that you know your child needs your help, but you've simply run out of ideas.

I understand this anxiety and desperation: The urge to feed and nourish our children is one of the strongest instincts a parent has, and to be honest, most of the parents who reach out to me are already at a very low point with their child's eating... sometimes things have to get to rock bottom in order to ignite a change. 

Help is at hand

I want to share an incredibly valuable strategy that I use in my clinical work when I feel that a child's picky eating is caused by a genuine fear of unfamiliar and disliked foods. It is all about laying the foundations for helping a child enjoy a varied diet, by teaching them to tolerate unfamiliarity. 

Before I get into what this strategy looks like, I want to explain a little bit about how anxiety can be be at the heart of a child's eating issues, because seeing your child's eating through this lens can be a complete game-changer.

Children can become anxious about food for many reasons:

• Perhaps they have sensory processing issues and their experience of eating certain food is so overwhelming to them that it is actually frightening
• Perhaps they have a naturally cautious and anxious temperament; for them, an unfamiliar food (just like an unfamiliar situation or person) can be really challenging
• Perhaps they have got into the habit of using their eating behaviours as a way of feeling in control. The idea of not being in control of their eating may be very scary as it takes a coping mechanism away from them
• Perhaps they are not used to being offered foods that they don't know and like. If parents consistently stop offering foods at the first signs of rejection, children quickly learn to fear the unfamiliar

This is not an exhaustive list of the reasons why a child may be anxious about disliked and unfamiliar foods. But it has a common theme: cautious eaters feel safe when their food is familiar and unsafe when it is not. If they are expected to eat foods which are not on their safe list, this is extremely anxiety-provoking. 

Laying the foundations for change: a 3 step approach to helping your cautious eater

1) Empathy. Before you can truly be there for your cautious eater, you need to try to understand how it feels to be in their little shoes.

It can be a bit of a shift of mindset to understand that your child's response to food is not 'bad behaviour' - that it doesn't necessarily fall into the categories of boundary testing or (developmentally normal) struggles for autonomy that run-of-the-mill picky eating can often be understood as.

Your child isn't trying to get attention, they are simply really, really scared of foods which are not on their safe list. Especially for children with an unusually high degree of sensory sensitivity, the experience of eating foods that are challenging in terms of taste, texture, appearance or smell, is just so intense.  

Many young children can't verbalise these fears. They may act out, and express their feelings through aggression or alternatively they may withdraw. The first thing you need to do in order to help them is acknowledge that their anxiety is very real indeed and is not a choice. Research is increasingly linking anxiety in children to eating struggles. However hard it may be to imagine being scared of the wrong brand of crackers - appreciating that your child's reactions  may be anxiety-driven can be very powerful.

2) Make sure that you have a good understanding of your role in relation to feeding your child. You may well already be familiar with Ellyn Satter's Division of Responsibility (DoR) model. If not, you can learn about it on the Ellyn Satter Institute website  where you will also find a very useful downloadable pdf about DoR. There are also lots of great articles written by feeding professionals about how DoR can help your family, like this article from Natalia Stasenko or this one by Sarah Remmer, which includes a fab kitchen printable. If you are more of a book worm than a blog reader, by Katja Leccisi, provides a great overview of how to understand your feeding role.

3) Teach your child to expect variation. This is the killer strategy that will make all the difference. You are seeing things from your child's perspective, you have educated yourself about your role in relation to feeding your child. But you are stuck, because your child will only accept a limited list of foods. 

You need to begin to teach your child to accept and expect the unfamiliar, in the context of their safe foods.

Much of my work with picky eaters draws heavily on cognitive behavioural therapeutic theory. Cognitive behavioural therapy (CBT) teaches us that if we avoid something we are scared of, that fear becomes stronger. If we confront our fear and manage to do something that is outside of our comfort zone, the fact that nothing catastrophic happened - it didn't give rise to a traumatic experience - tells our brain to produce a slightly smaller anxiety response next time that situation comes up.

A key aspect of successful exposure therapy is about making sure that you set people up to succeed and not fail. This makes sense if you thing about it; if you try something scary and find that the outcome is very upsetting because the goal was just not realistically achievable, you reinforce your urge to avoid that situation and your fear increases.

Setting your child up to succeed

You need to introduce variety in a way that will be manageable for your child and which they will not experience as intimidating. You do this by drawing up a list of their safe foods and devising teeny weeny baby changes to the foods on the list. These changes are not meant to be hidden from your child; we're not talking about sneaky changes that they may not notice as this erodes trust and will defeat the object.

The kind of baby steps I'm thinking of, are ones that your child will both notice and cope with. For example, if your they like plain pasta, take a pasta shape that you know they usually accept and cut it in two (when it's cooked... cutting dry pasta is no mean feat).

Combination and deconstruction

I use the twin concepts of 'combination' and 'deconstruction' as a jumping-off point for devising tiny changes to your child's safe foods. Combination is all about pairing two safe foods in a way that is new for your child, and deconstruction is literally about taking food apart and re-presenting it in a slightly altered form.

For this strategy to work, you need to understand that you have a lot of work to do before your child is even ready to try new or disliked foods, BUT that there is plenty of room for manoeuvre within the context of their safe foods. Some children will naturally be confident eaters, but cautious eaters need to learn food-confidence. And they need to learn it from within their comfort zone.

How this strategy works in practice 

At meals, introduce a tiny change to one of your child's safe foods. Don't draw attention to it, just make it available to your child. Don't praise them for eating it; this may increase pressure and fuel anxiety. Just remain focused on keeping your meals relaxed and upbeat. Perhaps initially try introducing change to their best meal of the day. For example, many picky eaters do best at breakfast - perhaps your child has toast. Cut it into fingers rather than squares. If they like raspberry jam, try sieving it before you put it on their toast so that the texture is very slightly different.

Laying the foundations for change (by helping your picky eater get used to unfamiliarity via constant tiny changes to their safe foods) will set the scene for the longer term task of introducing variety into their diet. It can take weeks - months even - for children to begin to feel comfortable with unfamiliarity. Introduce it at their pace, tune in to them and their responses.

You need to be patient, you need to be persistent and you need to be creative. Above all, you need to be in it for the long haul. But every time your child eats one of their safe foods in a new and different form,  you are inching incrementally closer to giving them a positive relationship with food that will last a lifetime.