First Bite: How We Learn to Eat. Bee Wilson

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      What if you have missed the ‘flavour window’ and are now attempting to feed a toddler who fears anything green? Is all hope lost? Cooke and colleagues found that even with school-age children, there was a great deal that could be done to change apparently fixed hatreds of certain foods. Their first revelation was that much of what manifests itself as fussiness is a response to the stressful situation of mealtimes. It can get to the extreme point where lunch itself is a ‘dislike’ – the pressure, the heightened emotions – no matter what is served. Cooke found that if parents could do tasting sessions with children outside meals, it could take emotion out of it. In addition, they only asked children to try pea-sized amounts of food, which reduces the feeling of pressure. ‘The demands on the child have to be very low.’ A whole plate of cauliflower is a horrible prospect if you don’t like it. A minuscule fragment might just be OK.

      Cooke helped devise a new system for encouraging more vegetable ‘likes’ called Tiny Tastes.⁶¹ It was trialled in both schools and in homes and has proved remarkably effective in making children actually like raw vegetables such as carrot, celery, tomato, red pepper and cucumber. I used the scheme on my own youngest child – then aged four – and was startled how quickly it turned him from someone who said ‘yuck’ when he heard the word cabbage to a happy nibbler of raw green leaves. It works like this. The parent and child together select a vegetable that the child currently moderately dislikes (as opposed to feeling deeply revolted by). Each day for ten to fourteen days, not at dinnertime, you offer them a pea-sized amount. If they taste it – licking counts, it doesn’t have to be swallowed – they get a tick in a box and a sticker. If not, it’s no big deal; there is always tomorrow.

      The usefulness of Tiny Tastes is that it provides a non-stressful way to enact the multiple exposures that we seem to need to develop new tastes. In our house, it changed the whole conversation around mealtimes, from one of stress and anxiety to something – mostly – more positive and mellow. Because he chose the vegetable himself, my child seemed to feel less trapped. Plus, he really likes stickers. Lucy Cooke said that before they started using stickers in their experiments, there would always be a few children who would refuse to take part; with stickers, participation went up to 100 per cent. Cooke’s research overturns the previous orthodoxy that offering rewards for eating would make children like the food even less. Her hunch is that rewards only work first when they are not themselves food and second when the child feels they have genuinely worked for them. If you reward someone for eating a healthy food that they already like, it confuses them. But it takes a real effort for a child who dislikes raw red pepper to put that first morsel in their mouth, hence they feel they deserve the sticker.

      This approach to creating new, better likes sounds almost too good – too simple – to be true. For one thing, it only addresses vegetables, which is a good place to start, but there’s a lot more to a healthy diet than just greens. For many children, it is the protein foods – eggs, meat, fish – that are the hardest to love. Tiny Tastes also presumes that a child will willingly cooperate, once stickers are proposed. What about the hardcore food refuseniks? Some people have very definite dislikes with their roots in complex conditions, which surely can’t be wished away with a sticker.

      When children have learning difficulties or other disabilities, one of the many daily tasks they often tussle with is eating. Children who are slow to speak also tend to be slow to master the skills of eating, because there is a strong relationship between the muscle control needed for language and for chewing and swallowing. Eating can also become a problematic business for those whose condition involves rigid behaviours and routines. Those on the autistic spectrum are far more likely to have a wide range of problems with food than other children. It’s been estimated that 75 per cent of children diagnosed with autism have severe feeding difficulties.⁶² They may demand exclusively ‘yellow’ food (crisps, corn, biscuits, popcorn, fried chicken), or refuse to eat a meal unless none of the components are touching. Above all, autistic children are likely to have a very narrow range of foods that they find acceptable.⁶³

      Jim,^fn1 aged three and a half, was an autistic boy with serious eating problems by the time he arrived at the Penn State Hershey Medical Center in Pennsylvania. He ate only two foods, toasted cheese sandwiches and hotdogs, supplemented with frequent glasses of milk. In addition, Jim tended to be disruptive at mealtimes, tantrumming, crying, acting out, refusing food from even his limited repertoire.⁶⁴

      But Jim was doing well compared to Kim, a five-year-old autistic girl referred to the same clinic. For a while, Kim too had eaten a limited diet of hotdogs, peanut butter, bacon, chocolate, eggs and toast. She too would cry, tantrum and throw food at mealtimes. After an illness, though, she stopped eating altogether and for six months had been completely dependent on feeding through a gastrostomy tube.

      Most parents would feel overwhelmed at the thought of feeding these children and somehow broadening their horizons. I know I would. Food refusal is demoralizing at the best of times; all the more so when you are dealing with the other challenges of caring for an autistic child. If a child disliked most foods to the point that they provoked tears and rage, it would be very hard to bring yourself to do anything other than sigh and make another toasted cheese sandwich.

      Jim and Kim sound like two hopeless cases. But they weren’t. Within two weeks of intensive treatment at the centre, Jim’s repertoire of foods had increased from three to sixty-five. Kim, meanwhile, would now eat forty-nine different foods and no longer needed the feeding tube. This huge increase in ‘likes’ (and decrease in ‘dislikes’) was achieved not through any magic but simply through a more systematic and intensive version of Lucy Cooke’s Tiny Tastes system.

      Therapists at the clinic engaged the children in many repeated taste sessions to expose them to pea-sized amounts of novel foods in the course of the day. Unlike with Tiny Tastes, the therapists added in an ‘escape prevention’ element: the child was told ‘when you take your bite, you can go and play’ and were not allowed to leave the room until the bite was taken. If they screamed or cried, this was ignored, but if they ate the pea-sized bite, they were praised. There were also ‘probe meals’ at which larger quantities of the new foods were offered – three tablespoons of three different foods – with a ten-minute time limit and no requirement to eat the food.

      The results of this experiment are astonishing. To go from being fed by a tube to being able to eat forty-nine different foods is life-changing, for the whole family. A three-month follow-up showed that Jim and Kim had not lost the majority of their new likes at home. They had not slipped into the old unhappy mealtimes of before. Food was no longer a trauma to them. Both sets of parents were continuing to offer the children taste sessions outside mealtimes. Jim’s range of foods was now fifty-three. This large repertoire of foods was all the more impressive considering that Jim’s parents had decided to become vegetarian since the start of the intervention, the sort of change that autistic children often find unsettling. Kim’s range of foods was still forty-seven. In place of a tube, she was now enjoying a wide range of different flavours and textures, without tears or rage. Autism goes along with restricted social interaction. Yet Kim’s new likes placed her back in the social world of the family dinner table.

      Similar work is being done by therapists at specialist feeding clinics across the world, although Keith Williams, head of the feeding clinic at the Penn State Hershey Medical Center, says that these methods are by no means standard practice. Too many feeding therapists still treat limited eaters such as Jim and Kim by offering them whole platefuls of disliked food and hoping they will suddenly decide to eat it. But when these interventions succeed, they show what huge potential there is for changing our likes and dislikes for the better through a change to our eating environment. No one is doomed to like nothing but cheese sandwiches and hotdogs. If it’s possible to train a severely autistic three-year-old to love fifty-three different nutritious foods, there’s hope for us all.

      The trouble is, though, that most of our food environment influences us in an opposite direction. СКАЧАТЬ