I was recently asked to speak at a local community center about picky eating, and to prepare for my talk I referred to the many books on the subject that line my office shelves. Each expert had different, valuable insights to offer, but I found myself returning again and again to one book in particular, Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorders, by Katja Rowell, MD and Jenny McGlothlin, MS CCC-SLP. The book is remarkably comprehensive and informative, and is an excellent resource for all parents worried about child feeding, even if they don’t have an “extreme” picky eater at home.
Today I’m so pleased to share with you Part One of my interview with Rowell and McGlothlin; I’ll share Part Two tomorrow or Friday. And at the end of both posts, learn how you can enter to win your own free copy of Extreme Picky Eating.
TLT: One of the things I liked best about your book is that you first discuss the normal eating behaviors that could easily lead a parent to think they have a “picky” child – and perhaps engage in interventions that do more harm than good. Can you talk a little about these normal behaviors?
KR & JM: You’ve picked up on a critical piece of this issue. Knowing what is typical around eating, growth and appetite is important so that parents don’t intervene when it’s not needed (second is learning to avoid possibly harmful intervention). Typical picky eating impacts one in three kids (a 2015 Dutch study described picky eating in 46% of kids at some point in childhood!). Typical picky eaters often prefer carbs, avoid most veggies, have favorites, and may whine and cry to get those favorites. Often this may be a child who ate well until they were about 15-18 months, then started to say “no” or try to get their favorite. They may ask for pasta, then reject it when it hits the table. They may pick out and remove any green specs, or want foods not touching. They may reject former favorites. They can be exasperating, their whims make little sense, and many parents spend a lot of time and mental energy trying to make these kids eat a greater variety. The good news is that you don’t have to work so hard and you can actually enjoy meals rather than endure “45 minutes of hostage negotiations” every night, as one mom called dinner. Our mission is to share with parents how to help and not make matters worse.
There is a lot of attention, effort and pressure to get children to eat more amount or variety. This can turn typical picky eating into a far bigger problem. In the 70’s and 80’s, kale wasn’t even in most stores, many of us grew up eating PB and J or a ham on wheat sandwich every lunch. Our parents didn’t worry about turning us into foodies (though many of us grew up to greatly enjoy a variety of foods!). A recent survey quoted in Time magazine shared that 30% of Millennial parents feel judged by what their children eat. Kale chips and green smoothie Facebook posts seem like public proof of “good” parenting, and there is a lot of guilt for many parents if their child resists veggies.
We see misperceptions about nutrition, growth, appetite and behavior contribute to counterproductive feeding, which is also described in research. For example, take the mom of a 12 month-old who worries her son isn’t getting enough protein, so she makes him homemade chicken nuggets every night since she knows he will eat them. Within a few minutes talking with this mom, it was clear her son was getting more than enough protein, and by not giving him opportunities to try and get used to other sources of protein, she is much more likely to have a three year-old who demands chicken nuggets. As is common in this scenario, this mom was also worried he was “too small” (though he grew steadily at the 25th percentile), therefore she almost exclusively made him foods she knew he would eat “just to get something in.” She also made a lot of effort to get one or two more bites in him at meals, while playing games, during screen time, using bribes etc.
Some children are just meant to be at the 25th percentile, or even the 10th percentile. If it is low, but steady growth for a child, that is likely to be healthy. The worry comes in with arbitrary cutoff labels like “underweight,” or the worst, “failure to thrive,” and many well-meaning, but frankly under-trained doctors tell parents to get kids to eat more. Research is increasingly clear that trying to get kids to eat more in terms of amount and variety backfires and makes matters worse.
A recent article in the Academy of Pediatrics described how more than half of American parents “ …ignore the child’s hunger signals and may use force, punishment, or inappropriate rewards to coerce the child to eat. These practices initially appear effective, but become counterproductive, resulting in poor adjustment of energy intake, consumption of fewer fruits and vegetables, and a greater risk of under- or overweight.” (Kerzner 2015).
TLT: In light of the foregoing, how can a parent know if their child really does have a picky eating problem? What are the warning signs?
KR & JM: Briefly, anytime the amount or variety a child eats impacts his or her physical, social or emotional development, or is a significant source of parental conflict or worry, that is what we call “extreme” picky eating and the family needs help. The child may or may not need individual evaluation and attention, but the parents need support and information.
In general, anything that makes it difficult, painful or uncomfortable for a child to chew, swallow and/or digest food can put the child at risk for more extreme picky eating. If a child has always struggled, did not transition well to solids, avoids entire food groups (all veggies, all fruits), appears anxious or isolates socially because of food concerns, that’s a big red flag. Any pain or discomfort with eating or digesting, or a history of pain or discomfort, can make the child reluctant to eat. Frequent vomiting, infections, falling off the growth curve, difficulty chewing or swallowing are also indications for a more thorough workup. Even after the medical issues are resolved, the reluctance to eat can continue, especially if feeding has been difficult or there has been pressure.
TLT: It seems pretty clear from the research that pressuring a child to eat will backfire, but I think some parents might be surprised at how broadly you and other experts define “pressure.” Can you talk about some common parental strategies to encourage eating that are actually counterproductive?
KR & JM: This all depends on the child’s temperament. Think about it… One child may happily accept help with tying his shoes, the other will fiercely resist ANY attempt at help or coaching, preferring to struggle and do it his way and in his own time. Eating is no different. At workshops when we talk about some of the less obvious forms of pressure, we often have a parent raise their hand and protest, “We do a ‘one bite rule’ and it works great for us!” Wonderful! If you ask your child to try a bite of everything and they do so without resistance, and they enjoy meals and a good variety of foods, then by all means, proceed! About half the time, the parent will then admit, “Well, it works great for two of our kids, but with the middle one, the ‘one bite rule’ is agony, and we fight with him for thirty minutes over one bite!” For any number of reasons, the rule and the pressure behind it is increasing that child’s resistance. We would argue that the other children will probably be just as adventurous without the one bite rule, maybe even more so, or maybe they don’t try a new food for weeks or months, but try one day and decide they love it.
One story I (Katja) like to share at workshops to illustrate how not pressuring can look features kohlrabi. When my daughter was maybe 3 ½, we had a CSA where kohlrabi showed up every week for 6 weeks. My husband and I love it. I prepare it cut into ‘fingers’ with a little butter and broth, just simmered until tender. My kiddo loved broccoli stems. I mentioned the first time we had it that it tasted a little like broccoli stems. She said, “I don’t like kohlrabi.” (This is typical of the picky eating stage, children may be naturally suspicious of a new food, or even declare they don’t like a favorite! Don’t get sucked in to negotiating or explaining.) “Okay” I answered. “You don’t have to eat it.” I knew with her that any attempts to convince or rationalize wouldn’t help. She didn’t take any on her plate week after week. (We eat meals family-style, the #1 tip that our clients say helps with anxiety, power struggles and picky eating.) I was pretty sure she would like it, and I was tempted to make her try it, but I held back. The 6th week, as I was beginning to clear the table, she pulled a piece onto her plate. I ignored that, then she tried it and declared, “I love kohlrabi!” I remained neutral. “I’m glad. Did you play in the sprinkler today?” I am convinced that had I MADE her try it, she may have reluctantly agreed, it would have spoiled mealtimes, and I think she would not have admitted she liked it even if she did! We want to let children explore and discover delicious foods without pressure, we want them to eat for pleasure, hunger and appetite, not to please us or avoid disappointing us. We also don’t want them to not eat something just to spite us.
We want to be very clear that not pressuring and not trying to get children to eat doesn’t mean giving up, or letting kids roam for whatever they want whenever they want it. Parents can do a lot to support children learning to enjoy a variety of foods, from eating together, offering a variety of foods prepared in appetizing and accessible ways (cut to the child’s skill level, keeping spices or fresh herbs on the side…), and doing so over and over again in a pleasant setting.
* * *
In Part Two of my interview with Rowell and McGlothlin, we’ll talk about what parents can do to reduce their anxiety about a child’s selective eating, the importance of family meals, and when – and how – to get the right professional help.
And now, for a chance to win your own free copy of Extreme Picky Eating, just leave a comment below by Monday, January 18, 2016 at 6pm CST to enter. You can share your own experiences with your child’s picky eating or you can just say hi. I’ll use a random number generator after the comment period closes to select one lucky winner and if you comment twice (e.g., to respond to another reader’s comment), I’ll use the number of your first comment to enter you in the drawing. I’ll email you directly if you win and announce the winner on TLT’s Facebook page, too. This offer is open to U.S. residents only.
[Blogger disclosure: I received a free copy of Extreme Picky Eating for review. However, I never accept any other form of compensation for the book reviews or author interviews you see on The Lunch Tray.]
Do you love The Lunch Tray? ♥♥♥ Follow TLT on Facebook and Twitter! You can also subscribe to Lunch Tray posts, and be sure to download my FREE 40-page guide, “How to Get Junk Food Out of Your Child’s Classroom.”