March is Nutrition Month. This year’s theme focuses on making small changes.

As a registered dietitian working at the Janeway Children’s Health and Rehabilitation Centre, one of the most common referrals that comes across my desk is of children with limited or restricted intake, sometimes labeled as picky eating.

For most people, changing the type of food or way we prepare food seems like an easy task. We may change what we eat based on our mood, our preference, a holiday or celebration, or if we feel the need to eat more or less of a food for health reasons. When we make small changes in our eating or eating habits, they are more likely to be effective – and last longer.

For others, especially children, changing food intake is not so easy.

Imagine feeling anxiety at the sight of a new food. Imagine not knowing how to chew or move food around in your mouth. Imagine being so overwhelmed with the smell of food that you have to leave the room or building. Imagine only eating the same 10 foods over and over each day.

Child enjoying vegetables

Eating is not as simple as we think. Most of us think of eating as putting food in our mouth, chewing and swallowing. In reality, eating is the most difficult sensory task a child has to do – it consists of 32 small steps!

When children attend school, their learning is enhanced by being consistently exposed to different concepts, such as letters, numbers or the same way of doing a math equation. Children grow, learn, and develop so quickly that if their food intake is limited from an early age due to food avoidance or fear, their exposure and learning about new foods becomes difficult. They may not fully experience the steps to eating, and any new food can quickly become something a child will avoid.

Children and food: A real struggle

Eating and good nutrition are so very important in overall health and development in a growing child that limited or picky eating can become very stressful and worrisome for parents and children alike.

Parents often feel extremely frustrated because mealtimes can be a daily reminder that their child is not eating the variety or amounts of foods they need.

Food school for picky eating

(l-r) Kim Winter, speech language pathologist, mother Joanna Tucker with child, Rebecca Tucker, and Aiden Greene, food school students

In 2015, Eastern Health established a ‘food school’ where some children and parents can learn the properties of foods via: food play, repeat exposure and routine. Occupational therapists, a speech language pathologist, and I, a registered dietitian, are part of the school staff team.

Our school helps children experience food using very small steps that aim to desensitize the newness of seeing, interacting with, touching, smelling, or tasting a new food over time. Our school is guided by a foundation of principles and knowledge about children’s physical, cognitive and sensory development, as well as by the division of responsibility. That is, we recognize that parents and children have their own jobs when it comes to food provision and eating.

A parent’s job is to choose and prepare a variety of foods for meals and snacks. A child’s job is to choose what and how much food they will eat from what is offered.

Parents often feel the need to get their child to eat or feel stressed when their child doesn’t eat enough of a particular food or meal. This can lead to pressure and an expectation to eat.

What we do

Children and their parents attend food school groups so they can learn from others while having fun with food. We guide the children in how they can interact with, look at, touch, smell, or taste the food without feeling any pressure to eat. Food play and exploration are incorporated for each child based on their ability to make the next small step in accepting a food. We work with parents so they too can become food school teachers at home. Food is the subject and the table is the classroom – and there is no expectation to eat. Parents are taught how to help children make small steps, which over time will improve their food acceptance and intake. The key is to remember to offer a variety of foods so that children have some familiar and preferred foods, along with some new or non-preferred foods!

Food play

(l-r) Cindy Penney, occupational therapist, and a food school student exploring food!

Food play can be a safe means for many children experiencing difficulty with foods. Learning about food can be fun without having to eat it. Some examples include: helping to bake or prepare a meal; using veggie sticks to make train tracks or letters and shapes; using pudding or yogurt to finger paint, examining the inside of a vegetable and discovering the shape, colour, smell and texture.

Being a food scientist is another approach used in our school. The goal is to interact with the food, and explore the properties of it by using our senses.

Food school a success

(l-r) A food school student and Sarah Chapman, registered dietitian with Eastern Health

Our food school has run through its first 12-week semester and is now preparing to start another session.

What’s more, our first semester received great reviews from participants! One hundred per cent of parents reported that our approach allowed their child to have a positive experience with food, and almost all parents reported that the school helped them create a feeding program at home.

After completion, most of the children showed improvements in how likely they were to touch, smell, taste, and eat food during the group session.

Grace Chapman enjoying food!

In addition to our food school, as health-care professionals, we are also incorporating similar concepts into many of our interactions with children and families in smaller or individual appointment settings. While most of us try to make changes in hopes to better our health through nutrition and healthy eating, during Nutrition Month, remember to start with small changes!

If you would like to learn more about Eastern Health’s Food School program, please contact Sarah Chapman via email at sarah.chapman@easternhealth.ca. ■

This story was written by Sarah Chapman, a registered dietitian with Eastern Health.