Encouraging a healthier diet for your picky eater

Marlene Cimons

THE WASHINGTON POST – Megan Pesch has three daughters, ages two, three and five, all of them fussy about their food.

“They want chicken nuggets. They want hot dogs. They want mac and cheese, and sweets too, of course,” she said.

“It drives me nuts.”

As a paediatrician who also studies childhood picky eating, she finds this especially frustrating, if not somewhat ironic.

“I look at their diet, then think about my (professional) role… and I cringe,” said Developmental and Behavioral Paediatrician Pesch at the University of Michigan’s CS Mott Children’s Hospital.

“But I wonder what else could I have done? I felt like I did everything right. I introduced vegetables at the right time. I was very careful about the food I brought into the house. Yet, here we are.”

While some children are picky to the extreme, it is, for many, a developmentally normal phase and one, as paediatricians often say, they eventually will outgrow
Continue to offer new food, even if the child rejects them

Pesch isn’t alone. She and many other parents frequently contend with children who stubbornly refuse to try new foods, or shy away from healthy vegetables and fruits in favour of high fat, salt and sugar laden choices – and constantly feel tense and anxious about it.

While some children are picky to the extreme, it is, for many, a developmentally normal phase and one, as paediatricians often say, they eventually will outgrow.

Studies indicate that picky eating ranges from 14 per cent to 50 per cent in preschool children, and from seven per cent to 27 per cent in older children.

Pesch thinks many parents worry unnecessarily about their children’s eating behaviours and urges them to be patient.

She said her daughters actually illustrate one of her theories about picky eating, which is that some children might have an inherent “picky eating temperament”, much as being a natural extrovert or introvert, or having a sense of humour, or not.

Regardless, “I try not to stress about it. They are growing beautifully, and all have healthy BMIs,” she said, referring to body mass index.

If parents think they must do something, there are actions they can take to encourage their children to try new foods, including healthier ones.

First, be sure kids are hungry at mealtime, which means skipping mid-afternoon snacks. Continue to offer new food, even if the child rejects them.

Involve kids in food preparation, from shopping (albeit easier in pre-pandemic days) to growing their own vegetables in a family garden.

Let them help wash and cut them – if it’s age-appropriate and safe – and let them stir the pot when the vegetables cook, or have them tap in the numbers on the microwave screen.

“All this increases their positive emotional relationship to these foods so they seem less averse and more familiar,” Pesch said.

“Anything that gets them to take ‘ownership’ is great.”

Pesch’s research has found that not all picky eaters leave this behaviour behind as they grow older, although most remain healthy and are of normal weight, she said.

With both childhood and adult obesity reaching alarming levels in this country, picky eating may be protective against an unhealthy BMI and excessive weight gain, she said.

“While some research suggests that kids may be low in some nutrients as a result of picky eating, overall most of them do just fine – they aren’t underweight or suffering from reduced growth or any serious negative health consequences,” she said.

Nevertheless, “we need more research to better understand how children’s limited food choices impact healthy weight gain and growth long term.”

Some picky-eater children become picky-eater adults, but usually without ill health effects, experts said. “When I talk with adult picky eaters, they are not unhappy,” said Katherine Dahlsgaard, a clinical psychologist who directs the food allergy clinic at Children’s Hospital of Philadelphia.

“They have found a way to live and travel and go to restaurants and find something they would like to eat. This is not the case, however, for all teenagers and adults who are extremely picky eaters.” Dahlsgaard, however, points out that there is a significant difference between typical picky eaters who may be going through a phase and “extremely” picky eaters whose behaviour seriously impairs their lives.

Extremely picky eaters eat only a narrow range of foods and often find foods with layers and textures – lasagna, for example – “disgusting and repulsive,” she said.

They have trouble eating in restaurants, travelling and going to social events, such as the season-ending sports banquet, she said. Some can suffer from malnutrition.

This disorder has a name: Avoidant Restrictive Food Intake Disorder, or ARFID. The actual prevalence of ARFID is still under study, but some research suggests it may affect at least five per cent of children. “It’s extremely hard for parents of these kids to get them to accept new foods without professional intervention,” Dahlsgaard said. “They are extremely resistant and inflexible, and have been throughout childhood, and are unmotivated to change.”

Children with ARFID are different from typical picky eaters, she said. It is evident in early childhood and persists.

“When I interview a parent of a 12-year-old who only eats two meats, no vegetables and one yogurt drink, and I ask how he was when he was younger, she told me that the level of stress was so high – and would last for so long – she didn’t know what to do,” Dahlsgaard said.

Most parents of these kids try all the recommendations for typical picky eaters, “but they already have a kid on hand who is so far worse than typical,” Dahlsgaard said. “Those techniques don’t work, and they feel very guilty about it.”

She has developed a promising approach which involves offering kids a “challenge” food, and giving them one or two minutes to eat it, then rewarding them – usually with screen time – if they beat the timer and eat the food. While many experts disparage rewarding picky eaters, this system primarily targets problematic children who don’t respond to conventional techniques.

“In my experience, the child will only eat the challenge food for the reward, which has to be highly motivating,” Dahlsgaard said.

“Access to screen time works the best. However, beating the clock is a very important piece of the treatment, and it comes first. Progress is very slow and should be steady. The more exposure they have to a challenge food, the more likely they are to go on and accept it.” These children may still be picky, but they often improve, she said.

“The family has a routine in place where the child can try a new food, and the more they try, the more likely they will find a food they will eat for ‘free’, ” she said. “It’s the child’s choice. If they try the food, they earn the reward. And if they don’t, they get to try again 24 hours later.” Scientists don’t know what makes a child a picky eater. Some research suggests babies show pickiness as early as two-weeks-old. “People have tossed around the breast feeding question because what mom eats affects the taste of breast milk,” Pesch said.

“There are also studies that show what the mother eats in pregnancy will affect what the child wants to eat.” Research also has found that both genetic and environmental influences are probably involved.

“It’s very common to hear parents say, ‘I was a picky eater myself’, or, ‘My mother-in-law tells me my husband was a picky eater’,” Dahlsgaard said.

“Also, environment absolutely plays a role. They are primed genetically, then American food culture makes it easy to continue. There are the same foods wherever you go for kids who like carbs, and who shun any meat that isn’t a chicken nugget and any vegetable that isn’t a french fry.”

Experts suggest parents of most picky eaters can afford to relax.

“Take a step back and be gentle on yourself,” Pesch said. “It’s okay to not force kids to eat something they don’t want to. Know that the needle on picky eating moves slowly. Even if they take a bite and spit it out, consider that a victory because they never took a bite before.”