Food and foster children

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• Author:Sarah Scotland
• Published:May 2022
• Country:

Food and foster children

An introduction to food and nutrition when looking after children in care

About the author, nutrition expert Sarah Scotland

This page has been developed by Nutritionist Sarah Scotland who is dedicated to helping communities with nutrition and developing healthy relationships with food. She works with carers and children, including areas such as learning difficulties, domestic violence, and families in crisis.

Through her own organisation, Wise About Food Sarah works with councils, community organisations such as the YMCA and housing groups. She now brings her knowledge and experience into the world of foster care.

Sarah has developed this page in conjunction and directly with foster carers themselves from around the UK.

Introduction to food and foster children

Trying to support children as a foster carer can be one of the most difficult and challenging jobs. Patience, perseverance and belief are all words you need.

Children will arrive with you at very different ages and often with very different needs. So often, however, their issues are similar, as are their instincts around food.

Background

There are many reasons why children who come into your care might have issues around food, some of these are:

• They might be malnourished, they may have been neglected.
• Their trauma and attachment issues affect everything, including food and eating.
• They might be anxious and stressed around or about food.
• They might worry that they are not going to be fed due to previous experiences.
• They may find comfort only in foods that are familiar to them.
• They might be on the autistic spectrum with ADS, if so have a look at our FosterWiki page ‘Autism and Food’.

Possible issues and behaviours around food:

• A feeling of being overwhelmed around food and eating.
• Hoarding.
• Not eating at mealtimes but eating secretly or alone.
• Getting upset if food is limited or taken away.
• Eating only familiar and “safe” foods.
• Eating too quickly and putting too much into their mouths, worried that the food will be taken away.
• Not confident eating with others.
• Used to different eating patterns, behaviours and routines.

Other areas to take into account:

• Food is a really emotive subject and can be used in many different ways.
• Food is often used as an emotional fix – often the wrong foods are eaten.
• Trauma is a huge pull for food, and can often result in overeating and the cues of fullness to be buried deeply. If this is the case then don’t be afraid to seek expert help, counselling can be a great way to support and allow to move forward. In the first instance speak to the team around the child.
• Are they religious – how does this affect food choices.
• What are the Likes and dislikes?
• Are there any medical issues?
• What is the child’s relationship with food?
• Food and mood – how can this be affected?
• Food and behaviour.
• Dental hygiene.
• The eating environment.

How can foster carers support children?

Thinking Adequate Nutrition

Children might very well come into foster care who are malnourished, they might very well have issues with food and be what is termed “food insecure”, not knowing where the next meal is coming from.

It is important to try and address these issues by offering nutritious foods. However these foods might be new to a child, they might have never eaten a piece of fruit before or eaten any vegetables.

Be aware of what foods are eaten and liked and when the child feels more settled then think about introducing healthy foods for them to try.

Getting children to help plan meals, cook, and shop can help them to understand not only where foods come from but how they can be made into yummy food dishes they can try.

Malnutrition

Children entering our care often come from families that may be in poverty, the neglect, even unintentional, can include a lack of sufficient food and nutrition.

The key signs that should be looked at to showcase whether malnutrition might be an issue are factors such as:

• Unintended weight loss.
• Tiredness.
• Low mood.
• An increase in infections.

In children, this can be identified more specifically as a failure to grow and unexplained behaviour changes such as being irritable, anxious or sluggish.

Childhood malnutrition is also on the rise due to children living with parents who are suffering from food insecurity.

The long-term effects of malnutrition

The lasting effects of malnutrition on children include long term issues such as increased incidence of illness and gastrointestinal infections, which compound and make it harder to fully absorb nutrients.

As such, malnutrition combined with infection can undermine a child’s growth, and in the long term can also undermine brain development, causing delays in motor and cognitive functions.

Furthermore, diseases which were eradicated from the UK and we are now only familiar with in books are actually making a new appearance in hospital admissions.

These include diseases such as scurvy and rickets. Scurvy is caused by a deficiency of vitamin C and rickets by a lack of calcium and vitamin D.

These illnesses are therefore a result of children not consuming foods rich in nutrients.

Causes of malnutrition

Money is a huge issue. Food poverty has increased dramatically during this pandemic and is a major source of concern. Children have been missing school and nursery which has also meant that they have been missing out on free lunches.

The Trussell Trust has had an 81% increase in food parcels due to household isolation and job losses, demonstrating that many families are struggling to put food on the table.

Data from the Food Foundation revealed in May that almost a fifth of households with children had been unable to access enough food in the preceding weeks, with children not getting enough to eat as already vulnerable families battled isolation and loss of income.

Another crucial factor in child malnutrition is inaccessibility to the right kinds of foods containing important nutrients. Cheap food is often energy-dense but does not provide the nutrients that are needed for growth and repair.

Money has a big influence on food choices and the equipment needed to make nutritious healthy meals.

The child’s relationship with food

Being aware of why a child might have a difficult relationship with food is a big part of the picture and can require a high degree of patience and understanding.

Memories can easily be triggered around foods, and they can be either positive or negative.

Food insecurity

Children who enter foster care often suffer from food insecurity in many different ways for instance:

• Has food had to be fought for?
• Was it taken for granted that they would get fed three times a day, or was this a luxury and food on the table was an unknown?
• Children in care will often have experienced a fear around food, that is linked to trauma, attachment and resulting fear and anxiety.
• This can often lead to behavioural issues around food, hoarding being one of the most prevalent.

What can help with food insecurity?

• Offer a safe place for food storage, a drawer, a shelf on the fridge – let them know this is theirs and it will always be filled up for them.
• Encourage security – have meal times together and make them fun. However, sitting together and eating is not something that might happen straight away. There might be anxiety and insecurities, so give it time and be patient.
• Children may worry about their eating habits and how they appear to other people and be really self-conscious, this again needs patience, time and reassurance.

It may be a short list because they haven’t tried a variety, but later you can start adding things to see if they like it. Get them to understand it’s ok to try new things but also to say if they don’t like it.

Make a cookbook together of favourite foods and build on that and keep a food diary so you know when they may be stressed and try and overcompensate for this.”

To hoard or not to hoard

The jury seems to be mixed about this, but generally is on the wavelength that is it is best to allow a child a special stash that is all theirs, it does not take long before they get more confident and feel secure enough not to hoard.

The worry often is that a child will eat all the extra food and not be hungry at mealtimes and miss out on quality family time, again this needs time, patience and understanding.

They know it’s theirs, I put all sorts of things in it for them to have when they want.

Sometimes they like to know what’s going in and sometimes they like a surprise. It’s surprising how quickly they no longer feel the need to hoard.”

Sugar and all things ‘bad’

Food is an emotive subject and one that can be used as a means of control. As foster carers, try as much as you can to ignore the bad eating behaviours, however hard this is, until at least you know the child well.

Don’t show a child you “disagree” with them eating certain foods, as they may feel judged, especially as this will more than likely be what they ate when with their own family, and it may feel familiar, comforting and a coping mechanism in the strange “fostering2 world they have found themselves in.

Again given time, patience and understanding they will develop confidence, will try new things, and feel more at ease around food.

Foster carer’s comment

So, the older teen got her boyfriend to put money in her bank so they could have a takeaway.

One had kebab and chips, the other had pizza and chips and 2 cans of full-fat coke each, delivered to the door! Enjoying unhealthy treats is fine as long as they aim for a balanced diet most of the time, once a month won’t kill her and it is a great comfort to her.

I’d say generally back off and set good examples. Don’t use food either as a reward or as a punishment.”

It is also important to remember that whilst we are striving for a nutritious balanced diet, this will take patience and time to develop given all those additional challenges.

Whilst there are general nutritional guidelines on the best foods to eat do not get hung up on ‘good’ or ‘bad’ food with children in care, try to frame it differently and encourage them to stay curious and adventurous around food, which they may not be, to begin with.

Always remember that treats are ok and often give our children great pleasure, so whilst focusing on good nutrition remember that they are children at the end of the day who like a bit of chocolate and an occasional McDonald’s!

Food and Mood

Psychological experiences can affect our food choices and allow us to yearn for those unhealthy food choices which we call comfort foods and become a barrier to maintaining a healthy diet.

These feelings are often only temporary but will reflect our mood. There is a longstanding relationship between nutrition and mental illness.

• Being irritable, suffering from mood swings having headaches or generally finding it difficult to concentrate can all be signs of food having an effect on mood.
• It is always difficult to remember what has been eaten and drunk – You could encourage your children to keep a simple food diary and write down emotions as well. Are there any certain triggers?
• There are lots of other reasons as to why the mood is affected, such as stress and anxiety in their everyday lives, however food can work on receptors in the body and affect mood too.

Foods that can help with mood

• Lots of fruit and veggies – Eating a balanced but varied diet will help ensure that a variety of nutrients are being consumed, as well as fibre and water.
• Vitamin D is difficult to source from food and is mainly got from the sun.
• Fish is great for mood, not all children will like fish, but you can get inventive, and there are all sorts of ways of hiding fish if they have an aversion to it, including fish fingers, fish cakes, and maybe a fish pie.
• Try to include foods that contain polyunsaturated fats such as nuts in the diet as well as oily fish for essential omega 3 oils.
• Try eating more low release foods such as protein or low GI – these will keep your blood sugars at a steady-state avoiding ups and downs. Examples of low GI foods are porridge oats, whole grain cereals, beans and lentils, basmati rice, corn tortillas, sourdough bread and as always a great selection of fruit and veg.

Foods that may have an adverse effect on mood

• Try and limit the number of processed foods. Mood swings may be linked to heightened inflammation markers which may be caused by processed food.
• Too much Sugar, remember sugar can be hidden in other places such as highly processed foods.

Always make changes slowly

Do not bombard your child or young person with very sudden changes, for a start, it may make them feel more insecure, anxious and worried and may put them off trying anything new. Go slowly, be patient and understanding.

Be child-centred and therapeutic in your approach to food as everting else.

What does a balanced diet look like?

Most people and all foster carers will know the basics of a balanced diet these days.

A minimum of 5 portions of fruit and veg a day, a good variety of foods to ensure that adequate amounts of iron, calcium, zinc, vitamins A and C are consumed and reducing the frequency of processed foods and sugars.

Drink water

Staying hydrated is very important and being dehydrated can really affect mood. Water is best, however not all children like to drink water, so sugar-free squash and other alternatives, but not fizzy drinks such as coke.

The body is almost all water so it’s good to keep it topped up.

Eat regular meals

Breakfast is the most important meal of the day – try and encourage your children to eat breakfast. Routine is often important in the care of looked after children, and routine will also help them feel safe and secure if they have food insecurities.

Healthy snacks are great in between meals to keep blood sugar levels and make sure they have enough energy.

Vitamins and minerals

Vitamin D
This is more a hormone than a vitamin and really is only available from the sun. This is a vitamin that can be supplemented, a simple spray works really well, but always check with the child’s social worker and GP before using supplements.

There are a few foods that are fortified so it is generally difficult to get from diet alone.

Iron
Iron deficiency across the world is huge and affects everyone. Iron is closely linked to the brain, well as iron deficiency anaemia.

Iron deficiency can cause developmental delays in infants and can be associated with cognitive alterations in adolescents.

If you are concerned that your child has an iron deficiency speak to their social worker and GP.

Good sources of Iron are good sources of iron include red meat, lentil, beans such as red kidney, edamame and chickpeas, nuts, dried fruit, soybean flour and fortified breakfast cereals.

Folate
Decreased levels of folate have been associated with depression and low mood. Some factors that affect absorption are Alcohol, the contraceptive pill, and anti-epileptic drugs.

Foods that contain folate are not many and it is also very volatile and gets easily lost, especially in the cooking water. Ideally use less water when cooking and use this for making sauces and soups, also consider steaming veg.

Examples of foods that contain folate are chickpeas, Brussel sprouts, okra, frozen peas, bananas, oranges, beans, peanuts, sunflower seeds, fruit juice, whole grains, seafood and fortified breakfast cereals.

Zinc
This is closely linked to mood. It is only a trace mineral so needed in small amounts. However, it plays a vital role Dietary sources are: meats, poultry and seafood.

Calcium
Important for building and maintaining strong bones. Your heart, muscles and nerves also need calcium to function properly.

Good sources of calcium are dairy (cow, goat & sheep) and fortified plant-based milk, like Soya and Almond. Cheese, yoghurt, calcium-fortified orange juice, canned sardines & salmon, Almonds.

Vitamin C
Vitamin C, also known as ascorbic acid is necessary for the growth, development and repair of all body functions and is needed for the proper functioning of the immune system, wound healing and strengthening bones and teeth.

Some sources of Vitamin C are citrus fruit, bell peppers, strawberries, tomatoes, broccoli, Brussel sprouts, cabbage, cauliflower and white potatoes.

There are lots of inventive ways to weave vitamins and minerals into even the pickiest of eaters’ diets, a quick google search will help with plenty of ideas, here for instance on the Healthline website are some fun ways to help children eat vegetables: https://www.healthline.com/nutrition/how-to-get-toddler-to-eat-vegetables

For more information on vitamins and minerals visit the NHS website here: https://www.nhs.uk/conditions/vitamins-and-minerals/

Supporting children in care with their cultural identity

Looked after children can come from very different cultures, have very different upbringings and religions, have totally different food experiences and needs.

Supporting children from different cultures, backgrounds and religions in their food needs is of paramount importance, and having a wide-ranging knowledge of these different needs is crucial for a foster carer.
Always check with the child’s social worker as to the child’s culture, background and dietary needs.

Check if the child or young person has any religious or cultural dietary restrictions, if there is a specific way food needs to be prepared or handled ask for help with this, don’t assume anything, check first.

To enable a child to feel at home and to help to reduce anxiety around food, ask them what they usually eat and try and make these foods part of the daily routine.

It may well be foods that you are unfamiliar with, so ask the children to help you, they will love getting involved and showing you part of their world, you may very well learn to like something totally different.

Here is a good article from Community Care from someone who is care experienced in identity, cultural heritage and food: https://www.communitycare.co.uk/2020/10/30/food-marker-identity-supporting-fosterchildrens-cultural-heritage/

Food Anxiety

Food and eating are a major part of home life so, at mealtimes, meals out and food are a continuance of that home and family environment, continue to create a home where everyone is valued and consistently send messages that they are safe and cared for.

• When a new child or young person is placed with you don’t immediately worry about eating a healthy diet or worrying about weight straight away.This can come in time, try and make that connection, try and help them to heal, forge a relationship that is trusting and caring, this, in turn, has a positive effect on food, diet and eating.
• Let them know there will always be food and when this will enable a routine to be established.
• Be mindful of the words you use around foods, you might think that pizza and McDonald’s are “junk food”, but try to use positive language to avoid shaming.
• Eat as a family, even if this is only two people, mealtimes should be fun, not stressful.
• Three meals a day, may not be enough, in the beginning, be prepared to serve meals more frequently.
• Always try and offer reassurance that there will be enough food.
• Make sure that there is always at least one food on offer that they like to eat.
• Get them involved, they can help to plan meals, shop for them and help cooking.
• Sometimes you may want to let children serve foods themselves rather than dished out onto their plates, then they can then take what foods they want to eat and make that decision for themselves.
• Provide a way to ensure that a non-embarrassing way of spitting out food, a napkin, or kitchen paper, lots of foods might be new to them and the taste may be unfamiliar and disliked.
• Remember as the adult, you are the role model, model good behaviour and habits around food, diet and nutrition for them.

Thinking about meal times

Mealtimes should be fun relaxed places, but so often they are the opposite. This is a time as foster carers to take a step back and understand that mealtime can be the worst time for a child, making them very anxious, stressed and fraught.

Recognise that some children will never have been used to eating big family meals around a table and they might find this intimidating or scary at first. Some might not have even eaten with a knife or fork. Be adaptable in how you welcome each child, be observant and inquisitive, work out what works for them and be willing to work together.

Foster carer’s tips and comments

Useful links about food and foster children

• Wise about food -Sarah Scotland website & training courses https://www.wiseaboutfood.co.uk/services
• FosterWiki – Food and Autism https://fosterwiki.com/wiki/food-and-autism/
• World Health Organisation healthy diet https://www.who.int/news-room/fact-sheets/detail/healthy-diet
• NHS – Eat Well, a guide to a healthy diet https://www.nhs.uk/live-well/eat-well/
• National Minimum Standards https://fosterwiki.com/wiki/national-minimum-standards-nms/