Yesterday I shared Part One of my interview with Katja Rowell, MD and Jenny McGlothlin, MS, CCC-SLP, co-authors of the excellent Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorders. We talked about how to distinguish a child’s normal eating behaviors from truly problematic ones, as well as the ways in which parental pressure at the dinner table can easily backfire.
Today, in Part Two of our interview, we discuss 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.
TLT: Yesterday we talked about why parents shouldn’t pressure kids to eat, but when a child isn’t eating well, parents often feel helpless and want to do something to help kids along. So why is using subtle pressure, like the use of praise or rewards, such a bad thing?
KR & JM: First, we would ask parents to reflect– why isn’t the child eating well? What is the definition of “eating well?” Is it amount? Variety? Are there challenges that need to be addressed? Has there been inadvertent pressure that may be contributing to the child’s resistance? Are there realistic expectations? For example, many small children are satisfied at some meals with a bite or two (self-regulating by eating more at other times) but parents would like the child to eat more, parents may expect unrealistic behavior, or want a child to be tuned in to the pleasure of food the way that they are…
Then, observe, think about your child. What have you been trying? Has it worked? How is your child responding? If praise and rewards seem to encourage your child and help him expand his variety, by all means, continue. That just isn’t the reality for the parents we work with, many of whom have already been trying these tactics on their own and with formal therapies for months and years with worsening struggles.
You’ll know if something you are doing is helping your child or not by how he responds. In our experience, and the literature supports this, the more parents worry and pressure, the less children eat. For many children, even the attention, the praise, the eyes watching, is enough to make them feel like they will disappoint their parents, and can really dampen appetite. Allow children to be participants at mealtimes, not the focus. (Watch this video from the University of Idaho to see how the attention can feel.)
TLT: If parents shouldn’t use pressure, how can they reduce their anxiety about their child’s eating patterns?
KR & JM: It is important to really dig into what the worry is. Growth? Protein? Nutrition? Have a talk with the child’s doctor (or read our book or another resource) to get an idea, “Do I really need to worry about this?” If so, address it, if not, what a relief! If growth is slow, but steady, that’s reassuring. Most parents also greatly overestimate how much protein a child needs, or are so worried about sugar or processed foods that the anxiety has become toxic.
Understanding WHY your child might not be eating well is critical. If parents can empathize that their child may be reluctant because of a history of reflux and pain, or sensory challenges, or that he is sensitive to pressure and why it backfires, that understanding can help parents trust the process of feeding children well and supporting them with eating. Understanding is empowering. Also, when parents’ observations are reinforced and acknowledged, that is hugely affirming.
A lot of anxiety around eating is about getting good nutrition. With this worry, perfect can be the enemy of the good. In other words, pushing for better or best can make right-now nutrition even worse and put the long term goal of raising a competent eater even farther out of reach. There is not a whole lot parents can do to get children to eat more variety or amounts, but there is a lot parents can do that slows the process down. Particularly for children with more extreme picky eating, it may take a long time, and initial progress is not about what is going in their mouths. Initial progress is about decreased anxiety and having a child who is comfortable at mealtimes and around new foods. Parents can do a lot to set the stage for progress. Like tending a garden, you pick a sunny spot, but not too sunny, water, weed, mulch and compost. Then, when the first shoots start to grow, resisting the impulse to try to pry open the leaves and buds can be hard!
TLT: Why do you think family meals are so important in helping children along in their eating?
Watching parents and the people children love and trust enjoy the foods they are expected to grow up and learn to enjoy eating is critical. If parents feed children separately, and then eat later, there is a lost opportunity. Pleasant meals together are a chance to connect and share.
When there are no more battles about picky eating, mealtimes become that protected space to enjoy your family.
Mealtimes give children pleasant opportunities to get exposures to the foods they are expected to grow up and learn to enjoy eating. They see the food, smell it, pass it, maybe even help prepare the foods. Again, it’s about the environment so that the child’s innate curiosity has a place to blossom. One father of a child with extreme picky eating related his own experience. Most of his childhood his parents talked about good nutrition and pressured him at meals to eat more vegetables and the “healthy” food. He resisted. When he was ten, he remembers that his parents “gave up” pressuring and talking about food, but still ate together. After a while he started getting sick of his sandwiches, and remembers the meal where his parents had Chinese food, and he suddenly discovered that it smelled good and looked better than what he had! He reported that that summer he tried more new foods than he had in years and grew up to be an adventurous eater. He identifies that once there was nothing to resist, his own curiosity had a place at the table. Critically though, there was a table where he was newly able to relax and enjoy mealtimes and where he was exposed to new foods.
TLT: When do you recommend parents seek professional help for picky eating?
KR & JM: If there has always been a struggle, or if an infant is resistant or appears unhappy or in pain while eating, getting help early is critical. The neural pathways and anxiety around all of this is harder to undo the longer problems persist. A good evaluation by an experienced feeding therapist is paramount when parents (and physicians) aren’t able to figure out why the child doesn’t eat well. The feeding therapist is a detective, wading through a child’s history, evaluating skills, and getting a feel for how feeding is going at home. Discerning if there is a problem with oral motor skills, sensory differences or needs, or structural issues is hugely important because these can go undetected and can be the root problem causing picky eating.
But, finding the RIGHT help is important. Bad therapy is worse than no therapy. We help parents learn about options, and learn to trust their gut. Many children, even with more than typical picky eating, or who have had challenges in the past, don’t need intensive formal therapy, or may just need one or two visits and then the parent needs to be taught how to help the child at home, perhaps through ongoing consultation. Jenny finds that partnering with the parents and teaching them to be the child’s “therapist” is the most effective approach. Being a model, coach, and guide (but not doing it for them) gives them the confidence they need to put strategies into place and the results are quicker and more enduring than if a parent relies on a therapist to “fix” their child’s eating.
TLT: Is there anything else you’d like to tell Lunch Tray readers about the book or picky eating generally?
KR & JM: Take a deep breath. For most children, picky eating is a stage. Learn how to not make it worse, and how to support your child’s curiosity and internal drive and skills with eating. Learn as much as you can, and if you struggle, find support. (A great resource for parents of children with extreme picky eating is Mealtime Hostage blog and Facebook private support group.) Find help if your child is struggling with anxiety.
Nutrition is important, but so is avoiding unnecessary struggle and anxiety. The good news is that having pleasant mealtimes and a relaxed child at the table will ultimately support good nutrition.
There is help and hope.
* * *
I want to thank Rowell and McGlothlin for taking the time to respond so thoroughly and thoughtfully to my interview questions. As I said in Part One of our interview, I highly recommend their book and am pleased to offer TLT readers a chance to win their own free copy of Extreme Picky Eating. To enter the drawing, just leave a comment below by Monday, January 18, 2016 at 6pm CST. 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.]
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bw1 says
“Then, observe, think about your child. What have you been trying? Has it worked?”
My parents did the exact opposite of these “no pressure” recommendations, which, frankly, sound a lot like the bleating of the self-esteem cultists who organize sports leagues where keeping score is forbidden.
Of the four children in my parents’ household, one was a picky eater as a young child, but that was quickly changed. We’re all known for eating whatever is available/put in front of us, and we’re all in great physical condition. And yes, we ran the gamut from compliant little apple polisher to defiant strong willed contrarian (I’m sure you can guess which one I was.)
Mom and Dad laid down the law – “I didn’t ask you if you liked it, I told you this is what’s for dinner.” We could not leave the table without finishing the first serving of everthing on the menu. Seconds were allowed with the understanding that we still had to eat “firsts” of the other items – this taught us that choices had consequences.
They also led by example – I was 27 before I was aware of there being a food my father disliked, and have yet to discover my 85 year old mother’s food dislikes. To my parents, and now, to me, part of preparing a child to be a responsible adult is eliminating the expectation that they will never eat anything that don’t love, and making rational considerations such as cost, availability, nutrition, of equal or even greater importance to taste in choosing sustenance. This is formative to the three components of maturity, impulse control, deferral of gratification, and rational, rather than emotional, decision making.
We (my parents, and now I) believe that children should be raised to be as low-maintenance as possible, because life frequently involves adversity and resource limitations. When disasters strike, or economies go sour, those who are lower maintenance will be better prepared to face the situation.
It’s also a matter of teaching critical, rational thinking. If a food is good for you, good for your wallet, and millions of people eat it every day without issue, then you’re not going to be materially diminished by eating it – quite the opposite. In my youth, I disliked at least 20% of the foods I now enjoy – they grew on me through repeated exposures, most of which were under pain of punishment as a kid. Many times, on the 10th, 20th, or even 50th time I ate something I disliked, I asked myself why I disliked it, and in analyzing that, ate it more thoughtfully, and discovered things I liked about it. If I catch myself now thinking I don’t like some food, I train myself to like it.
Bettina, I gave you a hard time before on the question of sneaking ingredients into her son’s smoothie. That needs
clarification – I don’t necessarily endorse the deception. My preference would be to add the carrots, tell the child
upfront they’re in there, and order him to give it a fair evaluation. Of course, that presupposes he has been trained to do so objectively, which, based on your own responses, is probably not true in your story. If that’s not possible, the deception becomes a necessary evil to set up a mind-opening opportunity. Thus, I would have turned the objections back on him by responding “but you liked it – what can we learn from that about the legitimacy of your objections?” Again, it’s not just about food, but about training a child to think rationally.
Almost everyone I grew up with had similar experiences and results. Something’s wrong with your theories. There are far too many counterexamples to accept that there’s any real science at work here. It all sounds like more new age calls to pander to childrens’ every whim in the belief that, on the eve of their 18th birthday, a fairy will sprinkle sparkly dust on them and they’ll magically transform into disciplined, mature, responsible adult citizens who won’t squander the tens of thousands their parents spend on college throwing hissy fits over trigger warnings, microaggressions, and the like.
Victoria Keen says
I fully agree with you. That is how my parents raised me and how I fully intended to raise my son. Before I ever had kids (and even before my son became an extremely picky eater) I used to say “I’ll never put up with picky eating”.
But I’ve tried it all. I’ve tried the one bite rule. I’ve tried the “you won’t eat it for lunch, you can have it for dinner, and breakfast and so on” until it can’t be microwaved anymore. I’ve tried family style and I’ve tried cooking separate meals.
I don’t remember the last time my son tried something new in my house.
There is absolutely science behind what they are saying. Your parents just got lucky. Your parents didn’t have any children that suffered from anxieties over food that reduced them to sobbing, screaming balls of child fury over a spoonful of peas.
I was raised in a “clean your plate, this is what’s for dinner” kind of house. That is the kind of house I wanted.
It’s not what I got.
bw1 says
My parents absolutely did not get lucky. There was a lot of screaming, sobbing, tantrums and, yes, horrors, physical punishment. I was the original strong willed devil child, and my sister (the picky eater) was pretty close behind. It’s often a battle of wills and some kids can wait you out for years to see who blinks first. A friend I met at my first real job talked about the most important lesson he learned in life – you can make your case, be persuasive, be angry, whatever, but in the end, Mom and Dad always win. If you’ve done the one bite thing, and cooked separate meals, you’ve already ceded critical ground, and reclaiming it won’t be easy, but if you outlast them, it’s worth it. For all the battles, by the time we were in high school, my parents could go to sleep while we were out, confident that we were doing the right thing.
Dad was fond of saying you can’t let the inmates run the asylum. I watched Charlie and the Chocolate Factory with our son today and couldn’t help seeing a parallel between this issue and how Veruca Salt ordered her parents around.
I’ve looked back on the battles we had with our parents, and I’ve both apologized and thanked them. It couldn’t have been easy. When I first started underperforming in school, my father took me for a drive through the most squalid ghettos in our city, and said “take a good look around, because if you don’t straighten up and fly right, without an education, this is where you’ll end up.” I was 7.
bw1 says
I think it’s also important to send the message that new foods are no big deal. That’s the problem with the one bite approach – by saying they have to try it or eat one bite, you’re implying there’s something negative about the experience. My parents were as casual about eating a food for the first time as they were about going to the bathroom; it’s just something mundane that’s expected of you, because EVERYTHING you eat had a first time.
Katja Rowell says
Thanks for commenting BW1 and VK. BW1, I would have agreed with you 15 years ago, “no child will starve himself” and “they will learn to eat it.” And I do agree that the “one bite rule” is often counterproductive (but that’s what parents are told to do when they look for help), and I’m not in favor of sneaking foods in the majority of cases, and yes, offering new or unfamiliar foods should be matter-of-fact with the expectation that they will learn to like it, at their pace. However, the forcing, pressuring tactics that you describe often backfire (glad they didn’t seem to for you). We don’t know all the components of resilience, and why you have grown up fine (by your report) and why another person with the same history develops an eating disorder (my colleague who works with adults with eating disorders shared that many have a history of being force-fed or vomiting at the table). As an aside, if your son vomited and cried every time you made him eat a food, would you persist? Is there any amount of resistance that would give you pause with the approach you describe?
I have learned the most over the years on house visits and consults with desperate parents, who are far from neglectful, from reading research and observing children. Your experience was your experience, and I hope you and your son do well in all ways, but it is not the experience of every parent and child. Your parents’ generation practiced the clean-plate-club, forcing, pressuring and often making children eat. I would suggest that overall, when we see how many adult Americans struggle with eating and health related to their relationship with food, statistically, this may not have been the best approach. If you read the book, what you would see is that parents are in control of what, when and where children eat, and children have the autonomy to eat or not eat from what is provided. This approach is not about children eating whatever, whenever they want, but about parents providing a supportive environment so the child can learn to eat to the best of his or her abilities. Many of the children who struggle had challenges you and your siblings may not have had. Perhaps oral motor delays, developmental delays, anxiety, and with the increased incidence of autism and spectrum and sensory challenges, this absolutely plays a role. Critically, we think many parents have been ill-served with bad advice, from ‘starve them out’ to ‘just let them eat whatever they want whenever they want.’ Some children comply with rules, others literally will not eat and end up on feeding tubes. Until one is faced with these challenges or listens to families and really hears the situation and factors involved, it seems like a simple problem of parents just getting kids to eat. It is not. VK, I wish you well on this journey. There is a lot parents can do to support tuned-in eating and enjoyment of a variety of foods. All the best to you both.
bw1 says
“I have learned the most over the years on house visits and consults with desperate parents”
Where? How many of these home visits were outside the indolently well fed first world? Step outside that narrow cultural context and things change, yet, we’re still talking about homo sapiens.
“I would suggest that overall, when we see how many adult Americans struggle with eating and health related to their relationship with food, statistically, this may not have been the best approach.”
And I would suggest that, historically, the incidence of picky eating and eating disorders correlates neatly with the rise of indulgent approaches to such things. You’re drawing your conclusions from a narrow time slice of a privileged minority of the world’s population.
“Many of the children who struggle had challenges you and your siblings may not have had. Perhaps oral motor delays, developmental delays”
Oral motor and developmental delays can be overcome by managing the mechanical properties of the food. They don’t impact the variety of flavors, or, within the mechanical limitations, textures fed.
Jenny McGlothlin says
If it was only as easy as you say! As a feeding therapist working with hundreds of children with oral motor and sensory issues, I’ve worked with those whose parents have met them where they are and haven’t pushed them to eat different foods…and also those who have taken the hard line like you suggest. The children who are allowed to choose from the (carefully selected for skill level and sensory characteristics) food that is presented without pressure or coercion go on to be happy and calm at mealtimes, and expand their diets much more quickly than those whose parents push them too quickly to consume foods that are frankly, terrifying to them.
Imagine if you put a novel food in your mouth, couldn’t chew it properly, felt it moving back in your mouth too quickly and thought you might choke. Your fight-or-flight mechanism kicks in, you panic, and your sensory system moves into overdrive. You gag until you vomit, and that food just became poison in your young, inexperienced mind. We know that neural pathways are laid down throughout childhood, and positive or negative associations with eating will stick with a child for a long time. If they have experienced a choking event or vomited a food….or even if they have been made to sit in front of a food for three hours until they finish it- these kids have been placed in a situation that significant impacts their ability to come to the table and try that food again.
Because this area of research is fairly young, we are just now finding out how wrong you are- that many people who are now in their 70’s and 80’s are now talking about how difficult their life as a picky eater was. I cannot even count how many parents have told me how they still can’t eat certain foods that they were forced to eat as children. They never learned to like the food just because someone said they should. That just isn’t how it works.
Another point: I work with families who have 5+ children and feed them all the same way- and then the 5th one doesn’t eat. Can’t/won’t/ just doesn’t. Lots of reasons why, but when eating is so negative for the child that they would literally starve rather than do it, no amount of forcing will change it.
You are, of course, welcome to your opinions bw1. I would like for you to consider, however, that there are families out there who have different experiences than you have had. I have been running a feeding therapy program for over a decade, and this problem is not new, and is not going away any time soon. One reason why is the sheer number of surviving premature infants now vs. 25 years ago. These babies are born with neurologically immature systems (GI AND brain) and feeding is the most difficult skill they have to learn. Those babies are at high risk for feeding problems, and there are many of them out there.
There are all sorts of developmental disorders that we don’t fully understand, and are just now in the last 20 years or so being actually studied (Autism, for one). So, no, we don’t know how many children fit into this category before this time of research and awareness. They’ve now recognized that there is a significant enough issue to create a new diagnosis in the DSM 5- ARFID. Adults are coming out of the woodwork self-diagnosing since this came out because they have been living with this their whole lives and finally have a framework from which to view their issues.
It’s complex, and while we are glad you and your sibs have come out fine on the other side, there are those with a different and much more negative outcome.
Bettina Elias Siegel says
The entry period for this drawing is now closed.
Carla says
Thank you so much for this interview. My husband and I are adventurous eaters, and growing up (I’m in my mid-30s) it didn’t even occur to me to reject a food or to ask my parents to prepare something else for me, even if I didn’t like what was being served. I think, though, that it wasn’t all to the credit of their parenting style. I think it was mostly the luck of the draw that they got two kids who by temperament were willing to eat (even if grudgingly) whatever they were given (though I definitely wasn’t so easy on other fronts!).
My dad, who is now in his late 70s, was adamant that my brother and I not be forced to eat anything we didn’t want to put in our bodies. The economic, cultural, and historical context of his own parents meant that he and his siblings weren’t allowed to leave the table until they cleaned their plates, and were sometimes physically punished for not eating. To this day — more than 70 years later! — he still gags if he eats anything green. His siblings were also picky eaters as adults, and harbored a great deal of resentment toward their parents. This is just one anecdote, but this happening to my selective-eater preschooler is not a possibility I’m willing to live with. I have purchased the book and look forward to learning from it.
Bettina Elias Siegel says
Carla: my dad, too, was forced to be part of the Clean Plate Club as a child and suffered from weight issues all his life. My mom was adamant that we not be raised that way and I think the freedom to reject food contributed to my own adventurous palate. (But, as a parent of a picky child, I also agree that there’s a big “luck of the draw” factor, too, just as you said!) Thanks for this comment and I hope you like the book as much as I did.