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Exposures at any cost?

In this post, we want to share a few warnings about how children are exposed to new and disliked foods. There is a lot of research on the value of exposure. We know that children who are avoidant eaters often consider something not on their ‘accepted list’ to be way out of their league. This is magnified when they are never around that food, perhaps because they don’t eat with their parents or are only given plated accepted foods.

To a child who is only comfortable eating crackers and fruit puree pouches, the thought of eating a carrot can be a bit like me contemplating signing up for a marathon when, quite frankly, just running around the block kills me. But by exposing the child to carrot, by ensuring they see others eating and enjoying carrot, we are able to gently shift their psychological framing of carrot from “this s***t is not edible” to “one day I may feel curious about that”. 

Exposure is especially important when children hit a naturally neophobic phase in early toddlerhood. This is when they decide that anything not ultra familiar is not to be trusted. That moment where many typically developing kids move from the nine month old who will try anything to the fourteen-month-old who declares “no!” because you put a little mashed banana in her porridge. If you can calmly navigate this phase, gently ensuring that your toddler is around a wide variety of foods (liked and disliked), chances are they will find their way back to enjoying a varied diet in their own time. 

So if exposure is so great, why the warnings? Well – all exposures are not created equal. We teach a responsive approach to feeding where children are given total control over how they interact with food and whether they decide to eat or engage with what is offered. Some types of exposure can be very damaging to a child’s relationship with food, others can be very supportive. But as a parent, how do you tell the difference? You read everywhere that exposures are important, so surely this is just a given – a key goal for parents of ‘picky eaters’? To help you navigate this minefield, we’ve created a list of responsive and non-responsive exposures: 

Types of responsive exposures

  • Being around a food during meals, without any pressure to try or even interact with it
  • Seeing trusted adults eating a food
  • Being around peers (e.g. at daycare) who are eating a food
  • Cooking with adults (with zero expectation that they will eat or try the end result!)
  • Growing vegetables
  • Picking fruit
  • Being around non-accepted foods in many forms (grated apple, apple slices, whole apple…)
  • Food play activities that a child enjoys, e.g. making potato prints
  • Learning about where different foods come from and how they grow
  • Sensory activities away from meals, where the child is having fun and taking the lead
  • Being allowed to be curious about non-accepted foods without pressure to try them 

Types of non-responsive exposures

  • Telling a child to interact with a food in a certain way during meals, e.g. “lick it”
  • Making anything (dessert, more chicken, TV time…) conditional on how the child interacted with food “smell a strawberry then you can get down”
  • Making a child have a certain food on their plate
  • Insisting on a ‘no thank you bite’
  • Food play where the adult pushes the child to do something rather than setting up an activity and letting the child lead
  • Not hearing a child’s “no”. “Go on, just touch it”
  • Incentive systems like sticker charts connected to food exposures
  • Adult-initiated food play during meals 

Let’s look at how the same scenario can quickly shift from responsive to non-responsive. Anya is five and does not like peas. One day though, she shows an interest in the bowl of peas on the table.

Responsive

Anya: “Peas look like little balls! They are funny”

Dad: “Yes they do! *takes a pea in his fingers and holds it close as if to inspect it* “This pea is a teeny green ball!” *pops it into his mouth*.  When I was a boy, your Grandma grew peas and we used to sit for hours shelling them for dinner. 

Non-responsive

Anya: “Peas look like little balls! They are funny”

Dad: “Yes! Why don’t you try one? Peas taste good and they are full of vitamins”

Anya: “No, they taste weird”. 

Dad: “Ok, just lick the pea, then. They actually taste sweet! You’ll see. Just take a little lick”

This second scene is not an obvious force-feeding scenario. It looks like a playful, even gentle interaction. It is superficially child-led. After all, Anya showed an interest in the pea in the first place. But because Dad – driven by his anxiety about the lack of vegetables in Anya’s diet and his belief in the value of exposure – used it as a springboard to push Anya to interact with the pea. 

At this point, Anya’s autonomy is compromised. This means that she is feeling the influence of external control. Dad wants her to do something she doesn’t want to do. Speaking psychologically, when autonomy is compromised, defenses are activated. Anya is learning that curiosity about non-preferred food is a dangerous game because it leaves her open to being pushed to do things she’s not ready to do. So next time, she’ll keep her mouth shut when she feels interested or engaged with something before she’s ready to eat it. 

Curiosity

A child’s curiosity is like a delicate flower. Especially when that child is naturally anxious, cautious, or prefers things to be the same way (behavioural rigidity). We can trample that flower by pushing for food interactions because of our own agenda. Or, we can nurture that flower by leaving space for curiosity – by validating a child’s reactions “yes, peas ARE funny green balls!” and by showing children (through our actions and words) that they can trust us to hold that space for them where they can interact with foods if and when they choose to. 

Exposure in a feeding therapy context

If you are working with a practitioner who uses a Responsive Feeding Therapy (RFT) approach, they may well incorporate exposure in the work they do. This is skilled work and requires a high degree of attunement to the individual child as well as an in-depth understanding about why a child is finding certain foods hard. Children may learn about foods in an interactive and fun way but it is at the child’s pace, carefully facilitated by the therapist. The therapist is an objective professional and is able to tune in to what a child is ready for in a way that can be very hard for parents who may be overwhelmed with worry about their child’s eating. 

Sadly, exposure may sometimes be used in feeding therapy in a non-responsive way. This is the case when children are not able to say “no” to an activity, when they are forced to swallow or taste foods or when therapy continues despite a child’s distress. If you are considering feeding therapy, find out in advance whether your child would ever be expected to do something they did not want to do.

Exposure in typical eaters

Many parents swear by the ‘no thank you bite’. They say their child may never have eaten spinach if they hadn’t pushed them to try it again and again, helping them get used to its tricky texture, strong colour and complex taste. And if this works for some children and the taste is undertaken willingly, then fine. If it ain’t broke, don’t fix it.  If there are no issues with the child’s eating and they are happy to take that bite, then these types of practices are just a matter of personal choice.

Understanding negative associations

If we use this approach with children who are avoidant (‘picky’) eaters, however, the value of the pressureful exposure is entirely outweighed by the negative association the child will be forming at the same time. Yes, they are more familiar with how spinach tastes if they were made to lick it. But they are also more scared of spinach and will cling more tightly to the coping mechanism that helps keep them psychologically safe at mealtimes: avoiding any interaction with foods that they are not confident about eating. 

The path to new foods is through a child’s innate urge to learn… their natural inquisitiveness that, if nurtured, will slowly and gently bring them to a place where it feels okay if something is a little bit different. But as long as we compromise their autonomy and see exposures as a goal that we need to make happen because it is an end in itself – an end that justifies the means – yes, we may get some stickers on that chart but we won’t be raising a child who is increasingly happy and relaxed at the table as they build their eating confidence day by day. 

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