We are wrapping up our series on Picky Eating.  If you are new here, check out the previous posts that have built up to this one.

I’m often asked what parents can do to get their kids to eat healthy.  While there are no quick fixes, I’ve gathered a list of proactive, research-based actions parents can take to positively influence their kids eating habits. 

While doing my research, I ran across an intriguing article in Choices magazine titled “Smarter Lunchrooms.”  It discusses how to use behavioral economics to create healthier habits in school cafeterias.  The authors, David Just and Brain Wansink, said something that struck a chord with me:

“When people feel coerced into doing something, they often react to this coercion by intentionally rebelling…. Thus, when people feel as if they have freely and consciously made a decision, they take ownership of that decision and tend to have a greater enjoyment of the outcome.”

The bottom line: we need to ditch the old ways of nagging kids to eat their fruits and veggies and make healthy eating positive, delicious and something kids will want to do when their parents aren’t around. 

So with this in mind, let’s see what actions parents can take to help little ones prefer healthy fare: 

1. Eat well during pregnancy & lactation: Helping kids accept nutritious fare starts at conception.   The amniotic sac not only transmits nutrition but the flavors of the food eaten.  Studies show that the wider range of flavors babies are exposed to in utero and through breast milk, may help to increase their preference for a more diversified diet later on.

A 2001 study published in Pediatrics assigned 46 women to consume either water or carrot juice for 4 weeks prenatally.  When the infants were given carrot flavored cereal at 6 months of age, the babies whose moms drank the carrots juice had few negative expressions and seemed to enjoy the cereal more.

 2. Get in as much variety as you can: Most babies and toddlers under two are willing to eat just about anything.  Research suggests that the more dietary variety kids get in the very early years, the more accepting they will be later on. 

So start with bland fruits and vegetables but up the ante.  Use herbs, spices, garlic and onions to make food taste good.  Once kids can eat table foods, let them join you at the dinner table.  Your mission is to get them to try as many flavors as possible.  

3. Make the unfamiliar familiar (and accessible): Research suggests that repeated exposure is the most powerful tool when it comes to helping children accept new foods.  A 2003 study published in Appetite showed daily exposure was much more effective than nutrition education or doing the same old thing.

But experts in behavioral economics say parents need to go a step further by making healthy foods highly accessible.  So lay out an attractive bowl of fruit on the kitchen table.  Include veggies with dip with meals and while you’re preparing dinner.  Studies show the visibility of food increases desire to eat it.

4. Show them how it’s done: “I’ve learned that at this stage, they so much want to be like their parents, so if I’m enjoying a nice green salad and broccoli or asparagus, they want to try it too,” says Lauren O’Connor, MS, RD, dietitian and mom of twin preschoolers.

Now this may not happen automatically for every kid, but research supports the notion that kids are more likely to eat a food when they see their parents eating it.

5. Make time for family meals: Family meals combine the benefits of repeated exposure with role modeling.  It also teaches kids how to behave at the dinner table and gives families time to connect.  I know your schedules may be wacky, but get this habit going as soon as you can.

Kathleen Cuneo, PhD, from Dinner Together says that switching from special kid meals to family meals was the turning point for her now teenage daughter. “I saw a positive change when I stopped nagging her and we made a commitment to family meals,” she says.  “When I backed off and she was expected to eat from what was made available, she became open to trying new foods.”

6. Entice them with food names: Parents can learn something that restaurant owners already know — you need to make food sound tantalizing.   In his studies, Brian Wansink author of Mindless Eating, demonstrates that the name we give a food can make a big difference in how children perceive it.  In one of his studies, when the researchers called veggies names like “X-ray carrots” or “princess peas” kids were 60% more likely to try it.

“Dinosaur broccoli reminds kids of dinosaurs – and they think they are cooler,” he says. “Re-naming food increases its appeal”

7. Use familiar sauces & dressings: Research suggests that children are more likely to accept new foods if they are similar to other recipes they like. In a previous post, Alexandra Logue, PhD, Psychology Professor and author of  The Psychology of Eating and Drinking, discussed how some fussy eaters are super tasters — and she used to be one of them.

When she first started eating salad her mom put a lot of her favorite dressing in the bowl and a small amount of vegetables.  Over time the dressing quantity decreased and the vegetables increased.  This is how she learned to like salads.   

8. Engage them in the process: Julie Negrin, certified nutritionist and cooking instructor, knows that getting kids involved in the kitchen can transform their relationship with food.  She says that because kids feel little control over their day to day environment, helping with meals gives children a sense of ownership and makes it more likely they will eat the meal.  

“I encourage parents to have kids pick out new vegetables at the market or flip through cookbooks for menu ideas,” she says.  “Kids have been helping with the meal preparation in almost every culture for thousands of years. It’s how they find their place in the “tribe” and the world around them.”

We’ll talk more with Julie Negrin in September when her book, Easy Meals to Cook with Kids, is released.

9.  Help them make the health-body connection: When certified pediatric dietitian, Angela Lemond, works with frustrated parents, she teaches them the three Es:  Educate, Expose and Empower.  The education part is helping kids understand how certain foods relate back to the health of their body.

“I tell my kids how fruits and vegetables have super-powers,” she says. “For example, I explain how these super powers put an imaginary shield around their bodies protecting them from germs and helping their boo-boos heal faster.”

10.  Try new foods when they are hungry: You probably notice there are times of day when your child is more hungry than others.  Work with your child’s natural appetite rhythm.  If they typically eat small amounts at dinner but seem ravenous at lunch, try new foods then.  And watch the in-between meal snacking and juice drinking that can be appetite killers.

11. Go for the crunch:It’s not always the taste of veggies that turn kids off it’s the texture.  Researchers from Wageningen University provided kids (4 to 12) carrots and green beans that were steamed, mashed, grilled, boiled and deep fried.  The kids preferred the boiled and steamed versions.  Why?  Because they were crunchier, had little browning and less of a granular texture.

So experiment with different crunchy textures and see how it goes. 

12. Pair the new items with old standbys: Lisa Gross, dietitian and mom of two young kids said that when her daughter was two, and turned ultra picky, she was tempted to provide her with only her favorites (she loved pasta!).

“I just kept offering the same food we ate but always offered fruit, bread and some accompaniant that she would eat,” she says.  “I hoped that she would outgrow this stage and now that she’s five it’s much better.”

13.  Serve fruits and veggies first. According to a 2010 study published in American Journal of Clinical Nutrition, preschoolers served bigger portions of vegetables as a first course at 47% more.

So put out the fruits and veggies while you’re putting the meal together, your kids might eat whole serving of fruits and vegetables, and then some.

14. Make nutritious food fun: When a group of 4 to 7 year olds were presented with two versions of fruit, one cut into fun shapes and the other not, the kids presented with the fun shapes ate twice as much fruit. 

While the researchers of the study published in Appetite say that the novelty can wear off, it’s important to remember that kids like fun.  And if we can present food in a fun and attractive way it can pique their interest and desire.    

15. Give them a choice: According to Smarter Lunchrooms, requiring kids to take a vegetable at school has no impact on consumption.  But if kids are given the choice between two veggies, they consume 20 percent more.

When you can, have your child decide between two items, the peas or carrots, banana or cantaloupe.  This helps them feel like they made the decision of what vegetable to eat.  And they might respond by eating it.

Get a big picture view

Sometimes when I’m all caught up in what my three-year old is (or isn’t) eating I have to remind self of the big picture.  She is learning to eat.  I’m providing her with a variety of food.  Her food environment is positive.  She’s going to turn out just fine. 

When you think about it, picky eating is really a parent problem.  Jennifer from The Mommy Archives said it well, “One of the feeding issues I had was with me.  I realized that I was the one that was panicking when I made a meal and he wouldn’t even try it. I would be so worried he wasn’t getting enough nutrients.  Once I let that go, and let him set the pace of trying new foods, our meals became so much less stressful.”

I hope this picky eating series has helped you look at feeding a little differently.  Stay tuned for more series including “how to manage sweets” and “essential nutrients healthy kids miss.” And don’t forget to visit our other series including Family Meal Planning and Eating Disorder Prevention.

Previous: 10 Pitfalls to Avoid When Feeding Picky Eaters

 References

1. Mennella JA, Jagnow CP, Beauchamp GK, Prenatal and postnatal flavor learning by human infants. Pediatrics. 2001 Jun;107(6):E88.

2. Cooke LJ, Wardle J, Gibson EL, Sapochnik M, Sheiham A, Lawson M. Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children. Public Health Nutr. 2004 Apr;7(2):295-302.

3. Wardle J, Cooke LJ, Gibson EL, Sapochnik M, Sheiham A, Lawson M. Increasing children’s acceptance of vegetables; a randomized trial of parent-led exposure. Appetite. 2003 Apr;40(2):155-62.

4. Spill MK, Birch LL, Roe LS, Rolls BJ. Eating vegetables first: the use of portion size to increase vegetable intake in preschool children. Am J Clin Nutr.2010 May;91(5):1237-43. Epub 2010 Mar 10.

5. Tanofsky-Kraff M, Haynos AF, Kottler LA, Yanovski SZ, Yanovski JA. Laboratory-based studies of eating among children and adolescents. Curr Nutr Food Sci. 2007;3(1):55-74

The previous article in our series on picky eaters discussed why kids eat the way they do. Now it’s time to step back and consider how the way we feed children impacts their eating habits and food preferences over time.

One quick caveat. This article is not to meant to add to the already overwhelming guilt parents face when it comes to feeding their kids. Instead, the goal of this post is to help parents understand why certain feeding strategies fail and others flourish. When you understand the why behind feeding, it’s easier to make a change.

So with that in mind, let’s review the 10 common mistakes parents make when feeding picky eaters:

1. Catering to kids: Board Certified pediatric dietitian Angela Lemond, RD who blogs over at Mommy Dietitian, said the common feeding mistake she sees in her practice is short-order cooking. These are parents who make another meal when their kids say they don’t like what’s being served.

“Parents are so concerned kids won’t get the nutrition they need that they operate out of fear,” she says. “They don’t realize that letting their kids decide what to eat exacerbates the issue.”

In Child of Mine, Ellyn Satter’s explains it clearly: Making an alternative food so readily available tells your child louder than words can say, “I don’t expect you to learn to eat your meals.” Remember that your child wants to grow up with respect to eating, but she will take the easy way out if it is offered.

2. Not considering children’s food preferences: In our last article we talked about how truly scared kids can be when it comes to trying new foods. So while you don’t want kids to dictate the menu, you also want them to look down at their plate and see something that is familiar.

Christina over at Spoonfed blog said it perfectly in one of her comments: I’m not a fan of “eat-this-or-eat-nothing. So by offering the new items in addition to items you know the kids like (as part of the family meal, not by special order), you avoid that ultimatum while still exposing them to new foods.

3. Asking kids what they want: Does this sound familiar?
Parent: Do you want a turkey sandwich for lunch?
Child: No
Parent: Do you want a quesadilla?
Child: No
Parent: What do you want?
child: The same Chicken sandwich we have at grandmas.
Parent: We don’t have time for that. What do you want???

Young kids exert their independence whenever they can which may be why they tend to reply “no” to food offerings when asked. It’s much better for parents to decide what’s for lunch. Giving picky eaters the choice between two items works well.

4. Feeding on demand:Feeding babies on demand makes sense but it doesn’t work for older children. First off, toddlers don’t always know how to communicate hunger until a meltdown implodes and older kids can use pretend hunger to get what they want (my daughter is always conveniently hungry when we go to Vons where they have free cookies). This type of feeding can also lead to grazing and poor behavior at mealtime.

Jennifer from The Mommy Archives implemented planned meals and snacks with great results: One of my biggest issues with my little guy is that he would literally get up from the kitchen table and exclaim ‘I’m still hungry, can I have a snack?’ The first time I explained to him that I had a snack planned for him later he said ‘OK’ and walked out of the kitchen. It was literally that easy. Planning the snacks has set his expectation that next meal would indeed come and that he couldn’t just snack when he wants to.

5. Over praising healthy eating: If you’ve been following the parenting literature, you’ve probably heard that over-praising kids can have negative effects on their motivation.

An article in Parenting Science does an excellent job of summarizing the research in this area. In the article, Gwen Dewar, PhD, makes this interesting point about praising kids for doing what they love to do anyway.

…suppose that Adam loves to eat broccoli. But every time he eats broccoli, his mom praises him for it. Consciously or unconsciously, Adam starts to question his motivation. Is he eating broccoli only for the praise? Adam changes his attitude toward broccoli-eating. It’s a chore, not a pleasure. If the praise ends, Adam loses interest in eating broccoli.

6. Pushing veggies: When I asked Jennifer Orlet Fisher, PhD, Associate Professor in the Department of Public Health at Temple University, the one thing she wants parents to know about feeding, she said: “The goal should not be to get kids to eat vegetables, it should be to make sure they like them.”

As she discussed in the last article, vegetables are not naturally preferred by kids and take time to be accepted. Instead of pushing the veggies, parents can focus on making them attractive and available to kids.

After all, studies show pressuring kids to eat healthy foods decreases their preference for such items. And which salesman are you more likely to buy from? The one who is in your face, pushing his product or one that sits back with an attractive looking product enjoying it himself?

7. Using food as a reward: A while ago I was reading a blog where the writer admitted to making her kids eat more food, like veggies, in order to get dessert. She said she knew “the experts” say not do this but she does it because it works. Her kids eat their vegetables and that makes her happy.

The question this mom needs to ask herself is will her kids eat vegetables when she is not around? Will they grow up liking vegetables or viewing them as obligation foods, like so many Americans do? 

Research shows that this feeding strategy not only decreases kids’ preferences for the food they are made to eat (usually healthy fare) but it increases their fondness for the “reward” food.

8. Keeping children on separate meals too long: When I recently told a room full of parents that by one year of age babies can eat meals with the family most of the parents looked at me like I had two heads. I told them that the kitchen table is where children learn to eat and the sooner kids can get there the better.

One of the moms from the class sent me an email after making the switch: My daughter is 13 months old and I was shocked to hear she should be eating with us, since she was still eating completely separate meals, very bland, usually pureed. I thought about what you told us and one night figured “what the heck” and gave her a chopped version of our adult food- she ate every single bite and loved it! Now we eat the same food every night, from curry to talapia to tacos.

9. Serving food naked: A reader wrote to me about making meals for her, her husband and her toddler: I need to realize though that a two year old probably will not be interested in plain, broiled fish fillets with steamed, unadorned broccoli.

You may like your food cooked with little fat and sauces, but your child probably doesn’t. Remember, kids prefer energy-rich food so adding dips and sauces (even butter) can aid their acceptance of such foods. We’ll save specific strategies for our next post.

10. Labeling kids as “picky eaters:” The other day at the grocery store I saw a young girl pick up raspberries asking her mom to buy them.

“Why do you want these? You NEVER eat raspberries when I buy them,” the mom replied in a stern tone.

What the mom didn’t understand was that this is how children learn to like different foods. They see it several times, they show interest, they don’t eat if for a while, they try a bite, they don’t eat it for a while, they try it again and so on. She was telling her daughter she didn’t like raspberries but that wasn’t true. Her daughter was going through the process of learning, the same way kids learn to do other things like read and write.

Lemond recently relished watching her picky-eating son take the last step in learning to like a food. Her daughter was eating carrots with dip and her son dug right in. “The process works but it takes time and patience,” she said.

This is why I like the Ellyn Satter Division of Responsibility so much. It keeps things simple — parents decide the what, when and where of feeding and kids decide the whether and how much of eating. Feeding problems typically occur when parents try to take over the kids job or children are allowed to take over the parents’ job.

Don’t miss our next — and final — post in our picky eating series where we’ll go beyond the Division of Responsibility and discuss specific, proven ways parents can help their kids grow into good eaters.

Previous: 8 Things Picky Eaters Wish Their Parents Knew

References/Resources:

Tanofsky-Kraff M, Haynos AF, Kottler LA, Yanovski SZ, Yanovski JA. Laboratory-based studies of eating among children and adolescents. Curr Nutr Food Sci. 2007;3(1):55-74

Picky Eaters — Ellyn Satter, MS, RD

It’s hard for parents to understand how a child can go from eating everything to barely touching their meals. It’s even more difficult for them to understand why kids are so reluctant to try new foods. And without a big-picture understanding of why kids eat the way they do, parents are left frustrated and upset and are more likely to make feeding mistakes.

So far in our picky-eating series we’ve helped you determine your child’s eating personality and whether or not their habits are normal. Now we are going to get to the good stuff — the why behind it all.

For those of you with babies chowing down everything known to man, this will help prepare you for what might happen in a few short months. For those in the thick of picky eating, this will help you gain perspective — and feel better overall. And for those who have been there done that, we’d love to hear how life is on the other side.

So I talked to some experts, reviewed the research and presented the information from a young child’s perspective.

1. I’m not hungry all the time like before. I know everyone wants me to eat but I’m just not that hungry. As a baby I wanted food all the time. But now that I’m a toddler I’m just not into eating as much.

After one year, the rapid growth that occurred will start to slow down. Birth weight triples the first year of life but then doesn’t quadruple until the second year. Children between age 2 and puberty gain an average of 4.5 to 6.5 pounds per year. This shows up in their meal patterns which can include days in which they seem disinterested in food. As long as their growth is on track, you can’t expect your child to eat the same amounts every day.

2. I’m really afraid. No really! New foods and certain textures scare me. I’m afraid that something bad will happen if I eat it. I wish my parents wouldn’t push it so much. Maybe watching them eat a bunch of times will help me calm down.

“Food neophobia, the fear of new foods, peaks between ages 2 and 4″ says Jennifer Orlet Fisher, PhD, Associate Professor in the Department of Public Health at Temple University. “This has evolved to protect kids as they become more mobile and are able to ingest foods.”

Fisher explains how this developmental phase has evolved from a time where fear of strange foods kept kids from eating harmful toxins. Even though people no longer hunt for food, kids are biologically driven to be skeptical of unfamiliar foods. She says food neophobia will vary in children and often matches temperament. So you might see a cautious kid also cautious about new foods and a more easy going one less afraid.

3. I want some control. I know my parents have done everything for me when I was younger but I’m older now and want some say in the matter. Plus, food seems to be such a hot button issue!

Picky eating typically starts in toddler-hood, right when kids are beginning to understand they are a separate person from their parents. Just like they do in other areas, they will test their limits during meal time as they establish a sense of autonomy. This is a very normal part of development.

4. Some flavors are overwhelming. I know my mom wants me to eat broccoli and other green vegetables but the bitter taste is too much for me to take.

“We all experience different tastes worlds,” says Alexandra Logue, PhD, Psychology Professor and author of The Psychology of Eating and Drinking.
“There’s a strong genetic component to taste preferences. It’s not kids or parents fault.”

Logue is referring to supertasters, who naturally taste lower concentrations of certain chemicals, making them sensitive to the tastes and textures of certain foods. She has firsthand experience because by one year of age she would only eat bread and milk. “I can remember as a kid how intense the flavors and textures were.”

This may be why some kids are Late Bloomers when it comes to trying new foods, as mentioned in the previous article. It is estimated that 25% of kids are supertasters. These kids are especially sensitive to 6-n-propothiouricil (PROP), a compound found in many vegetables. Logue gives tips on how parents can overcome such taste sensitivity (future post) and says it improves with time. As an adult she is now able to eat most anything (except fish).

5. I like to get the most bang for my buck. There are some foods that are just easier to like — and fill me up with less effort.

“Children have evolved to like sweet foods,” says Fisher. “That’s why fruits are highly acceptable and easy to like while vegetables are the least preferred.”

Fisher says children are actually hardwired to prefer sweet and energy-rich foods. To kids sweetness signals a food is “calorie dense” while sour and bitter indicate it might be harmful. Although this is true, kids (and adults) can learn to like vegetables through exposure and positive experiences. We’ll talk more this in the next post.

6. I have big swings in appetite. It’s weird but there are times I just could eat and eat. I get the feeling my parents want me to always eat the same amount but sometimes my body is telling me it needs more.

While growth slows early in life kids will periodically go through growth spurts where they eat more than they usually do. One notable time is the onset of puberty between ages 8 to 13 in girls and 10-15 in boys. Girls tend to gain some extra fat during this time, preparing for their menstrual cycle. We’ll talk more about this in an upcoming series.

7. I want to eat like my parents someday. I love my parents. They are super cool. I want to eat like them but I’m just not ready. Someday I’ll get there.

In Child of Mine, Ellyn Satter discusses how kids really do want to eat like their parents, even when it seems otherwise. “Because he thinks that you are great and have all the answers, when he sees you eating green beans he reasons that eating green beans must be the thing to do. You don’t have to say another word. All you have to do is enjoy your green beans. Observing that, your child will assume that someday he, too, will eat green beans.”

8. I still have a hard time chewing. I cringe when I see meat on my plate. I know I have all my teeth and have been chewing for a while but I still prefer my meats moist — and cut up some of the time.

By the time kids reach the preschool age, parents may assume they can chew and swallow like adults. In Child of Mine, Satter says young kids still have a way to go when to chewing and swallowing.

They can lose track of food in their mouth more easily and choke as they still haven’t mastered the up and back motion of the tongue to get food to the back of their mouth. Tough meats are especially problematic.

Be Prepared
“I find picky eating takes a lot of parents by surprise,” says Jill Castle, MS, RD, pediatric nutrition specialist and owner of Pediatric Nutrition of Green Hills in Nashville, TN. “It throws them off and they aren’t sure how to respond.”

Because Castle, mom of four, understood picky eating was a normal part of development, she was able to be neutral and not reactionary. Understanding what’s behind your child’s eating will help you do a more effective job of feeding.

The picky eating stage of development is long but it certainly won’t last forever. While no research can point to a certain age it stops, many of the experts I’ve spoken with say that by 5 or 6 many kids expand their palates. But how parents handle this lengthy stage of development can make a big difference in the long run, which is the topic for our next two posts.

Previous: How to Pinpoint Your Child’s Eating Personality (and Why it Helps)

Next: 10 Pitfalls to Avoid When Feeding Picky Eaters

References

Pediatric Nutrition Handbook. American Academy of Pediatrics. 6th Edition. 2008.

Wardle J, Cooke L. Genetic and environmental determinants of children’s food preferences. Br J of Nutr. 2008:99; suppl, S15-S21.

Cathey M, Gaylord N. Picky eating: a toddler’s continuing approach to mealtime. Pediatric Nursing. 2004: March-April;30(2).

You’ve all seen the articles where the writer brags about their young child eating spicy foods, clams, mussels and every vegetable known to man.  The parent gloats and takes full credit for the good eater they’ve created.  And because this makes them an expert, they offer up advice which is usually something like “Don’t change a thing, just give your kid EVERYTHING you eat!”

Those parents with less-than-adventurous eaters may feel a pang of guilt for not offering their child clams or super-spicy foods.

But something vital is missing from these all-too-familiar messages about feeding: all kids are different.  While parents have a strong influence over their child’s eating over time, each child comes into the world with their own eating personality.  And figuring out what that is, and working around it, can help parents and children immensely.

In part one of our Picky Eating series, we helped you rule out whether or not your kid’s picky eating habits are normal.  Now we are going to classify normal eating behavior to help you better understand your child. One quick note: if your child is under two their true eating personality may not be revealed yet.

Eating Style Types

In Ellyn’s Satter’s book, Child of Mine: Feeding with Love and Good Sense, she discusses findings from pediatrician and researcher Clara Davis.  In one study, Davis observed how children accept a variety of foods over time.  As a result, she classified children’s food acceptance in one of three ways. Take a look to see where your child fits: 

The Enthusiastic Eater:  These eaters will try and accept new foods easily and learn to like a variety of foods sooner than most children.  Like some kids learn to talk or read early, these little ones are quick learners in the food department. 

The Steady Accumulator: This is the category in which most kids are likely to fall.  They are cautious with new foods but over time, very gradually, add a variety of food to their repertoire.

The Late Bloomer:  This eating personality often shows up when solids are first started.  These children are extremely cautious with food and may take until middle childhood to learn to like a variety of foods.  While we’ll talk more about the why of picky eating in the next post, some believe these ultra-cautious kids may be “super-tasters,” and are much more sensitive to the taste and texture of foods. 

Temperament

Once you understand how your little one accepts new foods, you also have to consider their temperament.  Are they stubborn?  Easy going?  Somewhere in between?

Why does this matter?  It’s good to know if your kid does better with encouragement or not. Stubborn children are more likely to rebel while easy going kids might do fine with a little push (no forcing of course).

My three-year old is the in-between child, meaning some encouragement is okay but too much turns her off.  I mainly talk to her about trying new foods when she’s not eating.  Like a lot of kids, she takes pride in trying the food on her terms, when she’s ready.  But an easy going, enthusiastic eater is likely to accept encouragement easily.

How much they eat

I just went to a barbecue where I met an enthusiastic eating 7-year old girl.  Before dinner she snacked on fruits, cheese, vegetables and crackers.  She even made her own cracker sandwich with dried fruit and veggies.  I thought, if this was my daughter, there’s no way she would touch her dinner after eating that.  But this girl ate her entire dinner plus 2 servings of dessert.  Oh, and she was tall and thin.

Just as kids accept a variety of food differently, they also eat different quantities.  Bigger kids do not always eat more food than smaller ones.  Each kid comes with their unique metabolism determining how fast or slow they burn calories.

If we try to force kids with little appetites to eat more, they eat even less.  And if we try to restrict kids with big appetites, they’ll want to eat more.  As parents, it’s important to recognize that different kids need different amounts of food. 

Use it to your advantage

My daughter was a great sleeper from day one and responded VERY well to sleep advice.  My son was colicky and did not.  Luckily I armed myself with information about colic to help me get through the tough first 4 months.  I had to accept that my son was not like my daughter in terms of sleep but I also knew he could end up a good of sleeper if I stayed the course.

As a parent you already know your child’s way of eating extremely well.  But if you find yourself constantly frustrated, it’s probably because you are attempting to change an eating personality that is unchangeable.  Maybe you are trying hard to get your late bloomer to be an enthusiastic eater.   Or you are overly pushing your stubborn child to try new foods.  Or you are trying to make your love-to-eat child eat smaller amounts like other kids.

But the best news is that all kids can grow up to be healthy and happy eaters.  It’s just the road to get there will be different for each unique child.  And this series will provide you with the tools you need to be successful.

So I’m curious.  What kind of eater(s) do you have at home?  I have a Steady Accumulator who is semi-stubborn and eats a huge breakfast, medium lunch and picks at dinner.  My littlest one’s eating personality is yet to be determined.

Previous: How to Tell if Your Picky Eater Needs Help
Next: 8 Things Picky Eaters Wish Their Parents Knew

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Expert Profile: Diane Keddy, MS, RD, FAED is a Nutrition Therapist and a Fellow of the Academy for Eating Disorders. She has treated men, women and children with eating disorders, including selective eating, for the past 25 years. Currently she is in private practice in Newport Beach, CA.

If all children accepted the food parents gave them, feeding kids would be easy. In fact, this is usually what happens the first 18 months to 2 years of a child’s life.

But then one day the same child who ate almost everything starts to say “no” and reject foods. In the eyes of a child, new foods can be scary and intimidating. And parents are left unsure what to do, afraid their little one will become deficient in key nutrients.

Welcome to Raise Healthy Eaters’ picky eating series. Here we’ll talk about why kids eat the way they do and what parents can do about it. I believe what happens during this lengthy stage of development can have a big impact on a child’s future eating.

But before we get into what is normal for most kids in terms of food choice and eating habits, it’s vital to discuss what isn’t normal. There are times when kids may require professional help if they are to become normal eaters.

Selective eating
Selective eating is picky eating that persists into middle childhood and beyond with an extreme reluctance to try new foods. Unlike eating disorders, there are no body shape issues and weight of the child can vary, with many children being underweight.

“Most pediatricians are missing it,” says Diane Keddy, MS, RD , FAED, a nutrition therapist who has worked with selective eaters for 10 years. “The longer parents wait to get help, the harder it is to treat.”

Now this doesn’t mean that any 10-year old picky eater has selective eating. Keddy says these kids only accept a very narrow range of (usually white) food. The typical list includes pasta, macaroni and cheese and gold fish and some will drink milk.

Selective eaters tend to only eat their accepted foods at home even if someone else is making it the exact same way. When they try a new food it’s common for them to choke, gag or even vomit which leads to their anxiety about eating. Keddy explains that this is neurological because the part of their brain that recognizes food as pleasure is underdeveloped.

Typically by age 6 kids really start expanding their palate but with selective eating this doesn’t happen, making social activities anxiety-ridden for the child. They often fall off the growth charts and can experience slow bone growth if left untreated.

Who gets it?
“Children with a family history of autism, eating disorders, OCD and severe picky eating are at greater risk for developing selective eating,” says Keddy. “With autism spectrum disorders (ASD) on the rise, selective eating is becoming more common.”

A recent study published in the Journal of Pediatrics, showed that while both ASD and non ASD children had picky eating, the ASD group refused more foods and had a smaller repertoire of foods they would eat. As a result, these children had insufficient intakes of vitamins A, C, D, zinc and calcium.

This doesn’t mean non ASD children can’t become selective eaters, but it appears to be more common in children with ASD.

The treatment
Keddy says that the treatment for selective eating is very different than what she recommends for normal picky-eating kids. The division of responsibility of feeding does not work with selective eaters. She utilizes a treatment called “systematic desensitization.”

Children are first put on medication to treat their anxiety. Once their anxiety is reduced and they are better able to relax, she works with them on trying different foods. For each new food they try, the parents give them some kind of non-food reward.

She describes it as a negotiation, where kids are allowed so many “pass” foods. She says the treatment takes a lot of energy and commitment from parents, but it’s worth it. Based on her own experience, she estimates that about 80% of selective eaters eventually become normal eaters.

What worried parents should do
“Parents know their kids best,” Keddy says. “If they sense something is wrong, they should seek professional help.”

Keddy says to start with the pediatrician and if they can’t refer you to anyone, find a dietitian that works with eating disorders. She says that even if the pediatrician says your child’s eating behavior is not worrisome, it’s worth it to get them evaluated. “It can’t hurt,” she adds.

The sooner kids get treated for selective eating, the better off they’ll be. Keddy says the average age she sees kids are 10. But children often display signs at much younger ages, typically starting around ages 3 to 4.

And if left untreated, kids who are selective eaters will grow into adults who can only eat a short list of foods. This not only negatively impacts health but hampers social activities where food is often the central part of gatherings.

So when in doubt, get your child evaluated. If this isn’t an issue for you, stay tuned for our next post in this series about the kind of little eater you have at home (and why it matters!).

Next: How to Pinpoint Your Child’s Eating Personality (and Why it Helps)

References

Bandini LG, Anderson SE, Curtin C, Cermak S, Evans EW, Scampini R, Maslin M, Must A. Food Selectivity in Children with Autism Spectrum Disorders and Typically Developing Children. J Pediatr. 2010 Mar 31.

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