Course Notes – John Whitwell
1.The purpose of this training
- To understand how and why food is emotionally significant.
- To use this knowledge in everyday caring situations towards providing therapeutic child care.
- To help children who clearly have emotional problems with food and feeding.
- To explore our own relationship to food.
2.The training is not about
- Nutrition and balanced diets.
- Eating disorders.
3. Examples from ISP carers which illustrate the problems their foster children had with food and how they worked on it.
“Having arrived in placement with paperwork showing a boy with a high level of behavioural problems, Susan and Terry feel that they have not yet seen the boy as described, although there may have been little glimpses. One of the issues that they have been working on has been that of overeating. James (10) would load excessive amounts of food on his plate and would be obsessive in ensuring he got a good oversized portion before all the food had been shared out. He also finds it hard to understand the concept of sharing food, for example; if he is in the supermarket with Susan and chooses a packet of biscuits he will then get upset if they are put in the communal biscuit tin and family members eat any. Susan and Terry understand that this may well relate to periods at home when food may have been scarce. They are sympathetic and understand that James worries, but have found strategies to make him feel more secure and reassured around food and this has resulted in him feeling more relaxed and he has also managed to lose some excess weight (by becoming more involved in sport).”
Example from a carer’s AHR
“Thomas came to us with big food issues. He told us that although there was always food in the freezer he couldn’t cook. He recalled eating frozen food, being dropped off in a play area for many hours without food or drink. Also an occasion when he was left with a weird character, in squalid conditions, who fed him rotting food that made him vomit.
The result of this was a very skinny drawn appearance. Thomas was suspicious of any food that didn’t come out of a frozen packet or tin. We’ll never forget the look of sheer horror and disgust when he first saw us feed our baby organic meat and vegetables. Whenever we were out he would panic saying, “when will we eat?”, even if we’d just had a cooked breakfast and he knew we were only out for two hours.
We responded by putting small portions of new (previously untried) food on Thomas’ plate and assuring him he didn’t have to eat it, but he might be missing out on something he really loved if he didn’t try it. Whenever we went out we would make sure we always took a variety of snacks and drinks and always said we’ve got cash if we need anything, so that he could enjoy the outing feeling secure and cared for.”
“Dan was an 11 year old who had very few life skills, if any, and had missed out on many infantile moments (ie, being cared for appropriately as an infant). Dan had not been nurtured and was incapable of doing anything for himself. Supervision was needed at all times. Dan was functioning at a much lower level than his chronological age. He seemed to behave more like a child of about 6 years of age. It became very apparent, days into the placement, that Dan could not eat with a knife and fork. It was also obvious that Dan did not know one food from another and was only really ever fed finger food. This related to the fact that Dan’s mother was anorexic and never cooked for the family. I had to teach Dan what each different type of food was called and encouraged him to try it. From the beginning I had to take Dan back to basics introducing new foods a little at a time, explaining to him that it was alright to leave the food if he didn’t like it. As a result Dan is no longer underweight, having put on 3 stone and he is a happy, healthy eater. Dan now loves food and enjoys eating out with the family. His is now capable of preparing simple snacks, eg, beans on toast.”
Dan has gone to Agricultural College. His allotment is very important.
4.Why is food and feeding so emotionally significant?
The following extract explains how the feeding of a baby in the first few months is a crucial part of the bonding and attachment process between mother and baby.
“How you are cared for in the first few weeks and months of life affects the way you come to care about yourself for the rest of your life. It is not the only factor that influences how each and every one of us develops, but it is always significant.
A baby cries for his mother, for food or warmth. At first the baby isn’t sure if mum will come, but she does, and when this is repeated an endless number of times, the baby builds up a picture in his mind of a mother who feeds him, looks after him, tries to understand him and keep him warm both physically and emotionally. The baby gradually builds up a resilient picture in his mind that if mum isn’t here, she is just over there.
When mother can be confidently expected to come back soon, waiting isn’t too difficult and the baby has a reassuring experience that mum can be depended upon and that painful feelings can be managed without becoming absolutely overwhelming.”
“The emotional needs of young children” by Maggie Fagan
5.Being fed in those first few months of life is fundamentally linked with making an attachment to the mother (or mother substitute).
It is how we achieve “basic trust” (rather than mistrust). This happens through the infant feeling (built up over time) that she can depend on her parents’ intentions, their preoccupation with her, being tuned into her needs, and gain confidence that she will be reliably taken care of. Reliability is key. For trust to be established the carer has to be trustworthy. Consistency and reliability are important attributes of trustworthiness.
6. I will read an extract from a paper, “Hoarding Food: Hungry for Security” by Charley Joyce and Rick Delaney.
“…Not only is food a necessary source of life for the infant, but it is an important vehicle for emotional bonding, the development of language and social interaction….. When a six month old cries for their bottle, and the parent responds with cuddling the infant and feeding him, they are fulfilling the basic need of providing food in response to hunger, developing attachment through nurturing, and developing trust through a predictable [reliable] response…..So what happens if the child is cared for in a setting where the parent is negligent? At a minimum, the child is forced to become prematurely self-reliant in meeting their own basic needs. For example, in a situation where the parent is severely chemically addicted and as a result is inconsistent in their providing meals and having food available, it would be reasonable that when food is available that a child would see this as an opportunity. It would be logical that the child would respond to the availability of food in self-reliant ways, which could include over-eating, and hoarding food in secretive ways.”
7. It is crucial that the baby experiences their physical needs being met with loving care, as opposed to indifference or emotional coldness.
Being fed with loving care is one of the main physical needs.
Here, the idea of the complete experience is important.
Feeling hungry and anxious → being fed → contentment. This cycle being repeated many times helps to build trust and resilience.
8. Mothers instinctively adapt to the individual nuances in each of their children. We call these adaptations
Within the routines and structure of family life it is one way that a child can feel they are special and although it is “fair “ that all the children are equally well thought of, they are also special in their own way and this is recognised through adaptations (usually quite small) to their care.
For example, our youngest granddaughter, when she was 4 years old, relied on the pudding at Sunday dinner being apple crumble. If we fancied a change we had to ensure that she had her own small apple crumble. As a 7 year old she now happily tries different puddings.
This helps to develop the self-esteem of the child – Mum really cares about me, she knows what I like. The opposite of this is institutional care – fairness being defined as everyone treated in exactly the same way.
9. It is important for adults to understand their hang-ups around food. Fostered children may press buttons. Birth children may also press buttons!
10. Regular, good feeding experiences as a child → an enjoyment of food and eating experiences with others throughout life.
As children grow up they will get involved with food in different ways, for example helping in the kitchen [eating the cake mix before it goes in the oven!], helping to set the table, washing up and shopping. Initially, participation in the kitchen will be playful. The same sort of process may occur in the garden → growing vegetables. [Boom in allotments.]
11. I will read you an extract from a paper, “Kitchen Therapy” by Judith Issroff (Child Psychotherapist).
This concerns an 8 year old boy’s therapy which moved to the therapist’s kitchen.
“From my experience in various institutions and schools for maladjusted children, I already knew that the cook was generally one of the most centrally significant figures in such holding and therapeutically orientated settings. In certain units, such as for deprived and mildly retarded adolescents [moderate learning difficulty], merely learning how to cook basic things, learning to clean and prepare vegetables can be useful and therapeutic.
That Aron’s (age 8) problems stemmed from….early infancy, and that he missed out on significant and crucial feeding and socialising experiences with his mother at that period, was clear from his history…….
Aron came with his sandwiches, and whilst he painted or modelled with deep concentration and gusto, he certainly and expectedly messed beyond the area that I could protect. I did not mind cleaning up, but when he arrived with his penknife and began to dig beyond plasticine and modelling clay at carpet and furniture,…….., I suggested to him that we go down to my kitchen and I would give him a real knife and some real vegetables to cut up and we could make some soup and eat it. Of course, he accepted my suggestion with enthusiasm, and we proceeded to my kitchen – to my great relief![This is an experienced therapist thinking on her feet.]
The next session he arrived burdened under and beaming happily round a huge carton of assorted instant packaged soups to be added to his treatment box. For the following three years, as he talked about his activities, problems, achievements and dreams and reacted to my comments, he busily chopped vegetables and spices, which we added to diverse packaged instant soups, creating and devouring a new realm in heavily and often exotically flavoured soups. Sometimes as they were cooking, we would still draw or paint or work with plasticine or build a model. He planned a future for himself: he was going to become an architect (build himself a better – designed mother – environment) and he was going to run “a souperie”. Clearly we had internalised a spillover of care-giving behaviour.
Whilst Aron had spoken seldom during his analysis prior to our moving to the kitchen he now began to tell me things and to talk freely after a relatively short period of working diligently at chopping, mastering and sublimating aggressive cutting and biting. ……. It seemed that this concrete catering to his needs, including his sadistic ones, led to basic changes in improving his ability to trust, allowing for the establishment of real bonding and the dawning of shared play which overlapped with real work, all within the treatment alliance.
Simultaneously with the onset of moving to the kitchen, Aron’s mother reported a marked improvement in his behaviour towards his siblings at home. He fought less with them and to her surprise, began to busy himself in their kitchen, preparing soups (!), salads and omelettes and, later, cakes from recipe books he bought with his pocket money.
……As his ability to enjoy (joint), self-supplied food developed, his facial expression became more relaxed, less grim, and his sense of humour began to develop along with playfulness and an improvement in behaviour at school as well as increased capacity to learn and to get on with other children – all….signs of improvement in the direction of healthy living.
Also the messing together and clearing-up after, which was never demanded of him but spontaneously became part of the fun that we shared during his sessions, helped him to play with, to express, to enjoy and to master previously problematic matters in urinary and anal areas [his incontinence], largely due to his mother’s anxieties around these issues.
It is suggested that other children who have suffered deprivation of basic first year-of-life experiences which has delayed their development might benefit from such real catering to basic needs, by cooking and eating during treatment.”
“Kitchen Therapy” Judith Issroff | (Winnicott Studies No 7, Spring 1993)
12. This playful involvement in food preparation, cleaning up afterwards, growing things and shopping is a wonderful foundation for the time when a young person has to look after themselves.[It is all too easy to get into the frame of mind that it is too much trouble and it is simpler to keep children out of the kitchen. But….]
13. Children placed with ISP are likely to have had neglectful experiences regarding food, and disturbed attachment to their carers.
This next example from an actual case history illustrates neglect and the impact on relationships.
Gavin weighed 8lbs when he was born. It was an uncomplicated pregnancy and birth for both mother and baby. At 2 months he was referred to the GP for failure to gain weight – he was then 6.5lbs. On examination he was starving and hungry with a dry mouth. The doctor diagnosed marasmus (emaciation through starvation) and associated management problems and Gavin was admitted to hospital. There he gained weight rapidly and presented no other problems. A parental management problem was diagnosed.
At 18 months Gavin was again referred to the GP for failure to gain weight and, despite close supervision from the health visitor and GP, it was decided to readmit Gavin to hospital. The hospital felt that he was simply not being fed and was in a starved condition. Again he gained weight rapidly but was discharged by the parents against medical advice. The hospital summarised Gavin’s condition as not being fed, probably neglected and largely rejected by his mother.
A third admission to hospital was made when Gavin was nearly 3 years old. He weighed only 20.5lbs and was quite passive. He rapidly became more active during his stay, putting on 3lbs in 3 days.
When he was 3 years old he was placed ‘in care’ with foster parents where he improved in all areas, beginning to walk successfully and to play well. He was described as a strong personality with a temper when frustrated. On leaving this placement for adoption the foster parents thought him lively and attractive and were amazed at his lack of disturbance considering his years of deprivation. Inevitably, this emerged later. Gavin was adopted by Mr and Mrs D who had already successfully adopted another child. Gavin continued to make rapid progress, catching up with all his milestones.
14. This next example is from a children’s home and clearly had an impact on the staff team.
When ‘Mark’ arrived at Abington House he was unable to accept food from the staff group and found it intimidating to eat with others. We knew Mark has spent his first three years strapped into a car seat, had been fed Calpol to subdue him, and had watched his mother feeding the other siblings. We began by simply setting his place at the table but he forcefully rejected, ignored and spat at offers to eat with the group, continuing to binge on chocolates and jam, raid the fridge at night, and sometimes accuse staff members of plotting to poison him. The issue became a battle as adults tried to coax Mark in and help him accept a healthier diet. Mark’s rejection seemed pointed in such a small setting and it became frustrating as he became less and less healthy and more withdrawn. After months of discussion, observation and beginning to understand some of his difficulties – how food had been used to punish him in the past, how attacked he felt by our offers of care – the strategy we needed became clearer. For several weeks we provided him with his own cupboard with Pot Noodles, which he could prepare himself and eat where he liked. His place was still laid at the table and he was always quietly invited to join everyone. He chose however to prepare his noodles and eat alone. Gradually, as he sidled past, he occasionally took up the invitation and chose to half sit on a chair with the group and perhaps share a bought cake for pudding. This progressed and he eventually became able to add food from the serving dishes to his noodles and by the end of his stay would join the group mealtimes. This was a significant development for someone who had found this area so difficult.
15. Let’s examine some of the different fears and anxieties about food.
- a) There won’t be enough to go round. This is linked to an inability to share. This anxiety can lead to disruption at mealtimes because of the fear that there isn’t enough.
Answer: Individually prepared helpings until a child is ready to share (individual pies, individual buns rather than slices from a large cake, whole eggs rather than scrambled).
- b) Food is rubbish, boring, uninteresting grey matter. This can lead to indiscriminate overeating (shovelling it in without pleasure) or eating very little.
Answer: Rekindle excitement about food through finding a “special” food, which only that child will have. The excitement we are looking for is that experienced by small children before they can talk. This excitement has been lost, usually through unreliability, and needs to be found. For example, the special food for a boy I looked after was mushrooms. Once a week I cooked him a bowlful which he had for himself. This was not just about food but was also about developing the relationship. It brought us closer together, proving that I really thought about his needs.
- c) Food is shit. It’s been poisoned, spoilt, ruined. Some neglected children struggle to cope with freshly prepared meals, believing it has to be out of a packet or tin to be pure, uncontaminated.
Answer: Involve the child in the kitchen. Let them see what’s going on. Have special cooking times when grownups and child have a regular time in the kitchen together cooking things the child particularly likes: popcorn, cakes, pancakes, fudge etc. This will also develop the relationships and build upon trust. Whatever is cooked by the child doesn’t have to be shared. (Think back to the “kitchen therapy” example.)
- d) Food regularly stolen.
Answer: Make food available whenever the child feels hungry. It doesn’t have to be elaborate – bread and jam will do.
- Have a spares tin which the child can go to whenever he feels hungry (he doesn’t have to ask).
- Keep a fruit bowl stocked.
- Keep a tin stocked with food which can be kept in their room.
Here is how a therapeutic community tackled the problem of stealing food in their community.
One night the food store behind the kitchen was broken into. No one admitted to this in the Morning Meeting. The locks were increased but the door was broken down nightly; it was lined with steel, but was then totally removed – frame, and all – from the wall itself. We then experienced one momentous Community Meeting. Someone said hesitantly that when he burgled houses he always cooked himself a meal. Apparently this was a common activity. He spoke of having wrecked the kitchen, excreted on the carpet. Yet, after a couple of Meetings of hysterically recounting such exploits, the group began to sober up. They began to view their behaviour more realistically as bizarre and puzzling. The discussion moved forwards. Boys began to talk of their own homes, of material hardship, of depressed mother who did not cook, with stories of being packed off to buy chips, and then for the first time some expression of their sense of depression about the lack of comfort or standard of care implied by those poor feeding situations so many had experience.
Our experienced psychiatrist was able intuitively to suggest the answer. She proposed that we should set a table up at one end of the dining room. It would have bread and butter, jam, tea and milk and sugar. It would have an electric kettle and mugs, and it would be available day and night. In exchange, it was agreed that the food store would be locked at night and it was not broken into again, not for several years.
The boys’ behavioural message had – at its simplest – told us that they felt desperately deprived and also enraged. The physical response of providing actual food and drink in a particular place was most importantly a symbol. Everyone knew that the issue was not physical hunger but emotional hunger.
16. Hoarding and stealing are closely associated.
“Why does a child steal food from us? Why can’t the child get over it? Why does the child not ask for food instead of taking it on the sly? Why does the child doubt us when we say there will always be enough to go around?”
The short answer is neglect. The child feels insecure, unworthy of care, and lacking in a sense of partnership with [carers].
Strategies for overcoming stealing and hoarding food.
– food baskets
– flexible rules about food
– coupling nurturing with food
– bedtime rituals involving food snacks
The food basket consists of snacks that are healthy and that also appeal to the child. It’s important that the child has a say in the food items in the baskets, although not at the complete expense of healthy eating.
Explanation to the child is important. This should include clarification that food can be taken from the basked whenever the child is hungry.
What do the food baskets achieve?
– they reduce anxiety surrounding starvation through visual, consistent availability of food.
– the openness created through the use of them eliminating food, and self-feeding, as a secret, solitary activity.
– they positively interrupt hoarding as a primary strategy of survival for the child.
Flexible rules on food.
It is common for adults to have learned rules regarding food such as: no snacks between meals; finish everything on your plate; no eating before mealtimes and eat only in the kitchen. Many of us also had pleasant rituals inclusive of food such as birthday cakes, special foods for holidays, ice cream cones or other treats during special occasions and some special treat that grandma would make for us. There is nothing wrong with the food rules mentioned and the rituals are generally very pleasant memories. But none of these rules or rituals was associated with deprivation and the neglect of food which threatened our survival as a child. Before a child that hoards food will be able to respect a foster family’s rules regarding food, they first must have repetitive proof that their basic need for food will be met. This doesn’t mean that a foster family throws all their “food rules” out the window. However, it challenges a foster family to rethink their rules.
Coupling nurturing with food.
When you see the child that hoards using the food basket or backpack or food in a healthy way, offer some appropriate nurturing. At those times, tell the child how you like having them in your house, recognise something special about them or give them an appropriate expression of physical attention. This enables the child to feel good because an adult cares in addition to the availability of food.
With pre-teen looked-after children, a bedtime ritual where the foster parent spends some time reinforcing the child can be a rewarding experienced. The ritual may include a snack, a bedtime story, but most importantly a conversation directed by the foster parent about the special things that the child has displayed during the day. The conversation can also include a “things that could go better”, but this portion of the conversation should be minimal in comparison to what the child did well.
17. Contrasting difficulties with eating between children on the autistic spectrum and those with attachment problems.
|Present in both autism & attachment problems||Typical presentation in ASD||Typical presentation in Attachment Problems|
|Difficulties with eating||May limit foods eaten according to unusual criteria such as texture, shape, colour, make, situation, rather than what the food is (eg will eat chicken nuggets but no other chicken)||Anxious about the provision of food and may over-eat (or try to) if unlimited food is available|
|May adjust eating because of literal understanding of healthy eating messages (eg sell-by dates, avoidance of fat)||May be unable to eat when anxious|
|Restricted diet seems to be about maintaining sameness and the child is not easily encouraged by people the child is attached to||May hoard food but not eat it|
|May eat inedible substances||May be unable to eat much at a sitting|
|May ‘crave’ foods high in carbohydrate|
|Eating is transferable from situation to situation and the child can be persuaded by close adults|
|Children tend to have a range of eating disorders|
“Problems with eating are often mentioned in referrals for both groups of children with temper tantrums and rigid, obsessive behaviours around eating. However, careful elaboration of the nature of these problems showed considerable differences in how, when and where they occurred. The problems related to eating in children on the autism spectrum were often about the strong preferences related to physical sensations (such as texture and taste), the way food is organised on the plate, or its place in the child’s daily routine. Problems with food were pervasive, occurring wherever the child was invited to eat, regardless of who was offering the food and where it was being eaten. Denial of offered food seemed to be related to taste and texture preference and not who was offering it. In contrast, for children with attachment problems, the provision of food often had strong emotional significance and was associated with relationships. Problems were most evident in relation to parents or carers, with more typical eating habits in situations with other adults. Parents and carers often reported concerns about abstinence and gorging and these behaviours tended to be associated with deliberate (and planned) deceit such as throwing or giving away food, or hiding food and wrappers. Denial of offered food seemed to be with the intention of emotional hurt or emotional defense, something which requires an understanding of emotional relationships. The devil was in the detail: differences between the two groups were considerable, even though the headline in referrals could be ‘obsessive and rigid patterns of eating behaviour’.”
Heather Moran from the paper “Clinical observations of the differences between children on the autistic spectrum and those with attachment problems: the Coventry Grid”.
(Good Autism Practice 26.10.10)
Culture and Food
Rituals and Routines
“Families have many rituals and ways of doing things that can be quite perplexing for children coming into the family. Not knowing these rituals can make the children feel like outsiders, that they don’t belong. Time spent helping your child to understand ‘how we do things here’ can help him adapt and fit into your family.
Many rituals develop out of our awareness. We are not aware that we do things in a certain order, or follow a certain routine. Others may be more explicit. We sit together and share a pizza and a video on Friday evenings, for example. Helping children to understand these rituals can help them to feel a part of the routine. These consistent routines also help the child to feel more secure, and life to be more predictable.
Carers need to be aware that some of the routines they take for granted may appear quite bizarre to the child. Taking a shower every day, sitting down to eat meals at the table, even sleeping in a bed and having a consistent bedtime can be very perplexing for a child who hasn’t had this experience.
Children need to be helped to understand and enjoy rituals and routines that are already in place within the family. It can also feel good to be part of creating new routines. This can help children to feel not just that they are fitting in but that they have some influence over how the family is developing.”
Extract from, “Nurturing Attachments. Supporting Children who are Fostered or Adopted”, Kim S Golding
19. Routines, rituals, expectations in each family.
Things we take for granted but which seem strange to a newcomer. Smell can be important. Family homes have a distinct smell. A newcomer may find this a bit off-putting initially.
20. Celebrations using food.
In ISP we have “Thursday lunches”, originally set up as a way of caring for carers. Still important. This is an account of the origins of American Thanksgiving.
“The American festival of Thanksgiving was first celebrated in November 1621 in the tiny colony of Plymouth, Massachusetts. A small group of protestant dissenters, the Pilgrims, had arrived in December 1620 seeking to build a new life of religious freedom in the New World. Their tiny ship, the Mayflower, en route for the colony of Jamestown in Virginia, was blown off course by gales and landed in mid-winter on the cold and inhospitable shore of what is now Massachusetts. The Pilgrims survived that first winter through the help of the Native American people who befriended them, and showed them which of the unknown plants were good to eat. After the successful harvest the following year, the English settlers held a feast to give thanks for the harvested food which would see them through the coming winter, for their survival during their first terrible months, for their safe arrival in the new land of religious freedom, and for the friendship of the native peoples who had helped them. At the first Thanksgiving feast the Pilgrims ate the foods which the Native Americans had shown them: turkey, pumpkins, corn, sweet potatoes and cranberries. Legends say that the native people also showed the Pilgrims how to bury a fish with the corn seed when planting in the spring to fertilize the soil, and also how to make popcorn!
Thanksgiving is more than a harvest festival, although harvest is one of its main themes. It is also about a new beginning in a new homeland. The symbolic foods give a picture of new sources of nourishment, brought through a relationship with new people.
My own family, like the families of many other Americans, is of mixed heritage. My father’s ancestors arrived from England as early as 1643. My mother’s family were Russian and Polish Jews. Our family celebration of Thanksgiving was linked to gratitude for their safe arrival in America and for the freedom of religious expression. My mother always cooked the traditional Thanksgiving foods according to Polish-Jewish recipes, as her mother and grandmothers had done. And like them, our table always includes strangers and outsiders, people who had no home or family of their own. For this festival is surely about friendship, family, and hope!”
Extract from, “Festivals Together – A Guide to Multi-cultural Celebration”, Sue Fitzjohn, Minda Weston, Judy Large.
If nothing else, I hope you will take away, remember and implement the following points:
- That feeding is inextricably linked with attachment formation.
- That we are all likely to have some food or feeding hang-ups linked to our childhood experiences. It is better to be aware of them.
- Children who have been neglected as infants will mistrust carer’s capacity to reliably look after them, which includes feeding.
- Try to avoid battles around food. Be flexible and creative.
- Children will often respond positively to having something “special”.