Developmental Selectivity: What’s Normal

Between 18 months and four years, selective food phases are completely expected. Your child is doing important developmental work:

Testing boundaries. Food is one of the few places toddlers control their world. “I won’t eat that” feels powerful when so much else is decided for them. This is healthy independence, not defiance.

Food jags. Your child fixates on a particular food, wants it every meal, then suddenly refuses it. This might last days or weeks. They’re developing sensory awareness, adjusting to textures, or exerting control. It passes.

Neophobia. Your toddler is learning what’s safe and what’s scary. Food selectivity mirrors stranger danger; wariness keeps them from danger evolutionarily. Of course your home-cooked dinner isn’t poisonous, but their instincts don’t know that yet.

These phases are normal. If your child grows well, explores a variety of foods over a five-day period, and follows their growth curve, they’re learning exactly what they should be.

When Selectivity Becomes Clinical

Sometimes picky eating signals something that needs professional attention. Look for these red flags:

Shrinking variety. By 18 months, children should eat at least 20 foods. If your child’s list is getting smaller instead of larger, this warrants assessment.

Distress at mealtimes. We’re not talking about refusing a vegetable. I mean real anxiety, gagging at the sight of food, panic around eating. This impacts both nutrition and mental wellbeing.

Missing entire food groups. Protein, grains, dairy, vegetables, and fruit each provide essential nutrients. Omitting one creates nutritional gaps.

Weight or height dropping. Your Road to Health book tracks growth percentiles. A downward trend over time needs investigation; it could signal reflux, allergies, or failure to thrive.

Not progressing with textures. Eating involves 30 coordinated steps. If your child can’t move from smooth to lumpy foods or struggles to chew, they may have a mechanical problem affecting speech development too.

How to Navigate This Phase

Stay patient. Mealtimes should feel safe and positive, not like battlegrounds.

Offer variety. Different textures, colours, and smells expose your child to possibilities.

Model eating. Eat the foods you want them to try; kids learn by watching.

Don’t force it. Pressure creates anxiety around food. Let them touch, smell, or lick first.

Skip the alternatives. Offer one dinner. Don’t turn it into a game where they command the family menu. Remember, they’re testing boundaries.

Monitor your anxiety. Children associate your stress with food itself. Stay calm, and they’ll stay curious.

The Bottom Line

Eating requires skill development, just like walking or talking. Some pickiness is developmental; some signals real problems. The key is knowing your child’s individual growth pattern and noticing trends over time.

Most selective food phases pass. But if you’re concerned, don’t wait. Early intervention prevents lasting eating difficulties.

Worried about your toddler’s eating? Book a consultation at my Johannesburg practice. I’ll review your child’s growth, discuss whether this is a phase or something we need to address, and help make mealtimes enjoyable again.

The post Selective Food Phases in Toddlers: When Picky Eating Is Normal appeared first on Dr Maraschin - Paediatrician.

I chatted with a speech therapist, Marika Avramit, to answer my daughter’s question. Much of her work focuses on children with severe feeding difficulties, but she is also actively involved with parents embarking on the solids journey. Addressing the picky eaters is an area that takes a lot of time, and she believes that many of these food issues can be traced back to how the solid journey began.

I concluded that if my daughter was asking this question, many other moms must be in the same predicament. For that reason, I decided to share Marika’s insights with you:

1. Parents need to have an open mind about the solids journey.

   It will initially be about establishing a healthy attitude towards food rather than the calories. This means your baby is allowed to play with food. Touching, smelling, squashing, and tasting are all allowed. In fact, it should be encouraged. So out of the window goes the old idea that you shouldn’t play with your food.

2. Parents need to know the difference between choking and gagging.

   Marika recalled such an event with her little boy. During a meal, he gagged as he was still learning how to manage the texture and taste of the food. She got so frightened that she picked him up and started shoving her fingers in his mouth to get the food out. Needless to say, her baby started screaming, and the whole event was very traumatic. He wasn’t choking, just gagging. That’s OK. It teaches the child to get rid of something that could make them choke or that the child is still learning to manage from a taste and texture perspective. From there, she taught him how to work around the food and spit it out if he was gagging. She did stress, however, that parents should all learn how to create safe eating environments for babies, familiarize themselves with signs of readiness, and do a first aid & CPR course so that they know what to do in the event of choking.

3. Buy a good feeding chair.

   The chair must be one that can be placed at the family meal place. A baby that is part of the family meal is more likely to enjoy mealtimes. It should allow the baby to sit upright. A child that is slouching is more likely to choke. The chair must have an adjustable footplate that can be changed according to the child’s age. The baby must sit with the hips, knees and ankles at 90 degrees. Feet that are stable on a footplate allows for stability of the rest of the body. It’s not something we think about, but stability of the body allows for the ideal facial alignment for effective chewing and swallowing and for the baby to be in control of their body at the table. We discussed that the baby can play with the food, so your chair should be easy to clean. Straps are a very important safety feature. I see many children in my practice with head injuries after falling from a feeding chair.

4. Short, thick spoon.

   A silicone spoon with a nice thick handle is much easier for a baby to grasp. There are also pre-feeding spoons with little dimples on them. Puree gets stuck in the dimples so that baby can hold the spoon and gnaw on it.

5. Non-slip bowl.

   Hearing about this is a game-changer. I recall my own children flinging a bowl full of food onto the floor with very satisfied grins on their faces. Non-slip bowls, especially those with a little tray, are not as easy to pick up and drop. The baby will also not have to chase the bowl around the table if it doesn’t keep slipping.

6. Paper towel, baby-safe kitchen spray and a plastic table cloth for under the chair.<

   We are encouraging baby to experience the food, so mess will be part of the experience! Let it happen, then clean up after the fun has ended. Marika’s commented that: “Baby will enjoy the water play during cleanup too!”

7. Apron bib.

   This is a good idea for keeping the clothes clean. Be really sure that the bib isn’t heavy and weighing down on baby’s neck.

8. Tiny open cup or a straw cup.

Marika explained that a baby can use a tiny open cup from the age of 6 to 7 months. This means if you are breastfeeding, baby can go straight to this without needing a bottle. A straw cup is also really good, but it must be light and easy to suck from. Sippy cups are not a good idea as they cause the jaw to push forward and don’t teach the correct tongue placement or slurping pattern.

Conclusion

They say that you can’t teach an old dog new tricks, but I say that you are never too old to learn. My daughter’s question led me to think about solids differently. I have strongly advocated for healthy food but hadn’t considered what was necessary for the process. Thank you to Marika for taking the time to share her knowledge. I am now really pleased to have the opportunity to buy my granddaughter a really good chair. I have learnt that there are feeding chairs that can ultimately be converted into a study chair. Imagine that! A gift that can be used well beyond the baby days.

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FOODS THAT CAN INDUCE AN ALLERGIC RESPONSE:

• Cow’s milk protein, soya protein
• Egg white
• Salmon, shellfish, shrimps, crustaceans, codfish
• Tomatoes, legumes, peanuts
• Wheat
• Oranges, strawberries, kiwi fruit

New data regarding the introduction of allergic foodstuffs has resulted in alterations to the guidelines of when to introduce these foods. This data suggests that early introduction to these foodstuffs may in fact reduce the likelihood of allergies. One is thus encouraged to introduce these foodstuffs but it is very important that this is done slowly and cautiously to limit a reaction should your child be sensitive. The American Academy of Asthma, Allergy and Immunology (AAAAI) recommends that a baby who is older than 4 months of age and has tolerated foods which are considered non-allergenic like rice-cereal, sweet potatoes, carrots, bananas, pears and apples, can begin to have foods that may cause allergy. The recommendation is that all these foods should be given at home when first being introduced rather than at a restaurant or at day care. In the home environment parents are able to watch their baby carefully for any sign of reaction and are able to respond quickly. The data also shows that exclusive breastfeeding for at least 4 months protects against cow’s milk allergy in babies. It is also interesting to note that if a mother avoids allergenic foods like dairy, egg and peanuts during pregnancy or breastfeeding, it has NO significant protective benefit for the baby. In other words, a mother avoiding these foods is not preventing her baby from getting food allergies.

How should foods which may cause allergy be introduced?

The introduction of nuts, in the form of nut butters, between the age of 4 and 11 months of age has resulted in a decreased sensitivity of infants to nuts. An infant who eats nut products during this time has been shown to have less likelihood of allergy to nuts than infants who avoided nuts at this age.

To begin, first dip the tip of a teaspoon into peanut butter and this can be touched on the tip of the baby’s tongue. This should be repeated on at least three different days. If there is no adverse reaction, then the amount of peanut butter can be increased. First the tip of the teaspoon, then a quarter and only after some time a half. If you are certain that no reaction has occurred, then you may progress to a full teaspoon.

To begin, first dip the tip of a teaspoon into peanut butter and this can be touched on the tip of the baby’s tongue. This should be repeated on at least three different days. If there is no adverse reaction, then the amount of peanut butter can be increased. First the tip of the teaspoon, then a quarter and only after some time a half. If you are certain that no reaction has occurred, then you may progress to a full teaspoon.

A reaction can take different forms. If your baby demonstrates any of the following reactions please contact your doctor immediately- rash, swelling of the tongue, redness or swelling of the face or difficulty with breathing.

In a similar way, cooked egg white can also be introduced into the diet between the ages of 4 months and 11 months. The egg is introduced to the infant in the form of scrambled egg. To test if your baby will react to the egg, simply wet a teaspoon on scrambled egg and touch your baby’s lips and tongue. Observe whether there is any reaction. This may include a rash, swelling of the tongue, lips or face or difficulty with breathing. This process should be repeated three times in a week. If this exposure is tolerated, you can give a granule of scrambled egg three times in a week and watch for the same reactions. If your baby does not react you will then move onto a ¼ of a teaspoon, a ½ a teaspoon and a full teaspoon. If your baby tolerates this, you are able to give scrambled egg to your baby as part of the diet. Should a reaction occur at any of the stages during the introduction you must contact your doctor for advice.

If there is a strong family history of allergy to any one of the foods listed, please proceed with caution and ensure your doctor is aware of the allergy.

All allergy producing foods must be introduced in a similar fashion to what has been described for nuts and eggs.

Vitamins

Vitamins can be introduced in breastfed babies from four months of age. Infant formulas are fortified with vitamins so formula fed babies do not need vitamin supplementation. Babies that are kept indoors can become vitamin D deficient. Breastfed babies can also become iron deficient. A multivitamin with iron can be introduced at four months of age in breastfed babies.

Getting started with solids

(PLEASE WEIGH YOUR BABY REGULARLY WHILE SOLIDS ARE BEING INTRODUCED.)

You can allow for cultural differences when introducing foodstuffs as long as all the food groups are ultimately introduced. By this we mean cereals, vegetables, fruit and proteins. At first the taste and texture of the solid food may come as a surprise to your baby. Most babies will pull a face and spit it out. This does not necessarily mean that the baby doesn’t like the food. It is just a new experience, so don’t get discouraged. Placing the food on the back of the tongue helps to reduce the amount that is spat out. Your baby’s solid first feed will always be given in addition to his/her milk feeds. Milk intake should still be between 600 and 800mls per day. Offer baby’s solid feed about an hour after a milk feed. To minimise the risk of food allergy, start small portions ( 1 teaspoon) of new food at a time. Initially offer one solid feed per day and build this up to three feeds per day. Gradually increase the amount of each feed by one teaspoon up to about five teaspoons. When introducing a second foodstuff, add one teaspoon of new foodstuff to the already established foodstuff. Try a new foodstuff for 4 to 5 days before introducing another one to ensure that your baby is tolerating this food.

If you start solids at six months of age you will move through the introduction period quicker so as to have all food groups established by nine months of age.

In diagram form the introduction to solids will look like this:

1. Cereal

• Solids can be started with the introduction of a bland cereal eg, wholegrain rice cereal.
• The cereal is given one to two hours after the first milk feed of the day, around 8am
• Mix 2-3 teaspoons of dry cereal with cooled boiled water, formula or breastmilk to form a runny consistency.
• Cereal is given in the morning for three to four days. The milk feeds are given as usual for the rest of the day.
• Cereal can then begin in the evenings as well. This is given at around 5pm. Baby should then be bathed and given the last milk feed of the day.
• Cereal is given twice a day for about a week.

2. Yellow vegetables:

• Lunch is now introduced once your baby is tolerating the cereal. At this stage your baby should be on about four milk feeds per day. Lunch is given between 12 and 12.30pm.
• A new yellow vegetable is offered every four days until each of the yellow vegetables have been tried.
• The yellow vegetables include sweet potato, butternut, pumpkin and carrot. Be aware that carrots may make a vomity baby worse so this vegetable can be left for later.
• Vegetables are all low glucose index (GI) foods. They therefore maintain the glucose levels for a sustained period after their ingestion so baby is likely to feel satisfied for longer than on the cereal alone.
• You will begin with one teaspoon of vegetable and build this up to about five teaspoons.
• Freshly made vegetables are always preferable however there are a number of very good pre-prepared vegetables on the market.

3. Fruit:

• Fruit now replaces cereal in the morning. This is given at the same time as the cereal was given, around 8am.
• Cereal continues in the evening until such time as proteins are introduced.
• You will introduce a new fruit every four to five days
• The first fruits will include apple, pear, mashed banana (1/2) or mashed papino.
• Once each fruit has been tried a medley of fruit may be offered.
• Strained, fresh fruit is always best but again there are a number of pre-prepared fruits on the market for convenience.
•  

4. Green vegetables

• Green vegetables are introduced around six months of age if your baby started solids at four months of age. If solids are a new thing, then this will be slightly later.
• Remember that if you started the solids later than four months you will be able to move through the introduction phase a lot quicker.
• By now you and your baby are used to solids and the introduction of new foods will be easier.
• You will continue to test a vegetable for a few days before introducing something new.
• You are able to use the established yellow vegetables in addition to the green vegetables to make a more substantial meal.
• It is time to change things around a bit now as well. You are aiming to feed your baby in the same way that you would eat. You can begin giving the cereal in the morning, fruit for lunch and the vegetables for dinner.
• The green vegetables include baby marrow, gem squash, patty pans (yellow or green), spinach, peas and beans.
• Besides the beans and peas, other legumes including lentils, kidney beans, black beans and cannellini beans are highly nutritious and add fibre to the diet. They are also easy to add to the other vegetables if they are soaked, cooked and blended well.
• Please remember that legumes like peanuts and soyabeans are part of the allergens and need to be introduced with care. Take a look at how to introduce the allergy producing foods.

5. Dairy products ( from 6 months of age)

The following dairy products may be started between 6 and 8 months:

• Cottage cheese
• Plain yoghurt or any flavoured smooth yoghurt
• Kiri cheese

These products may be given together with the veg or fruit for example:

• ½ a block of kiri cheese in the vegetables
• Yoghurt added to the fruit for a dessert or lunch
• Small squares of lightly toasted bread with kiri cheese.

6. Meat ( from 6 to 7 months of age)

You and your baby are becoming accustomed to the world of food. New tastes and textures are so important if you want to avoid fussy eaters. Remember that food is an expression of who we are individually and culturally. Once you are able to introduce meats, meals become fulfilling and resemble the family diet.

By the time meat is introduced you will be giving your baby 3 meals a day. Breakfast will consist of cereal, lunch may be fruit and yogurt or vegetables and dinner meat and vegetables.

Please remember that your baby needs the protein and vitamins found in animal products for normal development.

Infants receiving a vegan or macrobiotic diet, with limited or no animal foods have a high risk of developing nutritional deficiencies. These babies run the risk of severe cognitive impairment unless they are given supplements containing animal foods like dairy or fish.

It is thus recommended that you introduce your baby to animal products but if this is completely contrary to your beliefs then supplements must be introduced.

• Strained meats
• Begin with chicken, beef, veal and lamb
• Liver and ostrich are high in iron and a very good source of lean protein.
• Again, these are added to vegetables to make meals interesting and nutritious.

7. Fish ( from 6 to 7 months of age)

Fish is a rich source of protein, Vitamin D, omega-3 fatty acids and other nutrients all of which are very important for neuro-development and strength in your baby. Fish is however, a food which may cause allergy. As with the other foods that may cause allergy, it is important that parents proceed slowly when introducing fish. (Please use the guidelines laid our previously on how to introduce foods which may cause allergies)

Mild white fish, light tuna, pilchards and salmon are all good choices. Fish may be steamed, baked or poached and then either mashed with a fork or pureed. Fish cakes or croquettes are also good preparation options and offers your baby a new texture as well.

Fish is easy for babies to chew if prepared correctly and goes well with vegetables to make a wholesome meal. By the time you introduce fish, your baby should be well established on all the vegetables so making a medley of foods like sweet potatoes, green beans or peas, carrots and even mashed avocado with the fish makes a great meal for your baby.

If you are preparing the fish yourself be very careful to check for bones. The fine bones found in fish are real choking hazards. The bones of tinned fish like pilchards are very soft so one can mash these with the fish into very fine bits.

8. Granular foodstuffs and finger foods (from 9 months of age)

Parents are often afraid to give their babies food that may require a little chewing. Be assured that those toothless gums can chew! Your baby will really enjoy picking up a tasty square of soft, toast and eating it.

Chewing is also a very important part of development. For this reason, we introduce babies to granular or lumpy food from 9 months of age. If you avoid lumpy or textured food you may run the risk of your child refusing such foods after this age. Even if your baby doesn’t have teeth the gums are strong enough for soft lumps and certain finger foods. Not only will this increase the variety you can offer your baby but your baby will enjoy the experience of feeding him or herself.

Your baby should be sitting at this stage and bringing his or her hands to their mouth. You can offer finger foods so that he or she learns to feed themselves. To avoid choking, make sure that the finger food is easy to swallow, cut into small pieces and soft. Some examples include:

• Small pieces of banana or panino
• Lightly toasted bread with a little kiri cheese, ricotta or Bovril
• Wafer biscuits
• Scrambled eggs (only if you are sure your baby is not allergic to eggs)
• Well-cooked chicken finely chopped

Well-cooked and cut up potatoes, squash or peas

Avoid foods that can cause choking for example:

• Hot dogs, meat sticks, biltong
• Whole nuts and seeds
• Whole grapes
• Chunks of raw vegetables or fruit
• Chunks of cheese
• Hard, sticky sweets
• Popcorn

9. Regular table foods (from 12 months of age)

Congratulations!!!! Not only have you and your baby survived the first year but your baby   is now ready for a regular family style of eating.

This means that your baby should be having three meals a day with a healthy snack in-between breakfast and lunch and again in the afternoon.

An example of the meals for the day would be:

• Breakfast- cereal, porridge or egg and toast
• Mid-morning snack- fruit, unsalted biscuit and cheese
• Lunch-finger foods or yoghurt and fruit
• Mid-afternoon snack- similar to mid-morning
• Dinner-meat and vegies or fish and veggies

10. General

   If at any stage, you are uncertain about what to feed your baby don’t be afraid to ask your paediatrician or clinic sister. Another very good guide is to check what foods are available commercially for your particular age group. Here you will find ideas for different combinations of food and quantities.

Be aware of food labels. It is highly recommended that you avoid foods containing sugar, excessive salt and preservatives. A tip is to look at the list of ingredients. Whatever is listed first is the ingredient that is found in the highest percentage, so while you believe you are giving your baby a pure product the label may indicate that this is in fact not the case.

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     Home cooked food is made with love and is also much cheaper than commercially produced   food. In some literature, however it is suggested that home-cooked green beans, carrots, squash, beetroot and spinach may contain high levels of nitrites. These are harmful as they can cause an unusual form of anaemia. Manufacturers are able to test for nitrates making these particular vegetables safer if commercially produced. This is only relevant during early infancy. Peas, mealies and sweet potatoes are very safe vegetables to make yourself.   

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At all times avoid forcing your baby to eat. One sure way of causing stress around food is to force feed. If you are having difficulty with feeding your baby it may just be a phase. Babies cannot distinguish between you being upset about them not eating or the food making you upset. If mealtimes are causing stress to the parents the baby often interprets the food and not the behaviour to be the problem. This in turn causes the baby to avoid food for fear of the parent getting upset. For this reason, mealtimes, should be fun, relaxed and offer a variety of tastes and textures to be explored and enjoyed.

Toddlers often become fussy eaters and this is just a way of them showing independence. There are a number of ways to overcome these issues.  Food play such as baking or icing biscuits, helping to make a salad or adding chopped vegetables to a dish you are preparing helps children develop a healthy interest in food and encourages them to try new flavours. If your child feels part of the family at mealtimes with his or her own plate, cup, spoon or fork, food will become more appealing. It is important that you stick to the mealtimes and avoid “grazing “throughout the day. This way your child will look forward to mealtimes and will have an appetite. Allow 30 minutes for a meal time. If your child does not finish, then remove the food (not in anger or frustration) and don’t offer an alternative such as milk or yoghurt. When mealtime comes around again the child is likely to be hungry.

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At all times remember that you want your baby to fit into your family with ease. For this      to happen you should ensure that your baby eats what you as a family eat. This you should aim to achieve by the age of a year.

Good luck!

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This is all fine and well, but there does come a time when some children become what is termed a” picky eater“, and this leads to parental anxiety around their child’s health.

My own son was one of these children. We struggled to get him to eat cooked vegetables. Soft, mussy textures made him gag. One day, he loved a particular food, and the next, he point-blank refused. If we tried to get him to eat it, we would be cleaning vomit off the carpet minutes later. It was hugely stressful, and mealtimes were anything but fun. Our standard saying for him was, “he eats with his eyes, and if he thinks he won’t like it, he won’t even try”. Little did we know we were experiencing the literal medical definition of a picky eater. And yes, eating does involve sight along with all the senses. Let’s go on a little journey into a day in the life of a picky eater.

What is the medical definition of a picky eater?

Picky eating (also known as fussy or choosy eating) has been defined in a number of medical journals. The general theme is that these children are unwilling to eat familiar foods or try new foods. They often have strong food preferences, resulting in a limited variety of food in early childhood.

What does it take for a child to eat?

In this section, I don’t want to go into the mechanics of eating but rather focus on the sensory side. I mentioned that we always said that my son ate with his eyes, but in fact, we use all our senses when we eat, and they all have to work together to make it a pleasurable experience.

• Sight – This is the first step to eating. The child needs to see where the food is, what it looks like, what shape it is and what its colour is.
• Touch – Your child needs to touch the food with their hands, face, and body so they can move the food from the plate into their mouth. They need to feel the food to establish what texture it is and what shape it is. Also, the sense of touch must tell your child if the food is too hot or cold.
• Smell – Your child will smell the food as it comes close to their mouth. The sense of smell is crucial for taste. We are actually smelling many of the things we think we are tasting. In fact, 80 to 90% of what we think we are tasting is really due to smell. This is why a lot of children, especially our picky eaters, will smell food long before they are willing to try it.
• Taste – Your baby will experience sweet, sour, salty and savoury with their tongue
• Hearing – Think of the sound of someone eating a crunchy apple. It makes me want one of those. Your child will listen to the sounds that food makes when they are eating it.
• Body awareness – Your child will need to know how much force is required to bite and chew an item. Think of the apple example. A child with poor proprioception (body awareness) will not know how hard to bite to get a chunk of apple off and then how much to chew in order to swallow. This can lead to choking. This same sense also tells your child how full the mouth is and gets the tongue to move the food into position for chewing. Correct seating is essential to support body awareness and balance. Your child needs to be comfortable, for their feet to be supported while they are at the table, and for their back, hips and knees to be aligned.
• Balance – This is known as the vestibular sense. It will help your child keep their head up and the body in the correct position for eating. This is very important to avoid choking.
• Interoception – This is the sense that tells your child what is happening inside their body. Am I hungry? Have I eaten enough? Do I need to go to the toilet? And so on.

Given the role of all these senses, we can see how critical it is to allow your child to experience food without being concerned about mess, touching and experimenting.

What causes a child to become a picky eater?

As with most developmental issues, there isn’t one single cause for the picky eater. Research into this condition appears to place the causes into three main groups.

1. Medical causes (the child)

• Reflux -Babies who suffer from severe reflux often associate food with pain. They develop what is known as oral aversion. If you expect something to cause you pain, then you will do all that you can to avoid it. Many reflux sufferers will have difficulty transitioning onto solids, are extremely picky and are reluctant to put things in their mouth. I can say that my son’s eating difficulties were definitely related to his reflux, along with other factors.
• Sensory defensiveness – Some children overreact to sensory input, affecting what they will or won’t eat. I like to use the example of peanut butter. A sensory-defensive child will hate the feeling of the slimy peanut butter, and if you are lucky enough to get it into their mouth, the sensation of it getting stuck to the roof of the mouth is likely to cause the child to vomit. My son is highly sensory-defensive when it comes to taste and touch. He knows avocado is very healthy, but he describes it as having to eat green Vaseline. I certainly wouldn’t enjoy avo if I experienced it in this way.
• Chewing or swallowing difficulties – There may be several reasons why your child may have chewing or swallowing difficulties. If it comes on suddenly, you may need to consider that there may be something stuck in the oesophagus, like a coin or piece of food. Enlarged tonsils or a blocked nose will make swallowing difficult. Issues with their teeth may also make a child not want to eat. Urgent medical attention is required under these circumstances. Long-term problems are usually experienced by children with cleft palates, large tongues or a weak jaw, developmental delays, prematurity and so on. Feeding specialists will assist here.

2. Parental

• A parent’s attitude towards food plays a big role in a child’s willingness to eat variety. Many studies have shown that parents with healthy eating habits are less likely to have children who refuse vegetables.
• In addition, a parent’s anxiety around meal times plays a huge role in the child’s willingness to eat. Imagine you get anxious or frustrated every time your child refuses to eat or try something new. Your toddler doesn’t for one second think that their behaviour triggers you. Instead, your child will blame the food. Oh, oh, here comes trouble. Mom gets mad when this plate comes out. See what I mean?

3. Parent child interaction

• In this toddler phase, your child is learning a lot about control. This is both physical and emotional. They are learning how to control their bodies for independence, but they are also learning to choose. This is particularly so when it comes to things like food and clothes. Deciding what they want on their plate or what they want to chew and swallow are all part and parcel of this control.
• On the other hand, we have parents and caregivers who just want the best for the child. They want to see the child healthy and eating well, so the adult seeks to control what is eaten and how much.
• Enter the power struggle, and you have a situation loaded with emotions. Parents develop extreme stress around food refusal, inadequate intake and nutrient deficiencies. The toddler, on the other hand, starts to act out their frustration at meal times, and this then descends into a very negative situation.

So, what can be done about this?

Firstly, if there is a medical reason for your child’s eating difficulty, find the correct help. Doctors, speech therapists and occupational therapists with an interest in feeding difficulties will be the right professionals to help you with your child.

If you are a parent who is about to start the solids journey and you are looking for tips to avoid the picky toddler, some steps can be taken:

• Messy is good – we spoke about how important all the senses are when it comes to eating. Your child needs to touch, smell, squash and feel the food to learn about it. Food play gives your baby the opportunity to experience the food without any pressure to eat it or try it. This play will encourage independence because it provides the baby with the chance to learn about the food and to bring it to their mouth without adult interference.
• Practice responsive feeding – Your baby must be fully engaged with the process. They must open their mouth for the spoon and be ready to eat. Distractions with the TV and cell phone are strongly discouraged.
• Introduce finger foods early – a baby that has a good grip can start holding food and getting it to their mouth. This will encourage independent eating.
• Give your child lumps – a baby does not need teeth to chew. Giving your baby properly cooked food that is easy to eat but not pureed teaches the child to manipulate food in the mouth, chew, and swallow it.
• Don’t give up on a new food if your baby appears to dislike it. It can take 10 to 15 attempts for a baby to get used to a new taste or texture.

For those of you who are in the throws of picky eating, institute the following measures:

• Get your child involved in food preparation. A little child can have fun washing veggies or popping items into the salad. Fingers are a good tool to use to prepare food, touch and feel.
• Let them help you choose a recipe, if they are old enough.
• Let your child choose if they want to eat. This is all part of learning what our body needs. Choosing not to eat at mealtime means they have to wait until the next meal to choose again.
• Let your child choose how much to eat. Children’s appetites do vary from one day to another. Remember, you, as the adult, do get to choose what is available. If you don’t want them eating junk, you simply don’t keep it in the house.
• Have set meal times. Grazing is not an option for these children. They need to have 3 meals and 2 to 3 snacks a day. These should be spaced by at least 90 minutes. Grazing prevents a child from experiencing hunger. This is an important body awareness function.
• Children can and do get enough in 10 to 15 minutes. Mealtimes should not extend past 20 minutes. I recall parents who said they were forced to sit at the table until they had eaten all their food. This has very negative effects on a child.
• Eating together so an adult can be a role model. A lot of bonding and special family time happens around a table. This is critical to healthy eating habits. Your picky eater must be part of the meal without feeling pressured to eat.
• Don’t allow milk to replace food. While milk is healthy in a child’s diet, the quantity must be controlled. A toddler shouldn’t have more than 1 to 2 cups of milk a day. As parents, we tend to think that milk is at least something when we have a picky eater, but the calcium in milk interferes with iron absorption, and this can lead to anaemia.
• Offer variety – your menu needs to be varied. You can’t serve the same meal regularly with the excuse that it’s the only thing your child will eat. Doing this will leave your child deficient in certain nutrients.
• Don’t make separate meals – the entire family must eat the same meal. Naturally, you will separate your child’s portion before adding salt or strong spices, but one family meal is offered. We made the mistake of always making a Greek salad because that was the only form of vegetables my son would eat. It gave us a real shock when a dietician friend pointed out that we were driving the pickiness and not giving him the opportunity to try new foods. Not only were we restricting him, but we were also restricting our daughter, who would happily try other food.
• If you have been using screen time to get your child to eat, please stop. It doesn’t matter if they get upset; it won’t last long. What is important is that children are engaged in what they are eating.
• Don’t let the child see that you are stressed. Try not to sigh, huff, or bargain with the child. Pretend you don’t care. If there is no one to butt heads with, the toddler will soon realize that the game of “tug of war” is over. If they don’t want to eat, that’s ok, but there is nothing else until the next mealtime.

Conclusion

As a father of a picky eater, I know parents’ frustration and concern. For us, it was a difficult road, and we did need the help of an occupational therapist to address his sensory issues. Today, he is all grown up and a fantastic cook. We are a typical Italian family, and we love to eat. Getting the kids involved with meal preparation and eating together as a family helped break the negative cycle. To this day, there are certain foods that he doesn’t like, green Vaseline being one of them. My daughter loves avocados because we kept offering them to the entire family. It takes courage, consistency, patience and a resolve not to give in when the meltdown happens.

Eating only white food or only peas is not ok. It is estimated that only 7% of children aged 2 to 18 years eat the recommended daily amount of fruit and vegetables in the USA. I see so many children with severe constipation issues due to the lack of fruit and vegetables in their diets. Obesity in children is also becoming an increasing problem worldwide. This can all be attributed to poor eating habits.

It starts with us, the adults. We need to role model good eating habits and encourage our children to be adventurous eaters by employing the strategies discussed.

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