Medical Nutrition Therapy Blog

How To Feed a Picky Eater

Do you have a picky eater on your hands? Is meal-time a struggle and you find yourself making macaroni and cheese or chicken nuggets every night just so the kids will eat something? It may be comforting to know that most caretakers have to deal with feeding difficulties at one time or another. Picky eating, often referred to as fussy, faddy, or choosy eating is a common childhood plight. It is typical for children to refuse to try new foods (neophobia) as well as familiar foods and have very strong food preferences (like plain pasta or hotdogs). Today we are breaking down picky eating, identifying how to know if it’s something more, nutritional consequences to extreme picky eating, and talking about the best methods of how to feed a picky eater for parents that they can incorporate into their daily habits. We will also give you practical tips to get your child to expand the range of foods they eat.

What is Picky Eating and When Should I be Worried?

Picky eating is estimated to affect as many as 50% of children. It is characterized by neophobia, limiting the variety of foods eaten, refusing foods (normally vegetables), and having food jags. An average picky kid may only have around 20 items they will eat. Extremely picky eaters or problem feeders have fewer than 20 foods and may only like specific brands. For example, they will only eat peanut butter and jelly on white bread with the crust cut off. If served something different, they will likely throw a tantrum, whine, or reject the meal. A child demonstrating food jags will only eat a small number of foods over a time period and reject anything else. Children commonly replace one food jag with another. The food jags change from time to time, but the child gets stuck in them and has difficulty getting out. It seems silly for this to happen, but if you’ve ever fallen into a “food rut” making the same meals for dinner every night or ordering pizza because you know everyone will eat it, you can probably relate.

Picky eating is estimated to affect as many as 50% of children.

We all get comfortable and complacent sometimes, but it is important to help your toddler through food jags to broaden their palate. Helping a child get through a food jag can also lower their risk for nutrient deficiencies. I work with many families who are relieved to finally talk to someone who understands what they are going through and can offer practical advice. Oftentimes the number of foods accepted got smaller over time. Concerned caretakers were advised it was a phase, and the child would grow out of it. Parents become short-order cooks and kids become ever more discriminating. Our willingness to give them something, anything, just to get them to eat backfires and the problem grows. As caretakers, we play a central role in helping our kids develop feeding skills and a relationship with food that results in physical and mental nourishment. If you are concerned about your child’s feeding behavior it is never too early to consult a professional. Changing troublesome behaviors after they have been ingrained is far more difficult than nipping them in the bud or preventing them in the first place.

Picky eating can cause familial stress, taxing mealtimes, and forceful feeding practices such as verbal or physical pressure to eat. Well-intended caretakers may resort to bargaining or offering incentives at mealtimes, which does little to remedy the problem. Instead, this can make the problem worse. Kids may enter the meal feeling worried or nervous about being pressured to eat. This mealtime anxiety further perpetuates picky eating. Extreme picky eating coupled with a significant deficit in nutrients and energy and often failing to gain weight is an eating disorder known as Avoidant Restrictive Food Intake Disorder (ARFID). You can read more about ARFID in our blog post here. If you think this is something that your child is experiencing, talk to your pediatrician right away, who will refer you to a specialist for screening.

Raising a Healthy Kid: Nutrients of Concern for the Picky Eater

It is important to eat a diverse variety of foods because our bodies rely on our diet to provide us with the nutrients we need to be healthy. In childhood, nutrition is critical for proper growth and development. Poor nutrition can lead to deviation in growth which in turn can have long-term consequences. A well-balanced diet should include a regular intake of fruits and vegetables, whole grains, protein, and dairy foods. A daily menu made up of all food groups can ensure that kids do not miss out on important nutrients. In practice, the most common feeding issues I see that result in poor nutrition are an over reliance on processed, packaged, and refined foods and omission of produce from a child’s diet. Many processed and packaged foods provide little nutrition and lots of energy (also known as empty calories). They tend to be high in added sugars and saturated fats, and are low in fiber. Since these foods tend to be short on nutrition but rich in energy (calories), over consumption can lead to being overweight and undernourished. To learn more about the effects of too many processed foods on the diet, check out our blog post all about ultra-processed foods.

Fruits and vegetables provide indispensable nutrients such as vitamin A, vitamin C, vitamin E, folate, potassium, magnesium, zinc, and fiber. Potassium helps muscles function during movement and supports normal blood pressure. Vitamin A plays an important role in the immune system to help your body fight off illness and helps promote strong bones as a key player in the breakdown and building up of bone tissue. Vitamin C boosts immunity to ward off infection and illness, protects cells from damage, is important for skin health due to its role in collagen synthesis, and helps make important chemicals and hormones. Vitamin C containing foods also help the body to absorb iron. Vitamin E prevents clots from forming in the heart, helps neutralize toxic substances called free radicals in our body that could do damage, and contributes to a healthy immune system. Magnesium is important for regulating blood pressure, stabilizing blood sugars, proper nerve function, keeping bones healthy, protein building, and allowing the heart to beat steadily. Zinc is important for recovery from an injury or open wound and immunity. Zinc, folate, and vitamin A play a vital role in the growing and multiplying of cells, making them crucial for children and adolescents.

Many kids avoid meat due to textural aversions or familial dietary preferences. It is important to consider nutrients found in meat and to increase acceptance, understand meat alternatives, or work with a dietitian who can help to craft a well-thought-out diet. B-vitamins such as thiamin and riboflavin, vitamin E, phosphorus, iron, and zinc are found in meat and other food sources. Thiamin is found in meat, whole grains, and legumes and helps break down nutrients for energy, and is responsible for the growth and function of cells. Riboflavin helps to break down fat for energy, and helps us process and use medications. Iron keeps our blood healthy and functioning, delivering oxygen throughout the body. Iron is vital to children’s brain development and growth and is one of the most common nutrient deficiencies of childhood.

If a child does not consume dairy due to picky eating, intolerance, or family preferences, a dietitian can help ensure that food choices are expanded upon to provide adequate calcium and vitamin D which are commonly known for their function in bone health but have many other duties in the body.

It can be overwhelming to think about the role that nutrition plays in the body, but it doesn’t have to be. A diverse array of foods from all food groups provide the vitamins, minerals, and other nutrients that are crucial for proper growth and development during all stages of life, especially in the rapid period of growth that is defined by youth. Therefore, if you have a picky eater at home, early intervention is the best way to prevent exacerbation and nutrient deficiencies that can be associated with it. Talk to your pediatrician and make a plan to partner with a pediatric dietitian. A pediatric dietitian that specializes in child feeding and family nutrition can help you to implement a feeding plan that is tailored to your family and broadens your child’s food preferences.

Next, we will discuss some useful strategies to put into action to help your child overcome pickiness and accept new foods.

Division Of Responsibility In Feeding

Start by implementing the Division Of Responsibility (DOR) In Feeding. Check out our blog post for the scoop on this feeding style. There are two basic principles of the DOR in Feeding.  The first is that caregivers are responsible for what, where, and when children eat. Will you serve chicken or steak? Mac and cheese or rice? Is there a vegetable on the table? As caregivers sometimes we forget that we are also gatekeepers to the foods that are available to our children. Are mealtimes at the table or are they in front of the television? Try to eat together as a family, and if possible set the table and let everyone serve themselves. Family-style meals have been shown to encourage healthy eating behaviors in children. In addition, allow your child to choose what they eat from what is offered.

The second principle of the DOR in Feeding is that children are responsible for if and how much they eat. Kids are good at following their own hunger and fullness cues. Insisting on “one more bite” or promises of an early bedtime if the plate is not clean forces kids to override the internal systems that control how much they eat. Your child should choose what and how much to eat at the meal. What is offered is ultimately your responsibility. Model the behaviors you wish your children to learn and repeat. If you want to see your child eat broccoli, they are more likely to try it if you eat broccoli. Interestingly, in my experience as a Pedi-RD, broccoli is one of the most loved childhood veggies. Who knew? Sometimes I get disappointed that my “Maybe broccoli doesn’t like you either” t-shirt is underutilized.  At the very least, show your child that there is nothing to fear in exploring new tastes and textures.

Insisting on “one more bite” or promises of an early bedtime if the plate is not clean forces kids to override the internal systems that control how much they eat. Your child should choose what and how much to eat at the meal.

Sometimes families tell me they are torn because a child may have nutrition-related issues that other household members do not have. For the most part, healthy mealtime behaviors that are good for one child are generally going to be beneficial for the entire family. When families adopt healthy habits together, everyone wins. Serve the same meal to everyone, eat together, and avoid creating a stressful mealtime environment. Don’t coerce or give constant reminders to take a bite. Make family dinner time about family. Ask the kids what they enjoyed about the day, what they are looking forward to, or what they need support with. Share details of your day. Pressure to eat creates a tense mealtime environment. This causes kids to be less engaged and more resistant to trying new foods or eating at all. Giving them control of what they eat at meal times while offering a variety of foods to them, gives them autonomy in making food decisions. Autonomy is a crucial step in asserting their independence as they transition from infancy to toddlerhood and beyond.

Tips to Expand Food Acceptance with Picky Eaters

A goal is always to prevent picky eating from getting worse by continuing to offer a variety of foods, despite food jags and multiple food rejections. It is often overlooked that it may take 10 to 20 times (or more) of exposure for a child to accept new or unfamiliar food, but parents tend to give up after only a handful of rejections. I have heard many Moms say “my child doesn’t like [insert any food here]” only to find out through some digging that the child has not tried or been offered that food in years. Mom decided at a young age that “he doesn’t like it” and it disappeared from the rotation. This can lead to a gradual spiraling down of food options until the child is only being offered a handful of foods and refuses anything else. For most kids, this becomes their reality and they are convinced that they do dislike food that they have no memory of ever trying. For some children, it takes months or years to accept new foods. Don’t give up!

Consistency is key and children should be offered a wide variety of foods daily and from each food group. This helps ensure they are getting the nutrients their growing bodies need. In addition, rotating the foods you’re offering each week and continuing to introduce a new food with an already preferred food is recommended. For example, if your child loves mac n’ cheese, offer them a small portion alongside a fruit they like, such as strawberries, and perhaps a new-to-them vegetable, like snap peas. This method of introducing foods will lessen the tantrums and increase acceptance of new foods over time, provided you do not force the child to eat or try the new food.

There are neutral strategies you could try to increase food acceptance. One is to have your child help you with your meal plan for the week. Ask them what vegetables they might want to try this week. Take them grocery shopping, to the farmer’s market, or show them pictures of a variety of colorful vegetables. Plan a meal or side dish together. Kids of all ages can help out in the kitchen. Measuring, scooping, mixing, pouring, cutting, using the stove or other kitchen tools or cookware are all ways that children can help prepare food depending on their age and skill level. Consider planting a garden or visiting a local pick-your-own farm. These are fun, neutral ways to encourage kids to try fresh produce and educate them on where food comes from. Getting them involved in the planning and cooking process helps familiarize them with new foods, which can help break down some barriers and anxiety that surround a new food.

Involving a dip with vegetables (like hummus, tzatziki, or tahini) or meats (like ketchup and barbeque sauce) can be beneficial in getting some children to try new foods. On a personal note, one of my daughters would eat anything in the infant and toddler stage as long as tzatziki was involved. I have distinct memories of covering mashed sweet potato in the cucumber yogurt dip to get her to eat it. I thought for sure she was destined to eat just like me. Wrong. I went through the same food refusal and food jags as everyone else. I survived, and you will too.

Make food fun! Arranging food in colorful shapes or designs is another fun way to increase acceptance. Your child might enjoy creating a rainbow of fruits and veggies before gobbling them up (okay maybe that is too optimistic?)…or at least trying them. Once a new food is accepted, try using what’s called a “food bridge,” also known as food chaining, to expand the child’s palate. A food bridge is when a food similar in color, taste, and texture profile to the accepted food is presented. An example of a food bridge would be offering a child who likes sweet potatoes, butternut squash, which is similar in color, texture, and taste profiles.

Finally, evaluate how much milk your toddler or older child is consuming. Too much milk can decrease your child’s appetite for food at mealtimes and can also decrease the absorption of some important minerals like iron. An appropriate milk consumption for a one to two-year-old is 16 ounces, or two cups, each day, provided as four half-cup, or 4-ounce servings. For kids three years or older, it’s two to three servings of dairy foods each day. This includes cow’s milk, plant-based milk that is fortified with calcium and vitamin D, or other dairy foods such as yogurt or cheese.

Final Thoughts on Dealing with Picky Eaters

In summary, none of us are immune to the struggle of dealing with a child who is a picky eater. It can be exhausting and frustrating at times for caretakers. Taking the easy road by “picking your battles” can alleviate stress for a single day, but it won’t help in the long run. Preparing separate meals for members of the home will not resolve picky eating. Neither will using coercion or bargaining with kids to eat. Instead, caregivers should be firm about mealtime expectations while being responsive and sensitive to a child’s needs. This may all sound a bit impossible at first, but I assure you it is possible to get through this and move on to happier days of blissful meals. It will take time and effort to help your child through picky eating, but the result will be a healthier and more satisfying relationship with food. Finally, do not wait for the picky eating phase to pass. Seek the help of a feeding specialist or a pediatric registered dietitian to help you create a customized, step-by-step plan that works for your family.

Want professional help with your child’s picky eating? Contact me.

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