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Introducing foods for ARFID / ADHD Children and Teens



Introduction of new foods

Introducing new foods to children can seem daunting, especially when it comes with temper tantrums, screaming or extended silence with a firmly closed mouth. The goal of food exposure therapy is to challenge the perception of introducing new foods and compare that to their actual experiences of eating the foods. This will challenge their thoughts about their food aversions, which are based on perceptions, not actual experience. (See form at the end of this document)

Establish a routine for everything, this reduces anxiety for the unexpected. Checklists for getting ready, the countdown for changes in situation and keeping them on task are all helpful in establishing a routine and reducing anxiety. Countdown timers can be used, that they can control, as this helps make them accountable for their time management and transition times. If the rest of their day is relatively calm, at mealtimes we can hope that this will translate to being open to new foods.

Introduction Recommendations

Don’t overwhelm the child. Introducing new foods along with food they already eat is a way to ease them into healthier food options. Adding protein covertly or overtly, is up to you and how open the child is to try new foods. Introducing foods they like, or are already consuming with foods they currently eat, is an easier way to migrate them into eating a more varied diet.

For instance, introducing a high protein pasta with regular pasta, I would suggest: 1-1 1/4C serving of pasta. Start with ¾ of their own pasta and ¼ of the new pasta. Move to 50/50, then ¼ to ¾, finally to 100% high protein pasta. This can take place over 5-6 servings.

You can do the same with a bean purée as part of the tomato sauce: using kidney beans (puréed red or white), add this to a sauce, 1/4C at a time, with the pasta will increase protein intake.


Monitor the child at the table with mealtimes; be calm, confident, firm but encouraging “I know this is seems tough for you, but I’m going to sit with you until you eat this (food).” Again, this is not meant to make them miserable, you are challenging the anxiety and dysmorphic ideas they have around food.

Bring 5 new foods to them, have them pick one to try. You are giving them the choice as to which foods they are willing to try, giving him some control over the process. OR You can make a game of it. Take a list of foods put them onto slips of paper and place them in a jar, have them draw 5 slips from the jar, they choose one food out of the draw to try. The rest go back into the jar to try later. You can draw 3 foods for the week to try and put them on the shopping list.


If they decide not to try the food, they must give you a date within two weeks to try it again. Put it on a calendar. They must do this with every food rejected until they try the food at least once. Make a calendar on the fridge or in the kitchen so that they can participate in when they feel they are up to trying the food again.

What is your child's currency?

Determine what is motivation for them to keep on trying new foods. Reward positive eating behaviours: praise and encouragement from the family is extremely important. A child not eating what everyone else is eating at the table puts a huge strain in the parents making the meals but also the rest of the family.

Meal times become more like a diner experience than and relaxing dinner. Establish what your child sees as motivation: extra time on a game, they get to pick the movie and the treats, reading a book before bedtime, hiking outside, visiting the beach, whatever they cherish. Have small daily rewards to start, working up to the week goal of trying and eating 3 new foods to completion.


When you introduce the new food, have them comment (non-judgmentally) on the foods prior to eating them, on their: appearance/colour, smell, texture, taste, feel.

Introduce foods that are similar in colour, flavour or texture that they currently comfortable eating:


Crunchy: nuts, Kind Bars, protein bars, apples with crunchy nut butter, carrots, celery, pickles.


Salty: nuts, seeds, kale chips, popcorn, edamame, roasted chickpeas, low sodium tortilla chips and salsa, goat cheese, air fried legumes, pickles, full fat cottage cheese.


Sweet: homemade protein bars/bites with honey, Kind bars, protein bar (Cliff, Stinger waffers, Good Fats…), fruit, dried fruits, dark chocolate (one square at a time), unsweetened yogurt with fresh berries and honey, sweet potato, smoothies with protein powder. The goal is to wean them off of sugar as much as possible, and offer natural sugars as fruit instead.


Fatty: Coconut fat bombs, coconut meat, avocadoes-guacamole, fatty fish, whole eggs, nuts and nut butter, seeds, goat cheese, plain full fat yogurt or cottage cheese, olives, whole organic cold expeller pressed oils. Combining textures: Whole fat Greek yogurt with homemade granola, celery with nut butter and a few raisins, carrots and hummus, apple and hard goat cheese.

Schedule 3 smaller meals and 3 snacks at the same time throughout the day. Over time this habituates the body to stimulate hunger receptors, and appetite. When you starve yourself, your body will store food. When you eat, your body knows it can burn the calories that it has consumed.

Working directly with your child, teach them to express their emotions, rather than suppressing them only to express them explosively later. Pay attention to them when they speak, make eye contact so they feel like they are heard, encourage them when they express emotions openly instead of bottling them up. They may want to express their anxiety over new foods, validate their feelings but assure them this is for their health and wellness and in the long-term they will feel better and grow stronger.


Things to watch out for:

  • Reduction in appetite, no stimulated hunger, introduction of a digestive enzyme can stimulate their appetite.

  • Reduction in taste and smell (also indicated in a decrease in appetite), this can indicate zinc depletion, we can supplement zinc liquid if needed, and introduce foods that are high in zinc.

  • Eating smaller portions and feeling satisfied, along with weight loss is concerning.


Supplementation A child/teen that has dysmorphic eating patterns, are generally low in valuable nutrients. Supplementation is essential to get their body up to acceptable levels of nutrients. Let the child know that THIS IS NOT IN PLACE OF FOOD, this is to bridge the gap between what their body is getting (or not getting) and what their body needs to grow and thrive.


Even a child/teen that is not demonstrating physical evidence of malnourishment or blood levels are not indicating now nutrient levels, this does not mean that they are not depleted. Studies have shown that our lifestyle and diet in childhood, or early adulthood, influences our health in our twenties or thirties. Including supplementation helps the cells in the body by adding essential nutrients as part of long-term illness prevention.


Super DHA fish oils are essential food for: ADHD, ASD, Anxiety, Depression. This feeds the brain and in studies has shown that DHA has helped with brain function.

Good quality multivitamin is essential nutrients needed for cells to grow, regenerate, replace and improve body functions and energy. Again, THIS IS NOT IN PLACE OF FOOD, it is to help balance what the body needs and what is it not getting.

Calcium, Magnesium & Vitamin D. A body that is in constant stress, mental of physical, burns through these nutrients faster than the average body. In children their bone matrix is replaced every year until 12yo, in teens 13-18yo the bone matrix is replaced 4-5yrs, as adults 19+ the bone matrix is replaced every 10yrs. We are in a constant state of cell regeneration and keeping on top of building the nutrients for bone development and maintenance, is essential daily.

Protein is essential for so many aspects of our body, immune health, cellular regeneration, sex hormones, body hormones (thyroid, adrenal), muscle support and cellular regeneration. Reduced protein can reduce all aspects of our health. Vega or Genuine Health Fermented protein powders with 20g protein is best, easy to digest and offers a good amount of protein. Make sure protein powders are ingested within 30min of exercise, sport for optimal absorption and recovery.

Stomach acid is essential for all aspects of our health. Reduced stomach acid can reduce our body’s ability to break down foods for use in the body, prevents our ability to manufacture essential nutrients that help give us energy and help heal our body. Eating too quickly, eating in a stressful environment, eating on the run, drinking too much with our meals, are all ways we can reduce our stomach acid. Digestive enzymes can help establish good digestion and stimulate appetite.


Food combining for vegetarians and vegans is essential. Introducing more vegetarian food into their diet can help with nutrient dense foods.

Combining legumes and grains together completes a protein required for growth and immune health.

Legumes with grains: quinoa and black beans; chickpeas and oats; whole wheat with pinto beans; brown rice and lentils. I realize this is an ideal scenario but there are recipes for lentil, chickpea and oat based tortillas and wraps included that you could transition to start.

Seitan, a whole wheat protein source that is soy free. This can be cooked and added to wraps, stir fry’s, pizzas, whatever you feel they will eat. Start slow and add one to two pieces at a time. Seitan can be flavoured using herbs and light spices if you would like.

Sandwiches made with 100% whole grain vegan bread (sprouted is best) combined with a nut butter would increase protein. You can use bread, buns, wraps that have sprouted grains or wraps made with legumes and grains can help with protein and fibre.

Organic Soy is acceptable for children up to 6oz/wk without affecting sex hormones. Organic Tempeh is fermented soy, easier to digest, non-estrogenic, and is available in flavours, if that helps with the introduction. Organic Edamame is acceptable in a diet added to buddha bowls or on their own as a snack, air fried for a crunchy snack. Combine this with a whole grain makes a complete protein.


Sugar and ADHD

The brain is fat and glucose and someone with ADHD has a mind that is like a race car, always on the go, at a million miles an hour, sugar is their energy. They can be playing a game, music blaring and have streaming videos in the background, all of this energy matches their brain energy.


It is not a stretch to imagine that processed sugar, cookies, candy, chips, chocolate are the most desired snacks of choice. And even meals are comprised of highly processed foods as this seems to be the only thing you can get them to eat. This offers them the energy they want and need to make it through their day. Giving into these cravings can lead to blood sugar dysregulation, with high-highs and low-lows, causing the 'hangry' child. Long-term exposure to these extreme up and and downs can lead to metabolic syndrome and possibly Type II diabetes.


Sugar can also lead to a depressed immune system:


Sugar reduces the immune system significantly. Each sugar cube is 4g, one cube reduces our immune power 40% for an hour. When you read a nutrition label, divide the sugar by 4 and you will know how many sugar cubes is present in that food. For instance: sweetened yogurt can have 12g sugar per serving, that is 3 sugar cubes in a small pot of yogurt. The sugar in one regular cola or “healthy” green drink reduces our immune system 60% for 5-6hrs. We know that those with ADHD use a significant amount of energy, with sugar as the go-to for quick energy along with the rise in dopamine that accompanies sugary foods. This can be in the form of raw sugar, pastries, donuts, juice, pop or candy. Sugar is accumulative over a day, the more we take in, the more our immune system is reduced, the more blood sugar levels are dysregulated, causing mood disruption and increased cravings. This can eventually lead to metabolic syndrome and possibly Type II Diabetes.


Foods that can be used in recipes or blended.

HAAS Avocado 3g protein- add to smoothies or in chocolate pudding recipe.

Seeds: hemp, chia, sunflower, flax, pumpkin, sesame. As whole seeds or as a butter.

Nuts: peanuts, almonds, cashews, walnuts, Brazil nuts. As whole nuts or as a butter.

Grains: quinoa, wild rice, brown rice, black rice, red rice, long-grain brown jasmine rice, millet, buckwheat, oats, spelt, kamut, red wheat berries, amaranth (usually as a porridge), farro. Remove white rice as much a possible, you can mix white with brown and then increase the proportions.

Gluten free grains if you suspect Celiac or gluten sensitivity: quinoa, rice (red, brown, black, wild and red), amaranth, gluten free oats, buckwheat (kasha), and teff.


Dried unsweetened and unsulphured fruits: apricot, dates, raisins, figs, currents, prunes, coconut and cherries. These are great in transition but always accompany these with a nut to limit blood sugar spikes. Limit 3-5 dried fruits per serving, raisins and currents limit to 1/4C. Great when added to recipes like breakfast bards or cookies, homemade protein bars, or granola.

Legumes: chickpeas, broad beans, black beans, pinto beans, black eyed peas, Romano beans, kidney beans (red or white), navy beans, lentils, lima beans. Seasoned and air fried can offer protein, crunch and healthy ‘saltiness’ to the diet as a snack.


Fruits: Apples, Apricots, Blackberries, Blueberries, Cantaloupe, Cherries, Cranberries (unsweetened), Coconut (water, meat or unsweetened shredded), Currents, Dragon Fruit, Figs, Grapes, Kiwi, Mangoes, Melons, Mulberries, Nectarines, Papayas, Peaches, Pears, Plums, Raspberries. These are natural sugars and eaten as a whole food, can manage blood sugar levels and offer something sweet. Avoid sweetened or canned fruit in syrup. Unsweetened apple sauce, as a snack with nuts or granola.

Vegetables eat a good variety of them as possible, and in as many forms as possible, to keep a variety and keep it interesting. Fresh-raw, grilled, baked, sautéed, steamed. Avoid boiled vegetables (exception sweet potato) as these leech out essential nutrients. Switch out white potatoes with sweet potatoes when possible as they are much more nutrient dense than plain potatoes. When eating potatoes eat them with the skin on to get the most out of the vegetable.

Including probiotic foods will help populate good bugs in the gut, this can aid in the digestion of legumes and have him avoid issues with being windy with eating legumes. Healing Spirit Organic Coconut Kefir, unsweetened to smoothies, dips or puddings. Unsweetened oat or coconut Kefir, probiotic yogurts, organic dairy if coconut or oat is not palatable, are good options for probiotics. Sauerkraut, pickles, Kimchi, are also options as probiotic foods.

Animal Protein: grass fed / grass finished (when possible) if they are ok with meat. Free range chicken and eggs are healthy proteins, turkey is great to aid in sleep (tryptophan), lamb, duck, goat and ox tail. Eating a variety of these foods can help add variety to the diet, give them more options for protein and keep this introduction of foods interesting.

Keep in mind with self-restrictive eating, they are re-establishing their taste pallet, their likes and dislikes, taste and texture. It will continue to evolve, eb and flow. Be willing to go with the flow until you see a pattern of taste, texture, and flavour. IE homemade crispy chicken nuggets over chicken in a cream sauce with pasta. Or ground turkey as a meatball is preferable to ground turkey in a meat sauce with pasta. Simple clues like this can help introduce more foods, if they are comfortable with the form it is appearing.

Misc: nutritional yeast is loaded with B12 and helps with energy and cellular function. Add this to sauces, sprinkled onto popcorn or homemade kale chips, it offers a buttery taste without the dairy.


Exercise

Yes exercise. New studies have indicated that as little as 26min of exercise is enough to stimulate dopamine release in the brain, giving the child a nice happy boost of hormones. Obviously this is a minimum, maximum is when the child is too pooped to play anymore.


Most kids I see are mentally exhausted at bedtime, but flail around in bed like a drowning man, hot and sweaty. Their mind is tired but their body wants to run a marathon. Given all of the pend up energy from sitting all day and evening and their sugar consumption, its no wonder. Usually (pending age of child) sweat at night is cortisol release (stress response) and not hormones, closer to teen years its a bit of both. Getting the child (at any age) to get out and run around, away from blue light devices, to burn off energy and tire out their body, helps restore sleep cycles. Sleep becomes more restorative to them. Deep sleep is the only thing that shuts off cortisol, mediation and yoga has been shown to reduce cortisol release but not turn it off. ADHD kids are in constant balls of high energy and getting them to shut off can lead to long-term health and wellness.


Getting back to basics

NO eating in front of the TV or electronic devices. This contributes to unconscious or mindless eating, where before we know it, food had been consumed, bags empty, stomach uncomfortably full yet we have no idea how it happened.


Be present when eating. Eat in a relaxed environment as much as possible, calm music playing, telling jokes around the table, recounting the day’s activities, no electronic devices, including the TV. Eating in front of the TV or devices leads to stressful eating and can reduce the body’s ability to digest. In turn this reduces the body’s ability to assimilate nutrients, causes burping and flatus.


Have minimal liquids with meals or for a ½-1 hour after. Sipping a small amount of water during your meal is fine, 4oz room temp water. Avoid drinking ice-cold beverages with or between meals. Water with meals reduces the body’s ability to digest increasing strain on the stomach and pancreas.


Drink water. 750-1.5L for children and 1-2.5L water teens or adults. Water levels to be increased accordingly given surrounding environment or activity level. Always drink water between meals and throughout the day. Filtered water is best (zero filtered water or reverse osmosis). Herbal teas count towards the total amount of water consumed as they do not contain caffeine.


Blue light devices: Blue light has been proven to reduce the body’s ability to produce melatonin, our sleep regulating hormone. Blue light is generated from computers, TV’s, phones, tablets and LED light bulbs. Adding blue light filter to prescription glasses or purchasing blue light blockers reduces exposure to the circadian rhythm. Keep a reading light with an incandescent bulb, turn off all other lights in the room, read a paper book an hour before bed. This naturally tells the body’s it’s time to shut down for bed, which helps to induce the sleep cycle. This also aids in transition from awake to sleep for a child that has issues with transition times.


Food Introduction form

Supp_Food Form
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