Overcoming Anxiety at Mealtime

One of our biggest demons at mealtime is handling Alex's anxiety. The fear that embeds itself and stress it imposes makes eating a dreaded daily activity. Eating as a family is almost impossible for us as specific foods and smells cause him to gag and has at times caused vomiting. The constant panic that this is how every mealtime is going to go for him makes it so he doesn't want to try and forcing inclusion only makes matters worse making him want to exclude himself even more. Once we realized that anxiety was a primary cause of his struggles, trying to overcome that has become my primary goal. Anyone who lives with anxiety knows how hard it is to rise above those feelings of dread. We have a long way to go in our journey but there are several ways we have tried to help him with his battle and I wanted to share those with you here. Granted, what works for one may not work for all so don't be discouraged if you try one of our techniques and there are no positive results. And if you disagree with one of the methods we use with him, I respect that opinion and ask that you respect it as well. There is no need to parent shame anyone because in the end we are all just trying to help our children given the best tools at our disposal. You will hear me say this a lot; no one knows your child better then you do. You are your child's best advocate. Don't be discouraged by what others deem the "right way" to do something when it varies from what you think is best. As long as no physical or emotional harm is coming to the child, no one has a right to say their way is better then another. Now, that that's said, here's just a few ways we try to bring Alex peace of mind so he can eat with confidence.

Distraction technique. Most dealing with a mealtime monster will say that distraction is part of the problem because the child is more interested in the video or game than what they are eating. I feel that most professionals will tell you to keep all mealtime distractions to a minimum. No phones. No tablets. No television. For a while, I thought that too. But then I paid closer attention to his habits and realized that what might be the normal recommendation and work for most was NOT going to be the case for Alex.

Why? Well, the answer is simple. When Alex eats, he has a tendency to over analyze and will inspect his food with a fine tooth comb. Even foods he deems safe can turn a meal into a scary situation for him. If he doesn't have something to keep his attention, he is more likely to find fault with whatever we set in front of him. So for him, having his favorite show on TV or music video on his tablet is our best defense in keeping his safe foods safe.

The self-evaluation technique. For anyone dealing with a fear, regardless of what it is, understanding it is the first step to conquering it. Depending on the age you are dealing with, having a think sheet to work it out helps the person with the anxiety and those helping them with it can be a very useful tool. Why does it help? Sometimes when you are anxious you don't really understand why. The fear overwhelms and all rational thought is thrown out the window. You don't correlate your feelings and the symptoms that anxiety brings on. For Alex, anxiety causes upset stomachs and uncontrollable crying. Sometimes, physical aggression is also a piece of it as he wants to literally fight away the anxious feeling. By putting it down on paper, he is able to visualize his anxiety and better work through it on his own. For me, knowing what he's thinking as I see the signs pop up that he's anxious and knowing what he has identified as being helpful has been a game changer. It allows for earlier intervention and for us to minimize the negative impact each episode of anxiety has on his mental well-being. You can create something like this on your own as I made for Alex. I had created it as a way to help open up a dialogue between us to better understand his thought process and it's a useful tool to ake along with us to discuss the symptoms with his physicians. If you prefer to have one that has already been put together, I have made it available for others through my Etsy shop if you would like to try it with your own anxiety sufferer. You can find the one we use available here: https://www.etsy.com/listing/699560954/understanding-my-feelings-printable

Alex's Think Sheet

The no pressure technique. We have been told countless times, he'll eat when he's hungry. This always causes a mixed response from me. While I know most people mean well by what they say, we have had it where the advice giver is saying to take away his safe foods and in time he'll have no choice but to eat what the rest of the family is eating. "He won't starve himself," people will say. Eh, well, people, let me tell you something about my child. He will starve himself.

I know how bad that may sound. You must be thinking, "Wow, she has no faith in her child that he can overcome this." It's not that I don't have faith in him. It's just that I've watched him as he struggles daily with this monster, this demon, this unwelcome plague of fear... until he is able to work through his obstacles in a way that works for him, struggling with a severe eating disorder is not a matter of will power and who blinks first. His inability to regulate his thoughts and feelings surrounding food is not going to change just because I take away his safety net. All I end up doing in that case is invoke more fear and take away his trust in me making any effort I put forth that much more challenging for both of us. Now, I do agree with the statement that he'll eat when he's hungry as long as what is offered is a safe food. The majority of what he will consume requires no refrigeration or prep. His eating can take anywhere from 5 minutes for a "snack" versus a couple of hours for a "meal." (The reason for the air quotes is that his snacks and meals are exactly the same, it's just a matter of how hungry he is as to how we classify it.) We allow grazing in our house. This is another thing that some professionals would proably not recommend and if they are reading thins just cringing at the thought. They would say to enforce a strict mealtime where he eats with the family or not at all. So again, I would have to respond that knowing my child, he would sooner let himself starve. It's a harsh reality for him but let's take breakfast for example. His brothers and myself enjoy cereal for breakfast sometimes. The smell of cereal is overwhelming for him to the point he gags because of it. Forcing him to sit alongside us if he wants to eat breakfast while we enjoy a bowl of cereal is again going to cause too much undue stress and result in him skipping breakfast all together. So I have to beg the question, which is the right way to handle it in that case? Do I cause him more negative associations with food by forcing him to stay and eat with the rest of us or do I punish his brothers and forbid them to eat something that they enjoy just to bring Alex peace? (For those that answer the latter, his aversions don't stop at cereal so boycotting specific foods as a whole family isn't the answer.) Since his foods require no prep, he has his foods within reach for him at all times. If he's hungry, he never has to ask me to help or for permission to get a snack. I never want to discourage the act of eating. He already has so many negative connotations surrounding food, limiting his access to it doesn't encourage him to enjoy his meals. My goal is to increase his calorie intake by any means necessary. If that means that he eats alone because that's what HE is comfortable with, then so be it. He is ALWAYS welcome at our table and don't get me wrong, he DOES eat with us when he's comfortable in doing so. Going back to the distraction technique, that is usually key to giving him enough confidence to sit with us while we eat as a family. Fighting anxiety head on technique. We had a scare earlier this summer where Alex was over analyzing all of his crackers and refusing to eat the staple item in his diet. One afternoon, I decided we would take lunch outside. We sat there and I let him inspect each cracker. One by one he would take the cracker out and I had him tell me what he liked or didn't like about each one. If he liked it, he would eat it. That particular day, I think he only liked maybe 2 crackers out of the sleeves. For all the other crackers, after he told me what he hated about them I let him destory it by any means neccessary. If he wanted to crumble it, he was safe to do so. If he wanted to stomp on it, he was safe to do so. If he wanted to throw it in the street... well, you get my point. The key to the activity is knowing he was safe and it was okay to feel the way he does. This allowed him to visualize the fear and gave him control in releasing it.

Addressing his sensory needs. While fear is a big factor behind his eating challenges, so much of it also stems from the sensory processing disorder (SPD) he also struggles with. Kids with SPD don't have the ability to properly understand the world around them through the use of their senses. Simple things like the seam of a sock or the tag in a shirt can be overwhelming. This also translates to food. The texture of a grilled cheese sandwich or the smell of a corn dog may be way too much for their senses and in turn result in a meltdown or refusal to eat entirely. It's important that when you recognize any signs of SPD or autism, that their sensory needs are met so they can learn to self-regulate. Finding a good OT is a great place to start. I miss our OT days something fierce. For us, between insurance and financial restrictions we weren't able to stay in a program long. We were given invaluable tools while we were there including introducing us to the Wilbarger Protocal, sensory bins and other self-regulating tools. Spinbrushes for example are great for oral stimulation. When we first introduced Alex to a battery powered tooth brush, he would carry it every where. Kids with sensory issues often have poor oral sensory systems which contribute to their picky eating. By providing that oral stimulation, it awakens muscles and nerves in the mouth not otherwise used in a picky eater which may in turn bring about a change in behavior. He loved playing with the sensory bins in therapy and recently my husband made some for us to use at home many of which are made using food items. He went out and bought seven plastic shoe boxes and filled each with different textured materials including pinto beans, rice, dry pasta, jelly beans, water beads and cotton balls. (For more ideas on sensory bins, click here.) Using the sensory bins, we rotate between the different textures and hide some of his favorite toys for him to dig in and find. (Speaking from personal expierence, don't put a toy in there that has any small holes especially in the rice bin!) Sensory play involving food can be quite beneficial in building a positive association with the food as it builds their comfort level. For this reason, I also love having Alex help in the kitchen prepare meals as much as he can tolerate.

Alex with his twin brother Michael and Daddy proudly showing me his sensory bins.

Anxiety is something that I feel is always going to be present for Alex during mealtime no matter what kind of progress he's able to make. All we can do as parents is give them the support and the tools to someday fight this on their own. The best thing we can do for our children, is to give them the reassurance to know that we are in their corner. In order for them to feel in control of their own fears, we have to give them a safe place to conquer them.

May you always be your child's safe place.

The information provided here is based on my own research of the disorder and is not intended to diagnose or treat. I am just a mom trying to advocate for my son and not a health care professional. If the symptoms and risk factors seem to match what you are dealing with too, please follow up with your primary care physician to discuss things further. Do not attempt to treat without the guidance of a trusted medical professional.