Jessica Martin, OTR/L, CLC
“I don’t want chicken for dinner.” “I don’t like green beans.” “I want hot dogs again.”Most parents have heard one of these lines at some time or another during their child’s life. Some of us have even said them ourselves. These are the words of a fussy eater.
What constitutes a picky eater?
- Decreased variety of foods that will be consistently accepted (should have 30 or more after 18 to 24 months of age)
- May tolerate new foods on his plate but will not initially taste them
- Reluctant to taste new foods but may be able to be persuaded to do so without significant behavioral refusal with bargaining or promise of reward
- Eats at least one food from all food texture groups but not enough that you can go to any restaurant and feel confident there will be food choices for him
- May be brand or “chef” specific (For example, will eat McDonald’s chicken nuggets but no others. Another example is will eat mom’s spaghetti but not spaghetti from a friend’s house or a restaurant).
- Will “burn out” on preferred foods and stop eating them for up to two weeks
- Will sometimes pick up a new food but there needs to be repeated exposure to and experience with it
What causes picky eating?
In the same household, there are often differences in what each child will eat. Why does your son eat everything you put in front of him, but your daughter wants a peanut butter sandwich at every meal? One reason is purely developmental. Dr. Sears (www.askdrsears.com) states that the first 1-2 years of life are a period of rapid growth and there is a natural decrease in appetite after that time. Children need less food so they take in less. The age of 18 months to 2 years is also a period of increased control and independence for toddlers. At this time, they will try to take more control in the areas where they are able: one of these is eating (sleeping and toileting are the others).
However, can developmental stages be the only reason a child is picky? In addition, what about the child who has been picky since you began offering solid-type foods? In the past, we looked at environment, parenting, and behavior as reasons children were picky; however, an article in the New York Times (www.nytimes.com/2007/10/10/dining/10pick.html) cites a study that claims genetics are the primary reason children have an aversion to trying new food.
Another school of thought claims that each person has a unique number of taste buds in each square centimeter of the tongue. Some children have many, some have just a few. The children with a large number of taste buds may be more sensitive to food tastes and textures and will only accept a few foods that they know are “safe” for them (www.parentingideas.org/articles/health/what-causes-picky-eating/).
How does being a picky eater affect your child?
Picky eating will affect all children differently depending on the severity of pickiness, their personality, and their overall health. For example, if your child is refusing to eat the food provided by the school, even the snack, he may be going several hours without nutrition. This could cause a drop in blood sugar, increased irritability, decreased tolerance to classroom stimuli and decreased ability to concentrate. Another child’s pickiness may not cause such a gap between meals, so the behavior changes do not occur and concentration is not affected.
There are also some ways that picky eating could affect your child socially. Eating is a very social event. Look at any family or friendly gathering and food will be present. This is the same for meetings, parties, and any other organized event. Going out to eat is a social gathering. Some children will choose to stay home from parties or going out to eat with friends because of their pickiness. They may feel different from other children and do not want the fact that they are not eating to be pointed out.
Most of us who were picky as children continue to have some pickiness as adults; however, over time we have increased our variety of food. We need less control over who cooks our food, what shape it is, what brand it is, and our food choices (or lack thereof) do not interfere with living our lives. If we are going to a dinner at a friend’s house or out to a restaurant there will always be foods that we can eat.
When does picky eating become a feeding problem?
Parents often worry about nutrition when they have a picky eater. Is my child getting the right amount of nutrition with such a limited diet? Doesn’t my child need to eat more vegetables? Is a vitamin enough? Most picky eaters continue to grow appropriately and, with vitamin supplements, meet their nutritional needs. As their children continue to grow, parents can use different behavioral techniques to get them to try new foods and some of these will become favorites to them. But how do you know if your child is just picky or if there is a feeding problem that needs treatment?
Signs that your child may need intervention:
- Decreased appropriate growth or falling down or off the growth chart
- Significant weight loss
- Avoidance of entire categories of foods or textures
- Has less than 20 different foods that he/she will eat consistently
- Foods lost from burn out are not picked back up
- Cries, has tantrums, or falls apart when new foods are offered
If you see any of these signs, you may want to reach out for help. There are occupational and speech therapists that specialize in working with children with feeding problems and your doctor may choose to refer you to one of them. There are nutritional supplements to help with weight gain if needed, and there are mental health professionals to help with mealtime stress and behavioral refusal. Talk to your pediatrician about what the right steps are for you and your family.
Tips for parents of picky eaters
- Don’t wage war at the dinner table. Remember that your job as a parent is to provide a healthy meal but your child decides if, and how much, to eat.
- Respect your child’s appetite. Every day is different in the life of an appetite. Some days we want more food and some days we want less. Try to “go with the flow” on this one.
- Get your child involved. Being involved makes everything more interesting. Have your child help you stir, add ingredients, and get the table ready. Take them with you to the grocery store and let them help pick out the foods. Let them help with serving the food.
- Have scheduled meals and snacks with no “grazing” inbetween. Do not offer juice or snacks within an hour of mealtime. A hungry child is more likely to eat well at mealtime.
- Have fun! Offer fun shapes and sizes with foods. Encourage dipping into sauces or spreads. Change the routine and offer breakfast foods for dinner or dinner foods for breakfast. Break those rules!
- Make the foods offered manageable for the child’s age. Cut foods into small pieces for younger children.
- Change your expectations. Many of us grew up at a time where children were made to “clean” their plates. We also may be miscalculating what an appropriate serving size is for children of different ages and expecting them to eat more than they should.
- Practice patience. Children often have to be introduced to a new food several times before feeling safe to put it in their mouth. Sometimes they will touch it and smell it but never taste it. If they don’t eat it when first offered, offer it again and again. You may be surprised that after seeing, touching, and smelling a food on 10 or more separate occasions, your child decides to eat it!
- Pick your battles. Do not ask a child a question if “no” is an unacceptable answer for you. This sets you up to battle. Instead of “Do you want some carrots on your plate?” you might reword to say, “I’m going to put 5 carrots on your plate. You do not have to eat them, but they must remain on your plate during dinner.”
- Plan ahead. Take food you know your child will eat when going to social gatherings. This may help avoid meltdowns and a hungry child.
Parent resources
www.ellynsatter.com/
www.parentingbookmark.com/pages/AN01.htm
www.askdrsears.com
www.mayoclinic.com
www.new-vis.com/p-fym.htm
www.mypyramid.gov/
Jessica Martin received her BS degree in Occupational Therapy from the Medical University of South Carolina in Charleston, South Carolina in 1995. She has been working in the field of pediatrics for almost 16 years with her first job being in Savannah, Georgia, at Memorial Medical Center. She then moved back to South Carolina where she began training in the Neo-Natal Intensive Care Unit and this was when her love for feeding therapy was discovered. After one and one-half years in South Carolina, she took a job at Children’s Healthcare of Atlanta in Atlanta, Georgia where she still works to this day. Jessica has specialized in feeding therapy, working in outpatient and inpatient areas. She has become a certified lactation counselor to assist with her treatment of feeding problems in the breastfeeding population. She currently is the feeding specialist in the Center for Craniofacial Disorders and continues her outpatient work with children of all ages with behavioral, motor, and sensory feeding problems. She also acts as a consultant at Kiddos Clubhouse in Alpharetta for children with feeding problems. She has spoken at both National and International conferences on the topic of infant and pediatric feeding, and currently holds speaking engagements across the state of Georgia.
Current contact information:
404-785-3716
jessica.martin@choa.org
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I like your expansive approach to picky eating. Some parents feel it is their fault, approach, or that their child is just stubborn to unruly. I hope this will give them a much better and broader view.
Joan
Comment by Joan K Teach — March 30, 2011 #
Great article…useful practical tips for parents. Thanks!
I have a question….do you believe that some of our young parents are contributing to their child being a picky eater by giving in to their “pickeyness” (new word) too much?
I know a child who will only eat their banana whole….if the parent cuts it up they tantrum. Isn’t this teaching inflexibility?? Also…they ask their 4 year old where they want to go when the family is eating out. What are your comments on this?
Comment by Gayle Born — March 30, 2011 #
Great article – excellent overview and practical tips – as a mom of a couple of picky eaters (sensory food aversions)and a Registered Dietitian that works with children with feeding disorders it is important to let parents know that they are not alone and there is help and hope. While many children will outgrow their “pickiness,” some children can benefit from multidisciplinary feeing therapy, especially those with developmental delays. Carol Ann Brannon MS RD LD
Comment by carol ann brannon — April 4, 2011 #
I am extremely impressed with this article. I know it will be an article that I use often to explain to parents about picky eating. I enjoyed the links and resources that Jessica used throughout her article, it was quite informative.
Comment by Shahnoor Dharamsi — April 7, 2011 #
Gayle to your comments, I do think that parents are contributing, especially based on the examples that you provided. At some point, a parent needs to make a decision whether they are going to give in or stand their ground. There are times when a parent will not deal with a tantrum, at other times, it is important to let the child know the expectation of the meal or snack. I think in the past years nutrition, obesity, and picky eating has been in the forefront of the media, so I think parents are finding ways to try to be as nutritious as possible with meals. However, they are forgetting to think about the repercussions of giving into their children that may be causing increased feeding problems.
Comment by Shahnoor Dharamsi — April 7, 2011 #