ANRED: Children and Picky Eating

It worries conscientious parents, but usually nothing need be done. Here are background information and suggestions.

An overview

Although it worries parents, picky eating is usually a stage that children outgrow, a normal part of childhood development seen in toddlers who are learning to be independent and enjoying the power of the word "No!" Needless to say, extended food refusal can drive parents to frustration and feelings of inadequacy, leaving them frantically searching for ways to get their kids to eat.

In less frequent cases, children are picky eaters from birth, consuming only small amounts of a few favorite foods. If parents do get food into them by tempting, punishing, manipulating or bribing them, results may range from tears to tantrums to physical distress such as vomiting. Then well-meaning moms and dads, legitimately concerned about their children's health, are left feeling even more frustrated, ineffective, anxious and guilty.

In the first situation, parents are faced with a power struggle. In the second, physiology may play a part. Researchers are finding that about 25 percent of us are "supertasters," people who have many more taste buds than the general population. Supertasters find certain fruits (such as grapefruit) and vegetables (especially broccoli, cabbage, brussels sprouts, and cauliflower) intolerably bitter, avoiding them at all costs. Cooking does not diminish the bitterness. Children are more likely than adults to be supertasters, suggesting that the sensitivity to bitterness diminishes over time.

Some children have "slow stomachs." It takes longer than usual for food to pass through their digestive tracts, which means that they do not experience hunger as often as their parents think they should. A simple medical test can determine if this condition exists.

Other children may have inherited genes from one or both parents that predispose to picky eating. In times gone by, these genes would have protected children from accidentally eating dangerous things such as poisonous berries or mushrooms. (Research reported in American Journal of Clinical Nutrition, August 2007. J. Wardle, et al) The researchers conclude that genetics plays a greater role in determining eating preferences than does environment.

Supertasters, children with slow stomachs, and those predisposed to eat selectively make up probably a minority of picky eaters, which leaves the majority engaged in developmental power struggles on their journey to adulthood and independence.

Although most children outgrow picky eating, it sometimes persists into adulthood. Some adults remain supertasters and find strongly flavored foods repugnant. Children with slow stomachs often grow up to be adults with slow stomachs, although there is medication to speed things up. Those genetically predisposed to choose foods from a limited menu will continue to do so.

In addition, picky eating can be a manifestation of obsessive/compulsive disorder and a desire for security, safety and control. Sometimes it signifies a power struggle -- with a living person or as a continuation of a pattern that was created long ago with someone who is now gone or deceased. Sometimes picky eating is a sign of a timid and cautious person who has found his or her comfort zone and does not care to venture out of it with new and different foods. And sometimes picky eating is a symbol of rebellion and independence: "It's my body and my life, and I'll do as I please regardless of what anyone else thinks! I'll even pay the price of social embarrassment to make my point."

What to do? Read on.

What can parents do about picky eating?

The first step should be a comprehensive medical exam done by the child's pediatrician. There are a few, fortunately not common, diseases and abnormalities that can present as picky eating. For your own peace of mind, let the doctor rule them out. If by chance something is found, then follow medical advice about treatment.

Chances are, the doctor will find nothing wrong with your child. Your next job is to realize that picky eating is very common. You are not alone; other parents are going through the same thing. Anywhere from half to two-thirds of children are picky eaters at one time or another. Parents of toddlers report that almost all of them eat selectively or ritualistically from time to time; for example, demanding peanut butter-and-grape-jelly sandwiches on white bread with the crusts cut off for lunch for months on end. Any variation, such as strawberry jam, is met with upset and distress.

Child psychologists recommend defining areas of responsibility. Parents are responsible for offering children a variety of healthy, tasty, nutritious foods and beverages. Mom and dad are responsible for creating enjoyable, peaceful, companionable and regularly scheduled mealtimes. Children, even very young ones, are responsible for eating -- deciding whether or not to eat and how much to eat. The parents' job is to present mealtime as an opportunity to enjoy food, pleasant conversation, and one another's company. The children's job is to learn how to participate in mealtime and contribute to the total experience. Arguing over food accomplishes nothing and can destroy opportunities to build relationships and personal responsibility for self-nurturing behavior.

Serve the food. If it your child eats it, great. Don't comment or praise the behavior. Your words may trigger rebellion later if the child feels you have won the battle. If the child does not eat what is served, remove the food without comment. If s/he later says s/he is hungry, between meals, and asks for a snack, gently but firmly say no. Refuse to allow him/her to eat empty snack calories, explaining that such items cannot take the place of healthy food, more of which will be available at the next mealtime. And then don't give in. If you do, you have not just lost the battle, you have lost the whole war.

In addition, restrict access to fruit juice and soft drinks to four ounces a day or less because picky eaters are notorious for filling up on sweet liquids that help them avoid solid foods. Juice and pop by themselves cannot provide sufficient nutrition for health and growth.

Introduce new foods as soon as your child can handle them. You will have more success before 18 months, but even then it is not easy. Even in the best of circumstances it may take 10 to 15 attempts before a child is willing to eat, or even try, new foods. Offer them and let the child decide what to do with them. If you push too hard, or make a big deal out of a new food, you may inadvertently create resistance. It helps if you yourself model enjoyment of the new foods. If your child sees that beets, for example, are an adult food, s/he may be curious about them and willing to taste. Don't expect instant acceptance however, especially of stronger flavored items.

And speaking of foods with strong flavors, if you suspect your child may be a supertaster, accept that s/he will avoid certain items, probably for years and maybe forever, and move on. It is possible to be well nourished eating only bland food with little or no seasoning. Provide a selection of mild foods, and notice if your child is more willing to try them. If so, you may be living with a supertaster. It's another human characteristic like red hair or brown eyes. Don't fight it. Enjoy your child, idiosyncrasies and all.

Worried that your child is not eating enough? Picky eating does not automatically lead to nutritional deficiencies and most picky eaters do manage to consume about 1,000 calories a day, which is the recommended intake for toddlers. However, they often have too little variety in their diets. They won't starve to death, but the sooner they begin to eat more healthfully, the better. In some cases food restriction can lead to permanently stunted growth.

Many picky eaters choose high-calorie, low-nutrient foods and little else. For example, their favorite vegetable is often french fried potatoes, overconsumption of which can contribute to overweight, early onset cardiovascular disease, and obesity. Cheese, peanut butter, and ice cream are other favorite foods that can be part of a healthy, balanced meal plan, but they should not be the entire meal plan. Ditto for pizza, cheeseburgers, candy and desserts.

Some parents find incentives useful. For example, "You can have dessert if you eat your green beans." Others find that bribes do not work. The child is happier avoiding the "icky" food than eating the required one. Parents can experiment with incentives. If they work, custom tailor them to your child's preferences. If they don't work, give up on them. Be careful not to teach your child to expect a reward for every healthy behavior.

Disband the clean-plate club. Let children learn to stop eating when they are full. Don't nag. Create relaxed mealtimes where family members enjoy each other. Don't associate food with arguments and criticism.

And on the other hand, don't label certain foods as bad or forbidden. Children who are denied reasonable amounts of snacks and fun foods are more likely to binge and gorge on them when they have an opportunity than are children who have had reasonable access all along. (American Journal of Clinical Nutrition, 2002)

Don't tell children that a particular food is healthy or good for them. They will immediately hate it. In fact, it's best to not comment on the benefits of food at all. Actions speak louder than words, and children are masters at identifying attempts to manipulate them, even when it's for their own good. If you model healthy eating of nutritious foods, and if you model consumption of regular meals and enjoyment of a balanced meal plan, your children will eventually get the idea. Be patient.

Above all, refuse to engage in a power struggle. There is no way you can win, and continued attempts will only cement your child's determination not to eat what you want him/her to eat. If you are concerned about life and health, talk to the child's pediatrician. Because there are a few, relatively rare, psychological disorders that can manifest as food refusal, ask for a referral to a child psychologist or child psychiatrist.

If you are an adult picky eater

Read the material above. Some of it will apply to you. If you suspect you are a supertaster, ask your doctor for confirmation. There is a simple noninvasive test. If you are a supertaster, work with a dietitian to make sure you are getting sufficient calories and nutrients every day.

If the reasons for your picky eating seem more related to psychological factors, a therapist who works with people who have eating disorders can help you expand your menu. If your motivation is strong, you can do just that. To save yourself time, money and feelings of frustration, on your first visit with the therapist discuss all the reasons you want to overcome picky eating and all the reasons you don't. Just clarifying that internal conflict will give you useful information.

As with changing any entrenched behavior, overcoming picky eating as an adult will take time. You can expect progress early on in treatment, but be gentle with yourself. Major change that is stable and lasting will take a while.

Sources

AAP 2004 National Conference & Exhibition: Session F170. Presented Oct. 9, 2004

Annals of the New York Academy of Science (Bartoshuk L. Ann NY Acad Sci. 1998;30:793-796)

Journal of the American Dietetic Association (Duffy VB, Batoshuk L. J ) Am Dietetic Assoc. 2000;100:547-555)

American Journal of Clinical Nutrition (Cooke L, Haworth C, and J. Wardle; 86:428-433. August 2007)

Children and picky eating (adults too)

An overview

What can parents do about picky eating?

If you are an adult picky eater

Sources