Handling the Picky Eater

Here are a few ideas…

Picky eaters are one of the most common feeding problems I am asked about in my pediatric practice.  How many times have you faced these scenarios in your home?

  • the toddler who takes two bites of food and then says “all done”
  • the child who will only eat five varieties of food and so you prepare those foods day after day
  • the child who says he wants food x, then after you prepare food x, he states he wants food y, and then after you get food y, he says, “No” he wants food z now
  • having daily mealtime battles where you find yourself bribing, coaxing and nagging bites of food into your child’s mouth

The first goal to is to avoid mealtime battles. Battles at the dinner table will usually only make a picky eater pickier. It’s not worth the battle! Realize that toddlers in that 1 to 3 year range have small appetites and don’t seem to need to eat as much. Their appetites can vary day-to-day and from meal-to-meal. Often breakfast or lunch are their biggest meals and if that is the case, focus on feeding them more at those meals.  It’s OK to throw some vegetables in at breakfast or lunch.  Dinner is often their lightest meal – at the end of the day, they are tired, there may be more distractions with siblings and both parents home.  Since the toddler is going to be going to bed soon, it may not be in their best interest to eat a large dinner anyway (of course, a dad who only sees their child at dinnertime may take this as an eating challenge and a place to battle their child, but they shouldn’t!).  Life is often just too exciting for toddlers and there are higher priorities than sitting at the dinner table. As you see in many aspects of a toddler’s behavior, they are seeking a new level of independence and control. If you are trying to control them from touching the TV set, they see it as a game and will try to do it, while looking right at you. If you are trying to control every bite of food, they see it as their job to do the opposite. Developmentally, toddlers are generally capable of self regulating their food intake and parents must sometimes learn to respect their natural appetites and variations.

If you are dealing with older children, you can start to set up some guidelines. The one bite rule may be effective for older kids (over 4 or 5 years). They need to at least try the bite of all foods offered, and if they don’t like it, they don’t need to eat more.   As parents, we have to hide our concern about whether they eat it or not.

Below are a few ideas…

  • Never coax, bribe, punish, nag. Avoid the battles! Hide your anxiety and concern about eating!
  • Be realisitic about portions.  Many parents have an unrealistic expectation of how much their child should eat.  Under about 5 or 6 years of age, use about 1 tablespoons of food for each year of age.  As an example, 2 tablespoons of peas if they are 2 years old, 4 tablespoons if they are 4 years old.  Give them less food on the plate than you think they will eat.  Then if they ask for seconds, they may feel like they have accomplished something. For that ultra picky eater, I have parents put just a tablespoon of each food on their plate to start and then see what happens.
  • Keep introducing new foods over again. Don’t avoid it just because they didn’t like it once, they may change their mind. Prepare the foods in different ways, cut them into fun shapes and model by showing your enjoyment of the food.  It can take 8 to 15 times of trying the food (even visually!) before they will like a food. Be matter-of-fact about the food – put it on the plate and don’t pressure them.
  • Have them touch or smell or lick the food to try it. Besides visually having it on their plate, using their other senses to experience the food, should be considered an important road to the process of trying the food.
  • Don’t dictate how much you think your child should eat. Let your child decide how much they will eat. The rule is: it is your job to pick and choose what to offer and your child’s job to pick what to eat and how much. Remember that as you go along the path with the picky eater! The “clean plate club” is not a good way to teach kids how to self-regulate when they are hungry or full. By trying to override their ability to regulate how much they eat, we may create more eating problems or weight problems when they get older.
  • Change up what you offer if you find your child is “stuck on” a certain food choice. Sometimes a child will demand only one food type at every meal.  Many times it is the starchy carbohydrates that are their comfort food.  Do not to fall into the habit of giving in every time and don’t be a short-order cook..  For an older child (3 years or so), explain that some days they can choose the food, but other days it is your turn to choose.  Again be very neutral and not alarmed if they refuse what you offer. If they refuse dinner, just say something like, “I am very sorry you chose not to eat tonight and you are hungry.  You can have a big breakfast when you wake up tomorrow.”
  • Offer fruits as part of the meal. If they refuse the vegetables, there are alot of antioxidants with vitamins and minerals in the fruits.  Try to find varieties of fruits with different colors to enhance the variety of antioxidants they are getting.
  • Avoid lots of juices, sodas and milk as substitutes for eating real food. Some kids will fill up on the fluids and not have much left for the food choices.  Too much milk (more than about 24 ounces a day) can lead to iron deficiency anemia.  If they love their milk, give them only 4 to 6 ounces with meals and/or let them have their milk at the end of the meal.  Limit juice to less than about 6 ounces a day (and make sure it is 100% juice for the most nutritional value!).
  • Avoid frequent snacking habits. Avoid snacks in the car or while standing around and playing. Your child should get 2 small snacks in the day, but they should not be grazing all day.
  • Disguise foods and combine foods they like with those they don’t like.  It’s OK to be a little sneaky.  Grate up zucchini or carrots into meatloaf or turkey burgers, add baby food vegetables or pureed vegetables to pasta sauces.  However, always keep trying to give kids the foods in their natural state too.
  • Try not to use dessert as a reward. For those stubborn kids who try to hold out for dessert and say they are “saving room” try not to use dessert as the bribe to get them to eat.  Offer fruit as dessert with yogurt or make your own fruit popsicles (have your child help you, it will have more value to them) out of fresh fruit, yogurt, and/or juice. You could even call for a special night like “backwards night” – they wear their shirt backwards and eat dessert first and then the rest of the meal.  Of course, make sure it is a small, reasonable serving of dessert. Most kids will not get full with a small dessert and then they are free to “indulge” in the rest of the meal.

When is picky eating a medical problem? 

Occasionally a child may have a real medical problem that is related to their inability to eat.  If you child is not gaining weight appropriately for their age or seems to have some other underlying issues, further evaulation may be necessary.  Children with developmental or sensory issues can have oral aversion to textures or tastes that make eating certain foods difficult.  In addition, some type of intestinal problem can cause pain, discomfort or problems with foods; medical conditions like gastroesophageal reflux, celiac disease, intestinal infections, other food intolerances or food allergies, or swallowing disorders to name a few.  Seek out medical evaluation and sometimes a feeding specialist trained in occupational therapy is needed.