Child eating high carbohydrate crackers

Picky, Picky, Picky: The Child Who Won’t Eat

Trying to get a picky eater to eat better?  Twice today and once yesterday, parents came to see me because their children wouldn't eat.  When I took a complete history, I found that wasn't entirely true. They were eating, or at least putting what passed for food into their mouths, and they were gaining some weight, but….

  • The cute little 2 year old pictured here was going into the sleeve of crackers her mothers brought along, and steadily consumed the entire package.  She was Carb-aholic #1
  • A teenager admitted to filling up on chips, polishing off a large bag in 2 days.  Carb-aholic #2, though fortunately he wasn't drinking as many sodas as I expected. 
  • An almost 1-1/ 2 year old was draining another bottle of milk while I spoke with the parents.  The parents also gave him Pediasure in the evening because they were concerned he might not be getting enough nutrition and otherwise he would sometimes wake at night for an extra bottle.  He's a Milk-aholic.

All three had started gradually, eating less and less, with the parents concerned that they weren't eating and wanting to give them something.  So they fell into a pattern, and the pattern became a habit, and the habit has put them at risk nutritionally.  They're filling their bellies, but they aren't getting the nutrients they need.

The parents each knew they had a problem.  But they didn't know how to fix it.  The milk-aholic parents had even tried taking the milk away, but their son seemed so lifeless and irritable, they quickly returned to their seemingly safe co-dependency.

Super-Selectivity

Kids, especially around 2 or 3 years of age, often go through "eating jags" when they'll want a peanut butter sandwich every day, and when they won't accept substitutions.  Or when they will eat as much broccoli as you want to give them, but they won't accept peas.  But if they won't eat any vegetables, that situation needs to be corrected.  Or if they'll only eat 1 brand of peanut butter, and they start to object as soon as you pull out a different jar, they're setting the rules, and to put it mildly, that's probably not best for them -- more so behaviorally than nutritionally.

The Strategy

  • Remember who's buying the food at the grocery store and choosing the restaurants you frequent.  If you don't buy the foods you don't want Jane or Billy to eat, they can't go to the cupboard and point.
  • The whole family needs to cooperate.  That means, grandma can't offer a special treat (or anything else) until the problem's solved; and brother Bobby can't eat his chips or cookies in front of Jane or Billy.
  • Mealtime is sacred.  Sit down with Jane at the table and eat with her. No television, screens or other distractions. (They can be used later as a reward for eating, and that motivation can be announced).
  • Do not allow any snacks or drinks for 1-1 1/2 hours before mealtime.  And only an ounce of water when you sit down (if you are at a restaurant, let the waiter know this.  You may also want to ask them to hold off on serving the bread as well).
  • Do not use Pediasure or similar high calorie snacks during the day.  They are often quite filling and may interfere with Billy's appetite.
  • For the toddler: Put what you want her to eat on your plate.  After you start to eat a little of her food, give her 3 bites on her plate.  When she eats those, give her a little more. she can pick them up with her fingers or you can put them on a fork but let her put the bite in her mouth.  If she doesn't want it, keep eating other foods on your plate (all healthy of course).  If she gets angry, let her down for a few minutes and when you think she's ready for another try, bring her back to the table.  Do not let her have more than an ounce of water, so she can't fill up on it.
  • Older kids: Talk at the table and interact so the meal also becomes a social gathering and isn't just about gobbling down food.  Don't lecture or nag about what they need to eat.  Just make the meal a normal part of the day.  If you are at a restaurant, rate the healthiness on Nutrition4Kids restaurant reviews as a non-threatening way to have a teachable nutrition moment.
  • Offer a non-food reward for everyone finishing the meal (in peace).  For example, "after dinner, I thought we can all take a walk together or play a game or go…"

If you are having trouble with the plan, speak with your primary provider.  Sometimes an appetite stimulant can be used or there may be a factor, you've overlooked. 

Fixing the Problem

While this strategy doesn't work all the time, it does for the grand majority of otherwise healthy kids, where the choices are often a matter of control and starting a healthier path.  These suggestions may not work for children who have selective diets for other reasons (eosinophilic esophagitis, for example), where they are being restricted because of neurological or heart problems, or where they have severe autism.  In those children, and where the child doesn't respond, consider involving your pediatrician / primary provider, a child psychologist and a pediatric dietitian.

Recognize too that if you were or still are a picky eater, you may be sending subtle or not-so-subtle signals that, while you don't approve of the behavior, you're willing to "let it slide." 

Dr. Stan Cohen 01 March 2017

Dr. Stan Cohen is one of our founders and our CEO as well as the Chairman of our Medical Advisory Board. Dr. Stan is an internationally recognized expert in pediatric gastroenterology and nutrition. He is a Read More

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