The Picky Eater vs The Problem Eater: Understanding your child's eating habits

I have often been told that my children are great eaters, but one scenario always sticks out in my mind.  When my kids were around 3 years and 18 months we were eating at a local mexican restaurant and the mother of a family sitting nearby remarked at how well my children ate.  Both of my kids were eating chicken tacos, diced tomatoes, beans and rice.  To us, this was normal and definitely not some of the more interesting foods that they eat, but here was this woman's 6 year old son eating nothing but Teddy Grahams for dinner.  She laughed it off in comparison to my 1 year old, but I could still sense how frustrating it was for her to have a child who wouldn't eat normal food. 

There seems to be a common misconception about what normal eating habits are for babies, toddlers, and school aged kids.  In the US, chicken fingers, french fries, hot dogs, and plain pasta have become labeled as "typical" kid food with many kids not expanding their food choices far beyond that. Restaurants and schools subscribe to this "kid food" myth too; they all serve the same four kids meals: chicken fingers, hamburger, mac n cheese, and grilled cheese, all with a side of fries.  But where's the nutrition in those meals? I wonder what happened to fresh apples, berries, tomatoes, broccoli, grilled chicken, lasagna - why aren't these considered typical kid food? Somehow common knowledge about childhood eating habits has become skewed.  The normal assumptions seem to be:
- if a baby doesn't like a certain food on the first try then they never will
- toddlers snack throughout the day instead of eating meals
- toddlers are naturally picky eaters
- there is 'kid food' and then there is 'adult food'
- kids of all ages need to be entertained by the TV to eat a meal
    In actuality, many babies and even toddlers need to have a new food introduced up to 10 times before they may eat it.  And by 10 times, I don't mean once a month for 10 months; instead, you should offer it every day or every couple of days and eventually they will try it and begin to like it.  Age 6 months - 18 months is the best time to introduce your child to as wide a variety of foods as possible because they are more open to trying at this age than later on.  I even served my children food that I hated, like beets, olives, and mushrooms.  Aside from mushrooms, they both like a greater variety of food than I do as an adult.  You may also notice that toddlers begin to get more selective in their foods than they were as babies and this is developmentally normal as they are just practicing their independence.  Continue to offer the same variety of foods and eventually they will start eating them again.

   Toddlers do tend to eat smaller portions and snack more because their busy brains and bodies have a hard time focusing on eating, but it doesn't mean that you should deviate from a normal eating schedule of: breakfast, snack, lunch, snack, dinner.  If you give too many snacks they won't be hungry for a meal. To improve mealtime success, give smaller portions; your child will ask for more if they are hungry and by adjusting your expectation of your child everyone will be happier when they meet your new, more appropriate expectations.  Toddlers may need to move during their meal (this is normal); we allow our toddler son to get down from the table and move around, but we do not feed him on the run or allow him to walk around with food.  If we don't try to impose food on him, he will get back in his chair on his own and finish his meal.  Again, adjusting the expectation that children of all ages should sit still until their meal is finished to a more age appropriate expectation can make the experience more successful for everyone.  Just avoid trying to force feed your toddler child.  It's also good to keep in mind that toddlers fluctuate in the amount of food they eat, tending to go in cycles.  Some people notice that their toddlers eat more at certain meals and less at others; some people notice that their toddlers go through phases of eating more for a few days and then less for a few days.  Either way, it's pretty typical and your child will not starve, so do not force feed.  However, if there is an underlying medical issue or disorder or your child is losing weight, then seek professional advice.

    Other than pureed food for babies who cannot yet chew, there is no difference between what adults eat and what children should eat.  When we categorize food like this we automatically limit our children.  What you feed your children from an early age is what they are going to want to eat when they are older.  So, if it's pizza, chicken fingers, fries, gogurts, and pudding now without fresh fruits and veggies and other types of food, then they are not going to miraculously start eating these new foods when they hit a certain age.  A good rule of thumb is, whatever you're eating for dinner, your kids can eat too.  If you're making barbecued chicken, corn on the cob, and baked beans then serve that to your children; you don't have to play short order cook and make them a separate meal too.  If you're making salmon, green beans, and rice for dinner, give that to your kids!  If you can start this habit between 9 and 12 months (when your baby starts eating table food), then you'll be way ahead of the game.

    Babies, toddlers, and children do NOT need to be entertained by TV or a movie to eat.  This is another bad habit to get in to!  Appropriate mealtime behavior starts with a good model of behavior (that's you, parents) and conversation is a great form of entertainment that actually makes your kids smarter (TV will do the opposite).  And if a child is watching TV while they are eating they are not paying attention to the food or the meal experience: they won't develop a love of food, they won't taste what they are eating, they won't know how to pace themselves, and they will actually eat more than they need.  The family meal is a powerful thing and has positive impacts on your relationships with your kids, communication with your kids, your children's grades, etc. (I will get more into this in a future post on the importance of family meal time).  So, if it is your expectation that your children should behave appropriately at the dinner table whether you're at home or in a restaurant, remember that you have to teach it to them first and modeling a behavior is the best form of teaching it.  Playing a DVD while they eat is keeping them quiet (only while it's on), but it is not teaching them anything and it will be harder to teach them correct behaviors once you have already started the DVD/TV habit.

The truth is that most children are born with the ability to eat and like a wide variety of foods, like: tomatoes, beets, broccoli, strawberries, blueberries, beans, grilled chicken, fish, hummus, avocado, etc.  It's all about understanding how to introduce food, reading your child correctly, having appropriate expectations and using some strategies to make eating more successful.

   When it comes to why children are picky eaters, it seems to be a bit of a chicken or the egg scenario.  It's hard to tell if any given child came hard wired to reject most food or if his parents set him up for it by automatically introducing the "typical" kid diet because that's what they thought was the norm, thus never giving their child the opportunity to develop a liking of a good variety of tastes and textures.  Children who have a medical or congenital condition that affects their ability to eat or tolerate certain foods, such as a cleft palate, low oral muscle tone, severe reflux, sensory processing disorder, or autism legitimately have atypical eating habits and we classify these eaters as "problem eaters."  Other children without an underlying cause of their restrictive diets can be classified as "picky eaters."  There are several reasons why children become picky eaters, but this post is focused more on explaining the difference between picky and problem eaters.  At the bottom, there are also strategies to use with picky eaters and helpful hints for avoiding picky eating habits.

The Picky Eater

·         The picky eater will refuse certain foods and may show a preference for certain types of food, but over time with repeated exposure will eventually add new foods and textures to their diet

·         The picky eater typically does not have any major underlying problems that require intervention; but can benefit from a few helpful hints to use at home to make mealtime and eating more successful

·         It is typical for children to be picky eaters up through the toddler years; if they have an extremely limited diet, exhibit problem behaviors associated with eating, or the pickiness extends beyond the toddler years it may be indicative of some underlying issues and the child could benefit from a feeding evaluation

Common Traits of the Picky Eater:

-          Spits out new food, but after up to 10 attempts at introducing the same food will eventually begin to eat it

-          Avoids foods with a certain taste or texture, but with repeated exposure eventually begins to add new foods to diet

-          Will take more risks eating new foods when with peers or relatives, but are more controlling in their eating preferences with parents

-          Changes preferences for food over time; i.e. begins to refuse foods that previously enjoyed but also begins to eat foods that previous wouldn’t eat

-          More likely to try new foods or eat if using new colorful dishes, utensils, games, or music during mealtime

-          May tend to graze as opposed to eating scheduled meals and snacks

The Problem Eater

·         The problem eater has a very limited diet and exhibits behaviors associated with food and feeding time; this is most often due to an underlying sensory and/or motor problem

·         The problem eater typically requires a feeding evaluation done by an occupational therapist or speech therapist with a background in oral sensory and motor development to determine the underlying problems; this child will greatly benefit from therapy to address these issues

·         The traits and behaviors of a problem eater listed below are indicative of a problem more serious than just picky eating; they can be observed as early as 6 months and persist throughout the lifespan if not corrected

Common Traits of the Problem Eater:

-          Spits out food or refuses food repeatedly, even after more than 10 attempts at introducing it

-          Has developed behaviors associated with certain foods or mealtime in general: head turning, pushing food away, crying, screaming, throwing food, gagging, throwing up, etc.

-          The young child may only eat pureed foods; the older child may develop a preference for a certain taste or texture and will only eat foods in that category

-          Will only eat what they are familiar with, including only specific brands of food

-          Refuses to touch or pick up some or most food; also delayed in self-feeding

-          Mealtimes are extremely stressful for the child and parent

-          May show delays in speech development

-          Difficulty moving food around in the mouth with the tongue

-          May have avoided putting objects in mouth as an infant or may have mouthed objects excessively

-          Avoids/dislikes tooth brushing

-          May have a strong gag reflex; or may overstuff mouth with food and then choke or spit food out

-          May continue with thumb sucking, pacifiers, bottles, or sippy cups longer than typical

-          Child tends to be very controlling, at mealtimes and in general

-          May also avoid certain clothing, textures, and playing with messy or gooey substances

Helpful hints to avoid picky eating:

-          Introduce new foods to babies 6 months to 12 months as directed by pediatrician, increasing the complexity of taste as they get older; children are most receptive to new foods before the age of 1 year

-          Introduce new and thicker textures to babies 6 months to 12 months as they show mastery over simpler textures; babies who have mastered thick textures should be introduced to table food around 9 months and eating only table food at 12 months

o    A baby is ready to be introduced to new, thicker textures when they no longer gag, tongue thrust, or spit out the stage food they are currently eating

o    A baby is ready to start on small, simple table food when they have mastered thick textures and can chew easily broken down food, such as cheerios or Gerber Puffs; look for the ability to move food side to side in the mouth

-          Children are products of their environment and will respond to food and eating based on the parents’ approach:

o    Exposing babies to a wide variety of foods before the age of 1 year will help them eat a larger variety of foods as an older child

o    Self feeding promotes independence; start encouraging self feeding with hands around 7 or 8 months and with utensils before 12 months

o    Make eating an enjoyable and social experience by always eating with or sitting with your child while they eat

-          Keep open communication with daycare about what your child is eating; if necessary, send in the food you would like your child to eat

Helpful hints to use at home with the picky eater:

-          Make mealtime fun: use brightly colored utensils and dishes (especially with pictures at the bottom); play games and/or music; eat with your child

-          A new food may need to be introduced up to 10 consecutive times before a child will try even it

-          Introduce new foods one at a time and wait until child becomes comfortable  with it before adding another new food

-          Start with what the child is familiar with, even if this is pureed foods, and gradually add small amounts of texture (such as cooked oatmeal, mushy fruits/vegetables, cooked couscous or rice, alphabet pasta, tiny pieces of cooked carrots, peas, or other soft vegetable starting with an amount 1/8” in size and moving to 1/4” in size)

-          At mealtime, introduce a new food before offering foods the child prefers

-          Go slowly! Allow the child to touch, smell, lick, or bite new foods, spitting out if necessary (continue to introduce the food several times like this); place the new food 18 inches from the child and gradually move it closer to the plate as he/she becomes more comfortable and praise all efforts at interacting with or trying the new food

-          Once the child has become familiar with the new food then present a very small amount of food that he/she is expected to eat; as the child’s comfort with the food increases, gradually increase the serving size offered and begin to add the food in with the regular meal

-          If the child won’t eat mixed textures, separate out the foods using a divided plate

-          Finger foods may be more enjoyable if the child has trouble using utensils; but offer low-stress opportunities to practice with utensils

-          Allow the child to “dip” food into ketchup, sauces, syrup, apple sauce, jam, yogurt, or salad dressing

-          Get creative with food presentation by using cookie cutters, food coloring, referring to food by fun names

-          Avoid serving food in the container that it comes in, as children will start to notice and only eat specific brands

-           Involve your child in meal preparation

-          Change the location of the meal if necessary; use a booster seat at the table if the child doesn’t like the highchair, eat at a children’s table, etc.

-          Try to avoid power struggles over food and eating; make eating enjoyable and stress free by having a playful attitude; if a child gags, throws up, or exhibits any other behaviors in response to eating, calmly end the meal, clean up, and let child know that you’ll “try again later”  

-          Keep open communication with daycare providers or teachers about food and eating so all experiences are successful

-          If eating problems persist your child may benefit from a feeding evaluation done by an occupational therapist or a speech therapist with a background in oral sensory and motor development

The take home message here is that you do not have to just accept that your child is a picky eater. You can take steps to try and improve the range of foods your child will eat and their eating habits because it is important that all children get the necessary nutrients from food for their brain and physical development. A processed carb-heavy diet does not have the same benefits as a balanced diet with fresh fruits and vegetables, dairy, unprocessed whole grains and protein.

     If you are concerned with your child's diet and eating habits you can seek help from a pediatric occupational therapist who will determine if there is an underlying cause.  If present, the underlying issue needs to be worked on first before the eating can be expected to improve.  In any case, an occupational therapist can work with you and your child to come up with strategies to improve their eating.