Newsletter #149 for Internationally Adopting Parents
June 15, 2011
PAL Center Inc.

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Managing Eating Related Issues

Maria, a 6 year old recently adopted from Russia, has an aversion to eating anything - liquids or solids. According to her parents: "She drinks water and very little else on her own; when eating it takes perhaps 30 minutes for breakfast and maybe 30-40 minutes for dinner; she doesn't have many teeth in her mouth and gets very bored with eating. It's always a fight to make her eat, and invariably we end up feeding her at dinner. If there is no adult supervision she will not eat her school lunches and this leads to melt downs in the afternoon".

Sounds familiar? Such problems are likely a combination of medical and psychological issues, both rooted in pre-adoption experiences, often facilitated by inadequate parental techniques and overall situation in the adoptive family. The nature of such problems should be identified ruling out varies possibilities:

Ruling out medical issues:
The first step is to rule out (or to determine the significance of) physiological and neurological causes of Maria's feeding aversions through a thorough medical evaluation. A number of pediatricians participating in the AdoptMed discussion on this subject and familiar with orphanage children indicated that these children often have under-developed digestive systems as part of their developmental delay. After the age of 18 months, they are often fed with oversized spoons, the tongue is depressed forcing the food (porridges & pureed foods) to run down the throat without the child chewing and thus not releasing saliva and not "training" chewing muscles. As a result, at the age of 4 and 5 a child may be "tired" of chewing.

Next, it should be determined whether there are oro-motor issues present, e.g.: swallowing mechanism integrity, dental issues. This could be done by a qualified and experienced speech/feeding pathologist.

Ruling out sensory issues:
There is a lot of information on sensory problems of international adoptees on the Internet. A couple of sensible articles that we referenced in our Newsletters are:

• How to improve the feeding abilities of young adopted picky eaters
• Nutrition and the internationally adopted child: sensory and food issues

Working on psychological approach:
Several years post adoption is a long time to be struggling with this issue. Is your child malnourished or anemic? The child may be below the 5th percentile for her weight and height, but it can be due to her overall medical condition (ex.: FASD). Note also that food selectivity or food aversion are common in post-institutionalized children of different ages afflicted with PTSD as their hyper-arousal coping mechanism.

My understanding of the situation is that Maria definitely benefits from this behavior: this is her way of getting an overall control of the situation and total attention as she ends up being fed by the parents. Assuming that there are no medical issues that may cause food aversion and you are facing mostly psychological issue of control and attention, I suggest a simple behavior-based "common-sense" approach to address this problem:

1. Limit time for each food intake.
2. At the end of each meal food must be taken away and is not available for Maria until next meal.
3. The choice of food that is being served belongs to the parents but the amount of food eaten is the child's choice. In orphanage Maria was conditioned to "clean up the plate". Put a minimum food on her plate letting her know that "addition" is available upon asking.
4. No snacks - this rule is to be firmly reinforced.
5. The most important: do not make a "big deal" out of her eating habits or manners she demonstrates during meal time. Praise her for good eating, but ignore her "not eating". Again, she is not an anorexic or malnourished child and if she prefers not to eat at the moment, it should not be an upsetting or frustrating factor for you.
6. In school: in Maria's IEP a clear statement is to be made under the section of "School and Classroom Accommodations": A teacher aid or a teacher-in-charge is to supervise Maria's food intake during her lunch in the common dining area. A behavior modification plan can be written specifically for this person to implement an adequate control over her behavior during lunch time. More information on what and how can be done at school: Treating Feeding Difficulties in the School Environment
Boris Gindis Ph.D.

Sandra Lundberg
Healthy Discipline for Adopted Children
When you discipline your adopted child, you need to consider her chronological age as well as her emotional age.

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