Also called food aversion, food phobia is a fear of specific or even all food and liquids. The fear is not of the food, but of the potential to vomit or choke on the food. A combination of hospitalization and behavioral conditioning can help treat food phobia.
Food phobias in children are far more serious than a toddler refusing to eat its spinach. Vanderbilt University estimates that 3 to 10% of very young children in America will need to be hospitalized for food phobia. The fear is actually of choking or vomiting and not the food itself. Children may even complain that eating or drinking hurts. If left untreated, children can suffer from malnutrition and stunted growth.
One two year old boy in the UK, Bobby Glarvey, gained notoriety in 2008 because he refused to eat anything except yogurt. Food phobias in children can get that extreme. But a yogurt-only diet is an incredibly poor diet. Bobby did not grow as tall or as heavy as a normal two-year old.
Bobby’s fear was of any lumpy food. It is unknown what triggered his phobia, but often a bout of vomiting or choking can provide the trigger, according to “Eating Disorders: A Parent’s Guide, Revised Edition" (Penguin Books, Ltd.; 2004.) For example, a child who suddenly vomits due to the sudden onset of stomach flu may associate the very last thing he or she ate with the flu. Any other foods similar in taste, smell or texture may also be avoided. If left untreated, the list of forbidden foods may keep on growing.
Not every child with food phobia or selective eating disorder will need to be hospitalized but it is a definite possibility, especially if the child is becoming dehydrated. Vanderbilt University recommends keeping a malnourished, food-phobic child for about six weeks in hospital care so that the child has the structure to ensure it learns to eat.
Medication may be necessary in rare circumstances in older children. Many children with food aversion also suffer from anxiety disorders or depressive disorders. Many antidepressants and anti-anxiety medications increase the appetite as a side effect. However, these medications are usually considered too strong for children under 18.
Talk therapy is only useful if the child is old enough to pay attention and realize the consequences of its actions. But a family group session may help doctors to train the parents how to reward their children. Matthew K. Knock of Yale University writes abut a 4 year-old Latino boy that constantly spat up food or refused food The boy and his parents that were given 21 one hour sessions over 27 weeks to help the boy become more used to different foods. He was given small presents like stickers if he finished half of the food on his plate.
Bad behavior was ignored or the boy was given a time-out and then returned to the plate of food. He was asked to do very small things such as touching a spoon in order to get verbal praise or rewards. The eating process was broken down into steps that could be rewarded. First he touched the spoon, then held the spoon, then placed the spoon into food, then lift up the spoon and finally to place the loaded spoon in his mouth. Over time, food became associated with praise and rewards rather than vomiting or choking. After six months, he was eating almost normally.
Vanderbilt University Psychology Department. “Effective Treatments for Anorexia or Food Refusal in Children." Hannah Vaughan. http://www.vanderbilt.edu/AnS/psychology/health_psychology/FoodRefusal.htm
Daily Mail. “The two-year-old boy that will only eat yoghurt." 26 June, 2008. http://www.dailymail.co.uk/health/article-1029683/The-year-old-boy-eat-yoghurt.html
“A multiple-baseline evaluation of the treatment of food phobia in a young boy." Matthew K. Knock. “Journal of Behavior Therapy and Experimental Psychiatry." 33 (2002) 217–225. http://www.wjh.harvard.edu/~nock/nocklab/Nock_Food%20phobia.pdf
“Eating Disorders: A Parent’s Guide, Revised Edition." Rachel Bryant-Waugh & Bryan Lask. Penguin Books, Ltd.; 2004.