From lunchbox woes to lunchbox heroes

Like many other autistic children, Emily* often finds it hard to get food into her tummy. Her sensory processing difference is the main culprit, though anxiety and other factors also play a role. Like many of her neurodivergent peers, Emily has a short list of ‘safe’ foods, and smelling, tasting, or even touching other foods feels really stressful for her. The clinical term for Emily’s condition is “Avoidant Restrictive Food Intake Disorder”, or “ARFID”, which essentially means that Emily will only eat a small number of foods from her safe list, and there are times when she won’t even do that. Emily’s parents navigate her condition as best they can at home, but when Emily started school, things got more complicated.

Many of us have been on the receiving end of well-intentioned but uninformed comments about our children’s lunchboxes. In an ideal scenario, we’d pack a rainbow of nutritionally balanced foods and our children would eat them. Instead, we send the same ‘safe’ foods each day, with no guarantee they’ll even be touched, and they’re often foods that many would deem unhealthy. Some schools try to restrict lunchbox contents to a list of approved ‘healthy’ foods, but for kids like Emily, this can be really harmful. When teachers say, “Eat your sandwich first,” or “Oreos are too unhealthy for school, so please don’t bring them again,” Emily is likely to simply not eat. Her food anxiety spikes, school refusal can emerge, her relationship with food worsens, and she experiences guilt, shame, and embarrassment.

As a paediatric dietitian who specialises in feeding therapy for children like Emily, I’m far too familiar with the lunchbox woes my clients face every day. As the mum to my own “Emily”, I also know how hard it is to fight this battle continually. From both a clinical and personal perspective, we now know that Responsive Feeding can work wonders for kids like Emily, and it’s based around eight key principles:

• Feeling safe and regulated
• Internal motivation
• Autonomy
• Skill and competence
• All behaviour makes sense
• Attachment and connection
• Mealtimes are more than just food
• Health is broader than just what you eat.

Many of us come from generations that only knew how to use behavioural strategies to create compliance. Rewards and praise (sticker charts and prizes), negative reinforcement (no dessert until you’ve eaten all your peas), and escape extinction (stay at the table until everything is eaten), are the most common. Unfortunately, they’re also the most detrimental, especially for kids like Emily. We now know that for Emily to be able to eat, she first needs to feel safe, calm, and in control. She needs her own internal motivation, that feeling of wanting to eat, and behavioural strategies take this away.

Emily has the right to choose what and how much to eat, and as parents of our own Emily, we need to follow a division of responsibility that supports this. It’s our job to decide what food is available and when, and it’s Emily’s job to decide what and how much she’ll eat from what’s on offer. Kids do well when they can, so it can really pay to dig deeper into why our child is restricting their food intake.

Mealtimes are about more than just food, and so is overall health. When we cast our nets further than just “eating for physical sustenance”, we discover family, culture, connection, socialising, and mental, spiritual, and emotional wellbeing. All of these factors contribute to a child’s ability to eat, and when they’re not being nurtured, our child’s food intake is likely to suffer.

RESPONSIVE FEEDING AT SCHOOL

Knowing that kids like Emily need a Responsive Feeding approach instead of a behavioural one, how can we navigate school mealtimes when we’re not there to educate staff and/or advocate for our children’s needs.

KEEP SCHOOL IN THE LOOP

As parents and caregivers, it’s our responsibility to ensure that school staff understand our child’s food-related
needs. Your school likely already has accommodations and documentation in place, such as a personalised support plan, and if feeding is a challenge for your child, it needs to be explained and included. Be specific when educating your school about Responsive Feeding and what that should look like for your child. List the “dos” and “do-nots”, and make sure they are well documented.

GET THE KIDS INVOLVED

Encourage your child to be involved in packing their lunch, as much as they are able to. This reinforces the division of responsibility, gives your child autonomy, improves their skills and competence, and keeps you in the loop with their current needs and wants.

COMMUNICATION CARDS

While I have created official “Dr Rachel/Fun Family Food” lunchbox communication cards (which you can access at – fun-family-food.kit.com/products/mlr-communication-cards), the principle can still be implemented without them. These are laminated cards that go inside your child’s lunchbox and communicate on your, or your health practitioner’s, behalf. The cards might say things like, “I have a disability that affects my eating, and I do well when I am allowed to choose what and how much I eat,” or “Please refer to my personalised support plan to learn how to support my eating needs at school.” They take the responsibility off your child, educate staff about your child’s needs, and help maintain Responsive Feeding at school.

When it comes to restricted eating, feeling safe, secure, and in control is the most important thing. Anything we can do to support this at school can help our children gradually overcome their feeding challenges and blossom into happy, healthy adults.

*EMILY IS A FICTIONAL CHILD WHO REPRESENTS MANY OF THE CLIENTS I SUPPORT IN MY PRACTICE. 

Dr Rachel supports families in her Responsive Feeding practice Fun Family Food. She has a free Facebook group called “Dr Rachel’s Feeding Kitchen for Neurodivergent Families’ which is a safe, supportive space for all families with complex feeding journeys. You can follow Rachel on social media at @dr.rachelfeedingkids and learn more at funfamilyfood.com.au