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.]
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Emma says
I have a son who has had extreme eating issues that started around age 7. He is 19 now. I’m wondering if this book would be helpful for someone his age. Since you’ve read the book I was hoping you could answer that for me.
thanks
Bettina Elias Siegel says
Hi Emma: The book is geared for parents of younger children but I absolutely feel it would still be a useful resource for you, despite the fact that your son is much older. I’ll consider your comment an entry into my book drawing, but if you’re not the winner, I’d encourage you to buy a copy.
Karen says
Love that kohlrabi story! We abandoned the one bite rule a couple of years ago, but our picky eater still talks about the horror of that rule. Now I’m trying to be more like Dr. Rowell. I expect zero out of her in our house with regard to trying new things, but welcome news of her trying new foods with friends (the most likely source of any new idea at this age for her).
Katja Rowell says
Thanks Karen! It has made our house and meals a peaceful place. No mealtime battles, but still a lot we can do to support our kids! Kids often try new things away from home, or at places where food isn’t the focus. It’s fascinating!
karen says
Our house is definitely more peaceful, but we still struggle with planning family meals. That’s slowly getting better.
Reading the comments below shows how much anxiety the picky eaters have around food. Our picky eater is in therapy for her anxiety issues, and I’ve asked the therapist to help her work thru food issues. I think that is helpful too. It’s only since she started therapy that she’s been able to express her horror at the one bite rule. I’m glad she has found some words to communicate better on this topic. Above all, I want her to be healthy and free of any disordered eating.
Toni says
Looking forward to reading this to hopefully help my 7 yr old selective eater.
CarolineSF says
My son, now 25, was an extreme picky eater from a day at age 1 when he started refusing most foods — literally most foods. I won’t go into what he ate or how we dealt with it — too late now. He didn’t like to talk about it. (His grandfather was also very much like that.) My daughter, 21, was far less extreme but had extreme aversions to certain normal-seeming foods, such as fruits “with water inside” (you name it — that’s most fruits). On the other hand, she would try daring things by our family-of-origin cultural standards, like going to Chinese restaurants with Chinese friends and eating organ meats.
Daughter says (and has said since late childhood) that it’s a sensory issue, in both cases — an extreme aversion to the textures of certain foods that are nauseating. OK, here’s the possibly useful part — my son didn’t smoke pot till college, and as soon as he tried pot, he started eating far more normally. I don’t think it was the famed “munchies” because it affected his habits overall — I actually wonder if there was some effect on his sensory responses to food. Obviously we aren’t planning to roll joints for our ultra-picky 2-year-olds, but it does make me wonder about potential remedies to ease the responses.
My son got less and less picky but remained a vegetarian, which had basically been an excuse for his remaining pickiness. Then he met a fellow student and married her. She’s from Bulgaria and very, VERY no-nonsense, and an excellent cook of the foods of her native culture. Soon my son dropped being a vegetarian entirely and now eats like a normal person as far as I can tell. I asked what his first meat was — a hamburger from the local “best hamburger in town” Irish pub — which he loved.
During my son’s childhood I joined a list serve of adult extreme picky eaters, with members from all English-speaking countries. I followed it closely for a couple of years. It really bore out my observations about my son — an extreme aversion to certain things that caused people to fear (to a pathological degree) ever trying anything new. These people’s lives were severely affected. Just food for thought, so to speak.
Bettina Elias Siegel says
This is all fascinating stuff, CarolineSF! I would love to get Katja and Jenny’s thoughts, too. And re: the marijuana thing – do you think that’s attributable to just an overall lowering of inhibitions? Would alcohol have had the same effect? Again, obviously not a solution for parents (!) but very interesting nonetheless.
Jenny McGlothlin says
Intriguing comment, CarolineSF. Anxiety plays such a huge role in these children’s lives when it comes to food. I wonder if the marijuana actually served to lower his feelings of anxiety and calm him and that was the catalyst for him being able to try new things? Then perhaps when he wasn’t smoking, he remembered eating something new and realized he actually enjoyed it. Super interesting!
bw1 says
Hallucinogens in general alter sensory perception.
The daughter in law’s “no-nonsense” attitude toward food highlights that the whole picky eater dilemma is a typical first world problem. The majority of the world’s population doesn’t have the luxury of indulging their children’s hangups – they are struggling just to feed their kids anything, let alone cater to their preferences. Guilt over forcing kids to eat something they don’t like seems pretty indolent when you consider the plight of parents in other parts of the world.
Katja Rowell says
This is a common myth and surprised me as I learned more on this issue over the years. Much of the responsive feeding research comes out of developing countries addressing malnutrition and stunting. The WHO says that feeding practices “are often a greater determinant than the availability of foods.” A study from Bangladesh also showed that trying to force children there to eat, even when malnutrition was a real threat, resulted in lower intake and slower growth. (Google responsive feeding research to learn more, or try Pubmed search. There is a great 2009 review in the Journal of Nutrition from various countries and soci0-economic status.) A Dutch study last year showed similar rates of persistent picky eating as the US. Alas, I wish this was a problem that spared large swaths of the world, but that’s just not the case. This is a complex situation. Grateful to help let folks know more and get more help. Thanks for your comment.
Trish Stone says
Mealtime is miserable at my house!
Bettina Elias Siegel says
Oh, no! I’m sorry to hear this. If you’re not the winner, do get the book! I really think it will help.
Danielle says
I have an extremely picky 4 1/2 year old that is so stubborn! Totally frustrating for the entire family
Debbie Fredricks says
This book would be perfect for my daughter as she is struggling with her daughters picky eating.
Nicole Morrison says
Two of my boys are on the spectrum and all have sensory issues. Food and textures are a big issue with them. I think this book would be a great help.
Vanessa Sturgeon says
This book may be the game changer I need to help not only my son but also my anxiety and the stress I put on myself for his picky eating and lack of interest in food entirely.
Lisa says
My 4 y/o is on the spectrum and is a picky eater. We have found a wonderful OT who specializes in feeding. We are making baby steps with new foods, but for the first time in 2 years I feel hope.
Jess says
“You don’t have to try it.” This phrase has been a complete game changer. I offer this advice to my clients with picky eaters and they are reluctant to accept it but always amazed at the results. Great interview! Thanks for sharing!
Katja Rowell says
Yes! We love this advice as well! “You don’t have to eat anything you don’t want to.” Lots of other great tips to help remove the pressure from children who are very sensitive and resistant. Thanks for adding this!
Becky Schwantes-An says
I’ve found the work of the Feeding Doctor and Ellyn Satter’s DOR incredibly important. We have a challenging eater who is firmly in the picky stage. Not pressuring him has saved meal times and help us truly enjoy those moments in the day together.
Katja Rowell says
Thanks so much! Glad to hear it. I was so happy to have the opportunity to work with Jenny on this book. She has taught me much over the years and her experience with more clinical and resistant eaters and oromotor/sensory tips are a big part of the book.
Ushma says
We are struggling with my almost 4 year old’s picky eating habits. Its a power struggle and we are now in the process of implementing DOR. It is making things more pleasant and I am curious to see how long it takes for the efforts to bear fruit.
Laura says
I have two children with autism. One is a picky eater, the other is a selective eater, or extreme picky eater. She gags when she tries something new and sticks to less than 10 familiar foods daily. This book sounds very helpful!
RPearce says
As an adult picky eater who has struggled with trying new things, I’ve experienced some anxiety with trying to help my 3 1/2 year old overcome her picky eating habits. As of now she only eats around 6-10 different things and no fruits or vegetables (except squash and hidden zucchini noodles). Her dad is a very adventurous eater and says it is because his parents made him eat his dinner but I could never do that to her. I could use all the help I can get! Winning this book would be amazing!
bw1 says
Start with you. You can’t possibly hold a young child to a higher standard of self control than you achieve for yourself.
Why do you struggle with it as an adult? Your comment proves that you know you’re a picky eater, and that you see it as a problem. You have the intellect to understand the situation – now it’s just a series of decisions made and executed.
It’s not realistic to expect love at first bite with new foods. Behavioral scientists have found it takes 10 or more exposures to habituate. Each time you try a new food again, try to notice new things about it you didn’t notice the last time. Adventurous eaters don’t necessarily like everything; they’re just curious about everything, and they also base their eating decisions on other factors. It’s not realistic, in a world of limited resources, to expect that one will not eat things in life that fail to tickle the pleasure center of one’s brain. Alter your expectations, develop an exploratory approach, and take control.
Katja Rowell says
Hello RP. Mealtime Hostage has resources for adults, Michelle Allison, aka the Fat Nutritionist, and Jackie Lamanza (I think) also works with adults if you want to look into those resources. Secrets of Feeding a Healthy Family is also a great book. Best of luck on this journey! Some kids who were made to eat learn to enjoy foods, many do not. We explain much of why children may respond differently to different tactics and how you can help.
Katherine Weber says
Superb post Bettina, thank you. I look forward to part 2. What these authors said here express things I have seen EXACTLY in my family. One child is mellow and adventurous about food. The other is picky and STUBBORN to boot. I think I’ve done an “ok” job of not making food a battleground with her, but I have definitely had more moments of exasperation and coercion than I care to admit – and regretted it every time. The most helpful part of this post was the first paragraph – what normal looks like. It looks like my “picky” eater. Will get this book (if I don’t win it!) Thanks!
Bettina Elias Siegel says
Katherine: You’ve pretty accurately described my family as well! And, like you, I sometimes just can’t help myself and start applying pressure, even though I KNOW by now that it does no good and that I’ll regret it later. I also feel that if I’d read this book early on, I might have been more relaxed about my son’s eating; instead I may have inadvertently solidified some behaviors that were otherwise normal developmental blips. I can never know, of course, but I do hope this book can help others from making my mistakes. And good luck in the drawing!
Jenny says
Hi! My husband and I love good food, and I love to cook and bake. I’m a family physician, and I am pregnant with our first child. As a provider, so many parental concerns and so much of this advice rings true, although I’m sure I have yet to discover exactly how frustrating or worrisome it can be when your child won’t eat certain foods. Sounds like every doctor and parent should read this book!
Katja Rowell says
Thanks Jenny! As a family doc myself, I think more doctors would be well served to learn this info! How to help parents right at the beginning. We just did a medscape quiz, “Picky Eating, Is It Serious” for doctors and will do a follow-up. Please share with your colleagues! I am doing a talk to the family docs here in MN at the end of the month. Good luck with your little one!
Victoria Keen says
I have a 4 year old who, six months ago, ate no meat and no vegetables. I could list the things he eats on two hands. I finally gave up trying to make him try new things. It was just too stressful. We are able to have family style meals some times, but with work schedules, we don’t always have the whole family home at dinner time.
He also has celiac disease which was found through a very long and painful 6 month process. I truly believe this has affected his eating habits.
Whether I win or not, I will be checking out this book.
Thanks!
Katja Rowell says
I’m so sorry it took so long to get a diagnosis. Absolutely that will impact how he feels about eating. We offer an alternative. So many parents say they feel like their only choice was to fight over every bite or ‘give up.’ There is a lot parents can do to support a child’s healthy development with eating! Good luck on your journey!
Holly says
I would be very interested in this book. Our 9-year-old has never eaten easily, starting from Day 1 with reflux. The whole family needs a break from his eating habits and behaviors.
Amy Blacker says
I have a nine year old daughter who I don’t really worry about because she eats almost any fruit and a few vegetables. Although I wish she would eat more vegetables, I’ve got my hands full with a six year old son who eats NO vegetables and only two fruits, apples and pears (with the skin cut off, of course!) I know I have been pressuring him through the years to try new things or just to eat what I’ve made us all for dinner, and I feel guilty about it. I’m going to try to not talk about food at all with him for a while, just serve dinner family-style with no pressure for him to eat it. On his own, if he doesn’t like what I make, he’ll say, “I’ll have a bowl of Cheerios and milk,” and I let him get the cereal and pour the milk himself. I figure it’s fairly healthy and avoids us arguing over food, and now my aim is to not pressure him in any way about eating vegetables and more fruits. He doesn’t eat any meat, but he gets protein from milk, cheese and peanut butter so I’m not about to argue with him over it. I think putting zero pressure on him may help – I just have to catch myself doing it, especially when I do it subtly and it doesn’t seem like pressure to me, but I’m sure it does to him. I think reading Extreme Picky Eating will help, whether I win it or have to purchase it myself.
Leslie says
What a great interview. I have 3 children and the oldest is insanely picky and has been since day 1. I know there are a multitude of factors that led to his pickiness but at this point he has been through over a year of feeding therapy at Childrens Hospital in Boston and he is now capable of eating basic fruits like apple and pear but simply chooses not to. I know it is very much a behavioral battle between us two so I need to go the route of family style and no coaxing. It is hard though! I also worry about my oldest’s bad habits derailing my other two children’s healthy eating habits!
My question is… has anyone ever had success with having their child talk to a behavioral psychologist about eating issues? We have ruled out all physical/medical issues.
Katja Rowell says
Hi Leslie,
Good luck. I think the book will be helpful. Mealtime Hostage facebook private group has over 300o parents and may be able to answer your question. We see many children who “failed” behavioral and other therapies. Some children respond to rewards and praise, others resist even harder. Often, rewards may work on the short term and then stop working, or parents tell us, “Bribes with video game time works for chores, homework etc, but NOT eating.” Eating is fundamentally different from other “behaviors” and far more complex. Hope the book helps, and Mealtime Hostage as well. There is hope and there are resources out there! Likely he has had some “behavioral” therapy already. We also explain in chapter 8 what different kinds of therapy are out there, if you need it, how to find the right help for your family. Many children eat at the therapist, but not at home. Doesn’t mean a “behavioral” approach is the only option to what is perceived as a behavioral problem, if that makes sense!
Leslie says
Thank you Katja! I just joined Mealtime Hostage on FB, and the postman brought me a copy of your book yesterday and I am devouring it. Wonderful to find so many new resources after feeling frustrated for so long!
Bettina Elias Siegel says
Just in case Katja doesn’t come by to see this comment, I forwarded it to her directly. I know she and Jenny will be gratified to learn they’ve been able to help!
Katja Rowell says
Hope it helps! So glad we were able to share about our work here. Thank you Bettina! If the book is helpful, letting other parents like you know about it, via Amazon or other review can help. Keep us posted on questions and progress. We are on facebook https://www.facebook.com/extremepickyeating
Bettina Elias Siegel says
The entry period for this drawing is closed.