Nutrition • Feb 13, 2015

Picky Eaters: What’s normal, and when to worry

I wanted pizza!Some meals have become a battle ground in my home. Ok, maybe that is an exaggeration, but they have started to make me anxious. I’m sure my son is anxious, at times, as well.

There are a whole host of reasons that children, especially young children, don’t eat the way we would hope.  About 25% of children are identified by their parents as having some type of eating or feeding problem. I am not sure whether knowing I’m not alone makes me feel any better, but taking the time to think about the problem when I am calm, surely has.

Basic recommendations for creating healthy feeding patterns are well established and seem logical. They include the following:

Avoid distractions during mealtimes (television, cell phones, etc)
Maintain a pleasant neutral attitude throughout meal
Feed to encourage appetite
 • limit meal duration (20–30 min)
 • 4–6 meals/snacks a day with only water in between
Serve age-appropriate foods
Systematically introduce new foods (up to 8–15 times)
Encourage self-feeding
Tolerate age appropriate mess

* from Kerzner

Ok so that seems simple right? Maybe or maybe not, there are definitely pitfalls.

– Distractions: This one is probably fairly simple and it is worth making the effort to have that focused time with your children whether they actually eat.

-Parental attitude: Ok, sounds great. Have you tried this? Not uncommonly, one adult at the table may lose their cool with a child who is struggling with mealtime. This may also create tension between caregivers. Take time to discuss your “team” approach to feeding issues outside of meal time. Determine what is most important to you, create a plan, agree on it and stick to it.

-Encourage appetite:

  • Prolonged meal times have been a problem at our table. The longer your child is at the table, the less likely he is to eat. “Waiting them out” rarely works. They are stubborn creatures and if their body/mind doesn’t want it, they won’t eat it just because you make them sit for a long time. My son has missed playtime, bath time, and other activities he enjoys and it never lead to more eating. It definitely led to problems with my parental attitude.  It is much easier to keep calm for 30 minutes then for 60 or more.  “Ain’t nobody got time for that!” Just move on with your day.
  • If your child isn’t hungry (or is very tired) he is not going to be interested in eating much and is much less likely to try new foods. More than once, schedules have resulted in a late dinner and multiple snacks have been handed over to my preschooler to ward off the persistent requests at my feet for food. I often regret this response. Limit snacks and make what is offered healthy so that you aren’t as concerned if you over-shoot your mark and your child isn’t hungry at the meal time.

– The definition of age appropriate foods varies with culture and other contexts, but it does take time for children to develop the sensory tolerance for certain flavors, spice, texture and temperature. Children whose food is precut into bite-sized pieces tend to struggle less at mealtime. Children also respond well to visually appealing foods just as adults do. Making the food look fun can help. I continue to resist this to some degree, despite knowing it to be true. My “foodie”, kitchen-loving, CSA supporting ways have brought some unusual things onto my child’s plate. Since I have a “picky” eater, it does not always go well.  This does not mean that your child should be eating chicken nuggets, etc. at every meal.

– Repeated introduction sounds easy, too. “Neophobia” is normal in children  older than one year. It is probably protective. If you don’t know it’s safe you shouldn’t swallow it. It is a useful instinct; however, you can’t eat puffs your whole life. Have you ever tried to introduce a child to a green bean 15 times? I am actually trying this right now and it isn’t easy. You can’t just do it once a month for 15 months. It has to be more immediate. I don’t want to eat green beans every night for 2 weeks. I guess this isn’t about me, though. Some kids will overcome this tendency much quicker than others.  Congratulations if you have one of those kids, I will try not to be jealous.  Try not to challenge your child with more than 1 new food at a time.

– Self feeding is the way to go when encouraging a child to eat. If they aren’t willing to put the spoon in their own mouth (assuming they are physically able), they probably aren’t going to have an easy time chewing and swallowing it. Furthermore, if you accidently gag your child who is already anxious about what’s on that spoon, you may have lost that battle entirely; in the same way that as an adult you often don’t want to eat a food that your brain has associated with nausea and vomiting.

– Mess is what it is. If you encourage and demonstrate proper table manners, your children will gradually take up these behaviors as well.

If you are finding yourself frustrated with meal time or concerned about your child’s nutrition I recommend the following strategy.

1) Make sure you are using the techniques above and try to be consistent between care givers.

2) Keep a food journal of what and when your child eats and doesn’t eat.  Make note of what the food item is and how it was prepared. This can help determine whether it is a taste issue or a texture issue, environmental , or something else. It will also help you remember your successes and you may be surprised at how many things your child actually does eat.  If your child eats less than 15 different foods this is a red flag and increases risk for nutritional deficiency.

3) Don’t force your child to eat or explicitly punish them for not eating. This can predispose you child to anxiety, obesity, and other eating disorders which have lifelong consequences. Likewise, don’t reward poor eating by consistently letting your child eat chips and desserts later on.

4)  Discuss your observations and your child’s growth curve with your pediatrician. Most often we are more concerned than we need to be and a child just needs time to grow out of this phase. Your doctor can help you sort out if a feeding problem is a sign of a more serious illness, requires therapy for taste or texture aversions, or some other nutritional evaluation. They can also help you strategize how to work with kids who fall outside the normal range of age-appropriate feeding behaviors.

5) Unintentional weight loss or rapid weight gain should never be assumed to be normal in a child and requires evaluation by your doctor.

Drs. Pingel and Berchelmann have also written informative articles on feeding issues.