How Trauma Impacts Children and Food

[Music] Welcome back to this episode in the second series of the therapeutic parenting podcast from COECT, The Centre of Excellence in Child Trauma. This podcast provides people living and working with child trauma with effective coping strategies. I'm your host Serena Gay, and this episode is about ways to cope with the food issues that your traumatized child may be experiencing. And we're very lucky to be joined again by Sarah Dillon. Sarah is the COECT's therapeutic lead, and she is a child and adult therapist, helping people with attachment difficulties and complex and developmental trauma. She's also an author and international keynote speaker on adoption and fostering. Welcome back Sarah. Thank you for having me back Serena. Now lots of parents these days experience worrying food problems with their children. We're all aware of the high incidence of binge eating and bulimia and anorexia, but food difficulties can have a special significance with traumatized children. When we say food issues, what do we mean by that actually? We're talking about the way in which trauma impacts on a child's relationship with food and why trauma might impact on their relationship with food. So we might have things like hoarding food or stealing food or what I call taking food, yet hiding the food in certain places, maybe in your bedroom, that kind of stuff, not feeling full, constantly wanting to eat all of the time, or it could be that the child is refusing food, maybe we have issues where the child will only certain types of food or certainly where many of our children can be what I call sugar fiends. So there are lots of issues of very fussy sometimes around food. I have heard about traumatized children feeling the need to literally gorge on sugar. Why is that and what effect does the sugar gorgeing have? So we know that this arises from what could be a number of reasons, but in the main, often they have high cortisol levels, virtually all of them and there are exceptions of that rule, it's very few. So when we have high cortisol levels, we know that sugar can reduce the cortisol quite quickly and calm us, which is why many of us, when we are stressed, we were comfort because it's a release of dopamine in the brain. Now what we know is that sugar is eight times more addictive than cocaine. It lights up the brain eight times more than cocaine. There are brain scans you can view on Google about it. So it is extremely addictive. The problem that we have is once the cortisol levels go down for a little while, which again we must understand that high cortisol drives fight flight freeze based behaviors and therefore escalates certain things that the children do that we find difficult to manage. So once the sugar rush, if you like, has eased off, then unfortunately there's going to be a further spike in the behaviors. So it's a false economy if you like. It makes matters worse. So we wouldn't be able to say I don't think it's fair to say don't ever give a child sugar and quite frankly that's impossible because sugar is on all our carbohydrates, you know. So but we need to be very careful about how much sugar we allow our child to access. What else then is motivating your child to do things like spoil food for others or steal food or hide it or overeat? What's behind it? Well just to finish with what we were talking about a minute ago serena around sugar. If your child has grown up with addicts, you know, in their early life, if they were removed from an environment where there were adult addictions happening, a lot of the food that they would have had would have been just fast food or sugar related stuff food that you could kind of buy from the offline since that sort of stuff. And we've come across this numerous times. So it is the child's brain is wired for that kind of diet. So that's one of the things. Another thing could be sensory problems. So this interoception, lack of well-developed sense of knowing that they're full, or indeed to be able to fully tell the difference between hunger and thirst, which is something I still struggle with. So the child may not be able to realise that they're full. They don't get the feeling of being full. The chemicals that need to be released aren't released in the way, same way as they would be for a neurotypical child. So also it can be fear of they're not being enough food. So which is why they will take food. They will hide food. You know, they steal it and they store it and they hoard it, particularly in their bedrooms because why if nobody ever got up to you in the night and you were crying out as a baby for someone to come and feed you and nobody came. And when you go to bed at night, you know, because of a lack of well-developed sense of object permanence, which is the knowledge that even though I can't see my parent, they still exist. If that's not well-established in the child because they haven't had a consistent, predictable and reliable, available adults when they were babies, then it's a need that remains unmet. And what that actually means in real terms is that when they go to bed at night, their parent fails to exist. They are in that room on their own and they fall back into a state of trauma where they believe they're going to be left, fear of abandonment, fear of being forgotten, fear of invisibility. So they take the food as an act of survival. It's all about survival. That's the most important thing for us to remember. So there could be an underlying unmet developmental need, you know, it could be a medical problem going on. But nine times out of 10, it's through fear of not being fed or not being fed regularly. Okay. What about also though, in the case of overeating, that the sensation of having a full stomach is if you like a replacement for affection or is to simply is comforting. Yeah. Well, it's like having a big hole in utami, you know, an empty space, a big hole of abandonment, feelings of rejection, of not being good enough. You know, even children who are removed at birth, we really do need to understand that they may have significant food problems because there's that early life attachment rupture or even trauma they've been exposed to in utero in the womb. So they may have very high levels of cortisol that unfortunately will lead to them having quite significant issues around food. So therefore when we fill our stomach with food, there's a feeling for a while of being full, of being connected, of again, of dopamine. Just as an aside, and I know I'm going slightly off topic, but I do think this is very important for people to understand. Sometimes we have some parents who will have five, six, seven children, one after another and they all get taken for adoption sadly because the parent can't parent. I was asked to work with a parent just like this quite a few years ago and I said to a what's that feeling, you know, and this she was a former child in care and she said it's the only time in my life that I feel full. It's the only time in my life when I haven't got that hole in my tummy and it's the only time in my life when people call me darling sweetheart and look after me. So it's an important thing to remember. It's a big hole that needs filling. So also food is an act of nurture when we feed somebody. So our children are, they've got a nurture deficit. They're looking for food to meet that, meet that nurture deficit or as we call it, you know, the hungry heart. But so difficult in this day and age then to cope with this and not end up with a child that's overeating or, you know, over providing your child with food and ending up with an overweight child. Or a child who is underweight because they don't eat enough because they're rejecting of the nurture because you either fill a hole or you squeeze a hole but either way you want to get rid of the hole. So some of our children will restrict the food as a way of trying to, you know, stop feeling that way. It's a way of avoiding nurture as well or other children who will overeat and most of the time it is the children who overeat food and they are obsessed with food and meal times and taking food and hoarding food. But I don't want us to forget those children as well who are very fussy. They will only eat certain things or they reject nurture because they many, many of them may have some big sensory issues as well whether they're only sort of very beige, bland foods. That's another thing. And I guess this is where, you know, food allergies and problems come into play as well. If from an early age, they haven't been fed well. That may have damaged their digestion. I don't know. You're absolutely right. Many children from trauma, myself included, have problems with our digestive system. Many, many, many, many. It's like an ongoing problem because we have to remember that our gut is our second brain. So, you know, whatever we put in our gut is going to have a relationship with what's happening in our brain as well. So, yes, a lot of it is definitely feared driven about food availability as well. There are things that we can do to help that. So, first and foremost, is not to shame the child again, saying, you know, you've taken food, you've stolen food, why have you got that food? But rather so, I've noticed you've put food in your bedroom. I think sometimes you're a bit worried that you won't be fed. You might name the need and say, I think there were times when you were very little, when maybe you woke up in the night and cried for a parent and they didn't hear you or nobody came and say, you're worried about food. So, you could give the child a little tupperware box with a few food items that you can say. So, you've got this tonight. So, if you do wake up and you're a bit hungry, there are a couple of items there. So, it takes away the shame because you're meeting the need without the child having to go and source the food. Also, I, my foster mum always used to have what she called the magic bowl of fruit. So, the magic bowl of fruit was met, it was a bowl of fruit that was never empty, you know. So, when kids first moved in, they used to have diarrhea for about the first three weeks because they'd eat all the fruit you see. But eventually, when they realised the fruit wasn't going anywhere, they laid off it a bit more. So, also, we can use something like graze boxes where you, you know, put food in the different boxes for all the children in the home and you say to the child, sometimes I think you're a bit worried, there might not be enough food. So, I've got this box for you and you can help yourself to that throughout the day. If they eat all of it in one go, we'll empathise with that. So, my goodness, you ate all of it in one go, I think you're a bit worried, it wouldn't last. I tell you what though, we'll make sure that we fill it again tomorrow, but there's still the bowl of fruit. So, you're only fill it once a day, because we want the child, we're rewiring the child's brain, we're trying to promote synaptic development in their brain so that they know that food is always available. Any other preventative strategies, then, that you can think of before we actually talk about what, how you would cope, if you're in the room as your child is literally stuffing its face with sugar. Any other preventative strategies. So, the most important thing, which I call it critical, vitally important, is a visual timetable that clearly shows meal times and snack times. Children from trauma think in pictures. For some of our children, the only thing that kept them alive, or they felt kept them alive, or kept them safe when they were little, were their eyes. Children from trauma need to see what is coming next. So, they need to visually see meal times on a visual timetable and snack times. So, if the child starts to get worried about what times dinner, what times dinner, what times it we can say, look, we're just finishing doing this retie, and straight afterwards, we're going to be having our dinner. But if you're a little bit worried about food, you can get in yourself a piece of fruit, and then we'll be having the dinner then. I cannot emphasise enough the importance of visual timetables for children from trauma, because they've got to know the only way to build new synopsis in the brain is through repetition, repetition, repetition. And the way that we do that is through making sure there is a watertight routine. And when it comes to feeding, you have to feed them, have a routine that you might do with a newborn baby, whilst constantly helping the child to link their fears around food, or their issues about feeding full, or replacing the nurture deficit with food, is by linking those behaviours today to what happened to the child historically. So now, moving on to how you would cope, actually, if you like, during the act. You walk into the room and your child has got its face in the sugar bowl. What do you do? So, you might laugh, but you might be horrified and think, 'Oh my goodness, what have you done?' But the best thing to do is just say, 'I can see you've got the sugar, just a minute, I'm just going to pop the lid and I'll be straight back.' And the purpose for that is to say that you come back breathing properly. But if you're a fabulous pen, it does struggle that one. Then you might just say, 'I can see you've got the sugar.' I wonder if you thought you weren't going to be having X, Y and Z later. I can see you really like the sugar, all the biscuits or whatever it might be. I'll make sure that I put some of those in your snack box for later. But sadly, there isn't a lot left for a treat later on. So, there is a consequence, the consequences, let's say it's chocolate cake. They've eaten the chocolate cake. So there's none left for later. We'll give them something else later, but it might be, you know, a less interesting snack, you see. Sadly, we have to have something less interesting. But the most important thing here is somebody said to me recently, 'Oh, it's letting them get away with it.' Well, it isn't because it's driven by trauma. So we're helping the child to see, we understand why, and then we're helping them to link cause and effect by understanding that if I take all the chocolate cake, those none left, and sadly, that means that I'm going to have to have something less interesting like a banana. Yeah, don't be shocked by it. When you show the children your shock, shock, that's a reward to the child in the sense that, 'Oh, that one gets to you,' or it throws them into shame. And what kind of discussions then are you going to have after the act of whatever it is that they've done with food to express their inner turbulence? So one of the things that I think is important, don't ask too many questions about it. Why did you take the sugar? Why did you take the biscuits? Why did you eat the cake? Avoid the why? It doesn't help our children. What we need to do is give them the why. I think, or I wonder if you were taking that because you're a bit worried that wasn't enough to go around, you know, or I've noticed you've been a bit wobbly today. I know you've had a difficult tricky time at school and I've noticed you've been wanting chocolate all evening and then I found you eating the chocolate biscuits. I think you're using those chocolate biscuits to try and help you with those big wobbly feelings, but actually what you need is a hug. So we help the child to identify why they're doing it, where it's coming from and what they need instead. Is establishing self-control with regard to food a reasonable ambition for a parent to have with a traumatized child? In the long term, yes. In the long term. But my experience is that it's never 100% addressed because you fall back to that kind of baseline when you're stressed we regress, you know. So whenever I'm stressed, I will often, you know, go and see the sugar covered. But in the main, yes, we definitely can get it to a point where it's manageable where the child believes and trusts that the parent will feed them, but it is unfortunately a long journey. Well, thanks anyway for ending on an optimistic note, Sarah, and for taking us through how to handle food issues using classic therapeutic parenting techniques. Thank you very much. Very welcome. Thank you for having me. You can find out more about therapeutic parenting techniques through our website, www.coect.co.uk. And as I always say every week, if you'd like to receive this podcast, just press the follow button, which you'll find on the Apple or Spotify podcast apps, or wherever you access the therapeutic parenting podcast. And please rate, review and follow us, because it does mean more people will find us and benefit from our helpful advice. And that interview on food issues brings us to an end of this series of the therapeutic parenting podcast. Series three will start again in September. We're taking a bit of a break for the summer, where the theme will be self-care for therapeutic parents. And in the next series, we'll be bringing you tips and tricks on how to look after yourself during the stressful times that can arise when you're parenting children with trauma. It won't all be about glasses of wine and lovely long-hot soaks in a bath. But there'll be a bit of that. Until then.