Healing from Food Insecurity: Beyond the Stash

Contributed by:
by Katja Rowell, M.D. © 2020, with reviewer and adviser Erika Shira, LMHT, MT-BC
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Please do not reprint or reuse without permission. Contact Mary Boo to request permission.

Originally published in Adoptalk 2020: issue 2 (updated from a 2013 article). Adoptalk is a benefit of NACAC membership.

The information in this article is educational and not meant to replace careful evaluation and treatment by medical, nutritional, or mental health professionals.

Whether a child is 15 days or 15 years old, feeding and nurturing through shared meals is a powerful way to deepen attachment. But the family table is not always an easy place for children in adoption and foster care. Unfortunately, conflict and concerns around food, weight, and eating habits are common. When conflict defines interactions around food, trust and attachment can suffer and children may continue to struggle with eating.

Providing food is a powerful way to help children feel safe and cared for. Lynette, a seasoned foster mom, described a meal that made a big impact on her family. “We had a 15-year-old boy in foster care with a history of runaway episodes,” she recalls. “He was gone for about 30 hours. When he came back, we told him we’d been scared, made sure he was safe, and threw a box of mac-n-cheese on the stove to get him some comfort food. That floored him. It turns out that he’d been denied food in his prior home after his running. I think it helped him trust us more than anything else could have.”
Parents want to raise children who are healthy and happy, and may think that trying to get children to eat more, less, or different foods will help. For children who have experienced food insecurity or trauma, healing the trauma and anxiety around food is key to helping children learn to eat a variety of foods in ways and amounts that support health and well-being.

Food or Caregiving Insecurity and Survival Behaviors

When children are not fed reliably, have to compete for food, or do not get enough food, this leads to an anxious relationship and even a preoccupation with food. It can take weeks, months, and even years of reliable feeding for that trust in others and in their own bodies to build. A loss of a caregiver, even at a few days old, can teach a developing brain that caregivers may suddenly no longer be present or cannot necessarily be trusted to meet the child’s needs. Even children who had their basic needs met, but have had caregivers change whether due to death, foster or kinship care, or adoption, can develop food preoccupation, excessively turn to food for soothing, or show survival or “hoarding” behaviors that can look like:

  • Eating quickly, gobbling or stuffing food
  • Sneaking or hiding food
  • Not eating at mealtimes but eating secretly or alone
  • Eating large quantities
  • Becoming upset if someone eats off their plate or shared bowls
  • Getting upset if food is limited or taken away
  • Eating faster if asked to slow down
  • Eating only familiar and “safe” foods

It’s Not the Pizza Rolls—Trauma, Self-Soothing, and Food

By age 14, Tara had been through multiple placements. Her ACEs (adverse childhood experiences) score was high. She was self-harming and struggling with suicidal thoughts. Diagnosed with “obesity,” her care providers were told that their priority was to get Tara to lose 30 pounds. Tara’s favorite pizza rolls were banned, Tara and her foster parents fought over her diet plan, she avoided mealtimes, and binged when she had the chance. In therapy she shared that eating often calmed her when she felt anxious. Tara gained five pounds in six weeks. (More on dieting and weight below).

In addition to experiencing food insecurity, Tara, like many before her, learned to use food as an available coping/self-regulation strategy around trauma and difficult feelings. Using food as one way to self-soothe is common in healthy adults. “Numbing out” with food, or eating that feels out-of-control as the main or only method of self-soothing is a problem long-term. Reframing “overeating” as a behavior that may have served a purpose in the past can help.

Helping children and teens address trauma and find other coping strategies will help heal their relationship with food. Ways to help children and teens self-regulate, and connect with their bodies and tune in to hunger and fullness cues include:

  • Singing, making music, or music therapy
  • Dancing
  • Yoga
  • Making art or art therapy
  • Swinging, bouncing or spinning—an occupational therapist can provide suggestions for your child’s sensory preferences if necessary
  • Meditation or breathing exercises (see apps and online resources)
  • Walking or playing sports
  • Therapy focused on play, or somatic (body) experiences

Healing Food Anxieties

To stash or not to stash

Many resources on hoarding advise allowing children to have snacks in their backpack, carry food, or even have containers of food in the bedroom. Anneliese, mother of one adopted and one biological son, recalls that the main feeding advice she got from her social worker was to let her son carry around a baggy of carrots: “I just didn’t think that was going to help.” Other experts advise parents to avoid the stash and serve regular meals and snacks. Still others may suggest locks on pantry doors. The reality is, there is no one-size-fits-all answer (but locks can undermine trust, don’t address underlying challenges, and are not generally recommended).

Parents may offer a stash and see how things go. The stash may help at first, and the child may lose interest with time. If a child has a meltdown when his granola bar is taken away, allow him to carry it. Follow his lead. But the parent also has to be absolutely reliable about regularly providing food. Parents may need to offer food more frequently in the first days of placement, perhaps every hour or so, then over a few days, spacing out to a more typical routine.

Another concern with a stash is that when a child is allowed to get food whenever they want, they may still feel responsible for getting their own care. Or they may eat it all between mealtimes, which undermines appetite. It is also a missed opportunity to nurture and deepen attachment. To help bonding and a sense of security, food should be provided by parents at shared meal and snack times when possible.

Consider three-year-old Arielle, who was growing steadily at the 85th percentile when she was adopted at 11 months. Her birth mother was large so the pediatrician recommended small portions to “prevent obesity.” Arielle soon began to beg for food most of the day. Worn down from trying to keep food away from Arielle for two years, mom reached out for help and was advised to have a “healthy” snack drawer just for Arielle—but she immediately ate the food and cried for more. In this case, Arielle’s non-stop pestering for food was not the hoarding behavior of a child arriving from a place of food insecurity, it was actually due to months of trying to get her to eat less (restriction). Hoarding can be due to past or current food/caregiving insecurity, or not getting enough food reliably. Arielle’s stash wasn’t working.

Reassure Children with Words and Actions

One foster mom had a little boy she couldn’t keep out of the fridge. He occasionally ate to the point of making himself sick. Mom didn’t want to lock up food. Instead, she assigned him a refrigerator drawer. She stocked it with familiar food and told him that the drawer would always be full, and while he could not take food at random times, the drawer was his. He checked the drawer often, with Mom’s reassurance that it was his food, and he could help choose from it for meals and snack times. Mom made certain it was never empty, and gradually he forgot about it.

Reliably Offer Balanced and Filling Meals and Snacks

While parents can allow a stash if it works for their child, the best way to lessen hoarding behaviors is to lessen anxiety around food. Mia adopted two brothers at age five and seven. She describes how they reassured the boys, “Sam had some hoarding issues, but it didn’t last long. We let it run its course. We chose not to have food available to the boys all day and night. I didn’t think it would reassure them. I fed them regularly and sat and ate with them. They pretty quickly learned to trust they would get fed.”

Avoid Sugar Anxiety

Eight-year-old Yasmeen was adopted as a preschooler. Yasmeen’s parents didn’t allow sugar so she wouldn’t become “addicted.” At a friend’s house while baking cookies, Yasmeen ate spoonfuls of sugar straight from the bowl. Keeping sugar away from Yasmeen wasn’t helping her learn to manage it.
Yasmeen’s parents were encouraged to allow her to have sweets at least once a day with a meal or snack, and sometimes to enjoy ice cream out or bake cookies at home. They were also encouraged to not talk about foods being “good” or “bad.” Yasmeen ate a lot of sweets in the beginning, but a few months in, she was no longer obsessed with dessert and had stopped the out-of-control eating when she had access.

Avoid Reinforcing the Anxiety of Food Insecurity

Many children who experienced food insecurity have initial behaviors that scare parents, especially if the child is bigger than average. Even if a young person is labeled as “obese” or “overweight,” they can still feel food insecure. Research links food insecurity and binge eating with higher weight into adulthood. It makes sense. If enough food isn’t reliably available, eating as much as possible when it is around is rational and protective. Trauma, high ACEs scores, and social determinants of health (poverty and access to health care for example) are reliably linked with poor health outcomes.

For many children and teens, attempts to limit their intake will make them more anxious and worsen food-seeking behaviors, as happened with Tara, described earlier. Tara’s foster parents realized that despite all their efforts to control Tara’s portions and push vegetables, she was gaining rather than losing weight. And they are far from alone. Decades of research show that diets (efforts to get people to eat less to weigh less) fail in the general public 90 to 95 percent of the time, with more than half ending up heavier. Teens who diet experience more depression and disordered eating and tend to end up heavier than teens who practice “intuitive” eating, where they eat based on hunger and fullness. Dieting is also a major risk factor for developing life-threatening eating disorders.

It is critical to address a child’s initial food anxiety with nurturing, reliable feeding, even allowing the child to “overeat” while they learn to trust their cues of hunger and fullness. These children’s food regulation skills are not gone, but buried, and they can learn to tune in to hunger and fullness cues. Trauma and strong emotions can make it harder to listen to their bodies. Addressing trauma through healing relationships and building resilience is heart-healthy. Focusing on building connection and trust and helping children find resources to regulate their emotions and feel safe will help children and teens grow up to have a healthy relationship with food and their bodies. A trauma-informed, non-diet dietitian or therapist can help.

Consider Cultural Food Differences

Remember that many children may come to you with very different experiences with food, especially if they are from another country or a different racial or cultural background. Being presented with completely new foods can be very scary and anxiety-producing for children. Be sure to ask your children about what foods they are used to eating and what they enjoy, then find a way to make some of those favorites a regular part of their meals. (If the children aren’t old enough, you can check with your agency, birth family members, or their former foster parent to ask more about the types of foods they are used to.) You might find a couple of good options for takeout, learn to make their favorite comfort food, or make a plan to cook with them. Working together can help build attachment and show them you respect who they are.

These can be complex and challenging issues. For more information and support, check out:


 

Tips to Reduce Food Anxiety

Create a home and family environment where everyone is valued and consistently sent messages that they are safe and cared for.

  • Focus on healing trauma, forging a trusting connection, and healthy behaviors, rather than weight.
  • Structure is critical. Offer balanced and tasty meals and snacks every two to four hours. If you go to the park, bring food with you.
  • Don’t shame them for foods they like or were served routinely. Try not to use words like “junk” or “crap.” Try neutral words like “fast” or “prepared” foods.
  • Particularly if your child is of a different cultural or ethnic background, they may be missing familiar foods. Find out what they are used to eating and learn how to make or buy it.
  • Include foods that they want to eat along with the foods your family enjoys.
  • One caring adult eating with a child counts as a family meal.
  • Serve meals and sit-down snacks more frequently at first or if a child is healing from food preoccupation.
  • Offer reassurance: “There will always be enough food.”
  • Aim for pleasant family meals—if you’re battling over broccoli or a therapy task, that’s not helping them feel secure.
  • Include fat, protein, and carbs. A snack might be whole-wheat crackers with cream cheese and apple slices, or cereal, milk and a banana.
  • Feed with the Division of Responsibility. At meals and snacks, they get to eat as much or as little as they want from what you provide. Even if they eat a lot initially, this sense of control will reassure them.
  • Always provide at least one food they are likely to eat. They need to feel that they can come to the table and their hunger will be satisfied.
  • Invite children and teens to help cook and meal-plan. You can say, “We’re having chicken and lentils for dinner. Would you like cornbread or tater-tots with that?” Resist the urge to argue or pressure, even if they refuse food they chose.
  • Let them know that they may spit out any food they don’t want to swallow into a paper napkin. Children are more likely to try a new food if they can spit it out, particularly if they have a history of gagging or vomiting episodes.
  • Don’t battle over manners right away. Lead by example.
  • Serve foods family-style so a child can serve themselves and feel more in control. This also stops battles that begin when a pre-plated meal is served to the child who might erupt over something on his plate. (Clients tell me this is the number one tip to lessen power struggles.)
  • Modify family-style if shared serving bowls increases anxiety or conflict between siblings. This might look like adults putting half a cup of taco meat and three taco shells on each plate and allowing children to serve themselves unlimited beans, lettuce, and rice.

About by Katja Rowell, M.D. © 2020, with reviewer and adviser Erika Shira, LMHT, MT-BC:

Katja Rowell, MD, is a family doctor, author, and childhood feeding specialist. She has a special interest in helping foster and adoptive families with feeding challenges, through a relationship-building and trauma-informed lens. She is on the medical advisory board of SPOON. Her books include Love Me, Feed Me: The Adoptive Parents’ Guide to Ending the Worry About Weight, Picky Eating, Power Struggles, and More; Helping Your Child with Extreme Picky Eating; and the workbook Conquer Picky Eating for Teens and Adults.

Erika Shira, LMHC, MT-BC, is a foster and adoptive parent, music therapist, and child welfare clinician based in Boston. They provide counseling, consultation, evaluations, and advocacy to youth and families affected by the child welfare system, through a number of public, private, and nonprofit channels, as well as through direct contracts with courts and child welfare agencies. Their approach is to always strive to be trauma-informed, evidence-based, and honor all people’s connections to their cultures and families of origin.

Categories: Featured, Food & Nutrition, Parenting

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