Picky eating- a problem or a phase?

The saying “a toddler in the house is a perfect example of minority rule” is never truer than when it comes to food. This can become a real battle of the wills between parents or caregivers and the feisty toddler. Food’s taste, shape, colour or texture can all play a role. Choosing what not to eat is part of normal development. The toddler is asserting independence and learning about control.

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.