Picky Eaters
10/5/2020
How to help your child become a more adventurous eat
We all want our children to eat healthy foods and enjoy eating a wide variety of foods. But often our children get into food fads or food ruts, refuse all healthy things and would prefer to exist solely on Goldfish crackers! This week we will explore picky eating and ways you can help expand your picky eater’s diet as well as prevent picky eating.
Why are some kids picky eaters?
There are a number of reasons your child may be a picky eater or refuse certain foods. These reasons include:
• Oral motor dysregulation (can’t chew or swallow properly)
• Sensory sensitivities
• Reflux
• Constipation
• Allergies or intolerances
• Fear and/or anxiety
• Previously unpleasant food experiences
• Developmental delays
• Autism
• Low muscle tone
There are also some environmental factors that can make a child picky or appear picky:
• Sitting in a chair or highchair that does not provide proper support
• TV or screen time during a meal
• Lack of properly fitting utensils (age-appropriate utensils—a regular spoon is too big for an infant or toddler)
• Grazing or frequent snacking
• Bias against a food based on parent’s reaction or presentation (ex: You say “this smells funny” before presenting the food)
What are some strategies I can use to help my picky eater?
If your child has a medical reason that may be causing their picky eating, such as oral motor dysregulation, sensory sensitivities, or low muscle tone, it is very important you discuss this with their provider. They may need occupational or feeding therapy or other interventions. That doesn’t mean you can’t also incorporate some of the suggestions we will be discussing but you may need an approach that includes outside specialists.
POSITIVE TALK
Our children follow our lead. We need to provide positive experiences with food, and this starts with how we talk about food. We recommend never labeling a food “good” or “bad”. We do want you to tell your children the benefits of the food they are eating. For example, you can say “Green foods like your broccoli help fight off sickness” or “The calcium in your milk helps build strong bones” or “Those apple and crackers help give your body energy to run and play”. Giving food a function or a job and not a label is important to developing a healthy relationship with food.
We also don’t want to “Yuck somebody’s Yum” as we say in our house! That means everyone has a right to like or not like what they want but you don’t need to ruin a food for someone else with negative comments. We also recommend not speaking negatively about new foods being presented such as commenting on smell or an odd texture. Use this time to make a positive or neutral comment such as “Doesn’t that broccoli look like a tree” or “This is salmon” or “This is dinner with the pasta you love” or even “Wow, this food feels different on my tongue, how does it feel on your tongue?” You can also set the expectation of low pressure around eating. You can say “This food is new: you can taste it”.
Most likely your child will tell you they don’t like a food. Instead of getting mad or bribing the best reaction is to PLAY IT COOL! This is exceptionally hard to do. You want to avoid fight with your child to even take on bite. You also do not want to bribe them with dessert or a treat. These actions lead to power struggles. First you can set the expectation of low pressure around eating. You can say “This food is new: you can taste it”. If they refuse, you react with NO emotion and say “You don’t have to eat that” or “It can take time to learn, you don’t like it yet” or “You don’t have to eat it today” or “I really like it, this is how I eat it”. You also need to PLAY IT COOL when they eat or try a new food. If they want acknowledgement you can say “oh, I love this food too” in a casual manner.
The biggest tip is to treat all meals and snacks as a learning experience. Learning to eat new foods is not a quick process. It will take many exposures usually over 10-20 exposure before children are ready to eat a new food. But touching it, playing with it, and smelling it are all steps on the way to new food acceptance.
MEALTIME:
There are specific things you can do during mealtime to help your picky eater. First off, eating meals together as a family is associated with increased fruits and veggie intake. Family meals can be hard with busy schedules. We often associate a family meal with dinner, but it can be breakfast or lunch and doesn’t have to include all family members (although that would be great if it did). Also avoid any screen time, such as tv, tablets, or phones, during meals. That includes parents too!
It is also important to provide a supportive seating. If your child is in a highchair, they need to have adequate hip and trunk support as well as a footrest. Many highchairs do not have a footrest but one can easily be added. Foot support is a critical component of fine motor and eating skills. As is tummy time! We often think of tummy time in terms of gross motor skills, but it also has an important role in getting muscles ready for eating. Check your highchair or booster and ensure that your child is properly supported, can brace their feet against something, and are at proper height in the chair or at the table. An older child should be in a chair where their feet can reach the ground or a footrest.
Proper utensils are also important for eating. Adult size utensils are very hard for an infant or toddler to manage. Spoons or forks should be shallow to help manage bite sizes and have a short fat handle. This helps them grasp the utensil with their small hand and helps them be more successful getting the spoon or fork into their mouth. A lip guard can also be helpful to help keep the spoon or fork forward on the tongue. For older kids, making utensils more fun can help make a meal more exciting. You can use character utensils or even chopsticks!
SCHEDULE MEALS:
Scheduling meals and snacks is the most important thing you can do for all children especially picky eaters and children trying to gain weight. Scheduled meal and snack times help children develop proper hunger cues, they learn to feel full, and they often end up eating more calorie and nutrient dense meals. Grazing leads to less caloric intake, lower nutrient intake, and CAVITIES! Your mouth needs time between meals to reset the pH or else bad bacteria build up on your child’s teeth and increase the risk of cavities, especially if these are sticky or carbohydrate heavy snacks such as crackers. And your body needs time to feel hungry! An example of a good schedule is below:
7am Breakfast
9:30am Snack
12pm: Lunch
3pm Snack
5-6pm Fruits or veggies plate for snacking to tide them over for dinner if dinner is after 6
6-7pm Dinner
A snack should include a fruit and/or vegetable, a protein and fat. Without the protein and fat, your child will be hungry before next meal and blood sugar will rise and fall too quickly. Your child may ask for crackers or sugar/carbohydrate heavy food for snack. As a parent it is your job to choose the snack. Provide a small portion of the preferred or the safe food but add a protein and fruit or veggies, such as hard-boiled egg and some apple slices, to go with it. Now if your child refused dinner or you are working on weight gain, you may incorporate a bedtime snack. This snack should be nutrient dense and not “exciting”. Good choices are a banana with peanut butter or crackers and veggies with hummus.
As for dessert or incorporating higher sugar foods this is a family decision. Some families rarely do dessert, some do it occasionally, and some do it every night. There is not right or wrong way to incorporate dessert into a healthy diet. Bu you should serve dessert with the meal if you can. This decreases kids seeing dessert as a “bad” food or something they or you can use to bargain with. It also helps decrease an obsession with candy or “treats”. Things that are treated as special or with “scarcity mentality” often become a focus. Treating dessert or “treat” foods as just a food helps to normalize them and removes the power they have over your child. Often the first few times kids see dessert they will eat it immediately then proceed to their meal. With time, they often will ignore it or leave it until later. Remember you decide the portion size. For some kids it can be 2 chocolate chips and other nights it may be a dish of ice cream.
REACTIONS
Your child will not always like how the meal is presented, what foods are presented, sitting at the table, or the lack of a food or dessert. Planning your response ahead of time can be very helpful. For example, if you chose not to serve dessert and your child is upset, you can just say “That is not on the menu tonight” or “We’ll have more ice cream on Tuesday”. If they want only crackers for snack, you can provide those but add in the fruit/veggie and protein. If they want more, you can say “We can have more tomorrow at snack time”. A lot of what you will be doing with reactions is setting healthy and appropriate boundaries with your children. This in turn helps your child feel supported and safe. Boundaries are hard to set and hold but are the hallmark of all parenting!
FOOD RULES:
These are some house rules in regard to food that families should adopt::
• No pressure around food or taking bites. Allow your child to determine what they will eat and respect their choices around their body.
• Do not short order cook. The meal provided is the meal you are having.
• Always provide a safe food at meal or snack time
• You are the parents you decide
o When to serve food
o What food you will be serving (with at least one safe food included)
o Where you are serving the meal
But how do I present new food?
SLOW AND STEADY WINS THE RACE:
First off, accept that this will be a slow process and every step is part of the learning process. Here are some ideas at how to incorporate new foods on your child’s plate:
• Make food fun (see side bar) with special utensils, plates, muffin tins, easter egg cups, and food cutters.
• Play with food! Make potato stamps, paint with pudding or purees, play tic-tac-toe with green beans, peas, and corn
• Allow your child to help you in the kitchen. Even with the dangerous tools and using the stove! Working with children in the kitchen is proven to increase food acceptance. Kids can start using knifes with parental supervision at a young age. They even make special knifes that do a great job cutting but are safe for young children. You are also teaching them an important life skill.
• Try a food in different ways for example you can serve eggs scrambled, fried, as an omelet, dyed green (like in ‘Green Eggs and Ham’), hardboiled, or egg salad
• Try a different version of a safe food. For example, if they will only eat Annie’s Mac and Cheese in the purple box, buy some of the orange box and mix it into their favorite version. Or if they only eat a certain shaped pasta, try adding in a few new shapes into the safe shape.
• Pair a new food with a favorite. Put a large serving of their favorite food and a one bite/small serving of the new food.
• Try deconstructing a meal. For example, salad. Instead of mixing the ingredients together keep them separate on the plate. If you had a salad with lettuce, a hard boil egg, chicken, avocado, and carrots you would place small portions of each of these on a plate separated. Allow your child to try them alone and allow them to indicate when they may want to combine foods.
• Offer only small portions of new foods, let your child ask for more. A large portion of a new food can be overwhelming.
• Serve appropriate portion sizes of all foods based on your child’s age. For example, a toddler-sized portion of protein is ½ egg or 2 tbsp of meat; and for a fruit or veggie is 1 tbsp for each year of age. Too large portions can be overwhelming.
• Limit foods that require no work or interaction to eat (“mindless foods”). These include pouches, large quantities of milk, and large portions of low-nutrient carbohydrates such as crackers.
• If your child would prefer to drink their calories, usually this means milk, limit milk to 16 ounces per day. Provide water with meals and give milk after food.
• Limit empty calories such as juice unless medically indicated (for example, in cases such as constipation).
• Use other foods to increase food acceptance (aka sneaking in foods, you still need to continue to present the food outright). Pancakes are a great example you can:
o Add an extra egg
o Add a fruit or veggie puree to “dye” the pancake (beets, pumpkin or sweet potato work well)
o Try a new flour
o Add new spices
o Add fruit to decorate the pancake
o Add chocolate chips and fruit to make a face
o Make the pancake into a fun shape (see the picture in the side bar)
• Slowly w0rk your way from a safe food to a new food. For example. if you want your child to work on eating blueberries you can start with:
o Blueberry yogurt (safe brand), smooth, then
o Blueberry yogurt with a small amount of blueberry jam
o Blueberry yogurt that has blueberries “on the bottom: to mix in
o Blueberry yogurt with mashed blueberries in it
o Blueberry yogurt with whole blueberries in it
o A small amount of blueberry yogurt with a larger portion of blueberries
o Blueberries with yogurt “dip”
o Blueberries!
Feeding our children is something we need to do multiple times a day, every day (it seems like more often during COVID-19 precautions though, right?)! We hope the above helps ease some stress in your house around feeding your children, especially your picky eaters. Working on new food acceptance is a long road but with patience and a few tricks up your sleeve, you and your child will make progress. In addition to the above information, there is a wealth of information available online to help you navigate the process. Instagram pages such as @kids.eat.in.color, @autism.nutritionist, @biglittlefeelings, and @feedinglittles. They have great easy to follow tips that may give you new ideas and methods to help your family. Also remember that with persistent picky eating or with any child with a medical reason that is affecting their food intake, please do not hesitate to reach out to us or to make an appointment with our in-house pediatric nutritionist, Sally Knapp.
Children’s Health Care of Newburyport, Massachusetts and Haverhill, Massachusetts is a pediatric healthcare practice providing care for families across the North Shore, Merrimack Valley, southern New Hampshire, and the Seacoast regions. The Children’s Health Care team includes pediatricians and pediatric nurse practitioners who provide comprehensive pediatric health care for children, including newborns, toddlers, school aged children, adolescents, and young adults. Our child-centered and family-focused approach covers preventative and urgent care, immunizations, and specialist referrals. Our services include an on-site pediatric nutritionist, special needs care coordinator, and social workers. We also have walk-in appointments available at all of our locations for acute sick visits. Please visit chcmass.com where you will find information about our pediatric doctors, nurse practitioners, as well as our hours and services.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.