As a parent, how do you know the difference between a picky eater and when a child is a “selective eater” or “problem eater”? After all, every toddler is a picky eater, right? And a child who is hungry will eventually eat whatever you give them, right?? If not, they will most likely outgrow it, so you shouldn’t worry about it; just keep on how you are doing it…right??? Although there is some degree of truth to each of these statements, there are many things that we can do at home to facilitate healthy eating habits in our children, no matter the severity of the feeding difficulties. Although toddlers and young children learn that they can have an opinion and will often get “stuck” on requesting a certain food (what we call a “food jag”) for days or weeks at a time, this does not mean that the parents/caregivers should perpetuate these poor feeding habits. And although many children will progress past this and eat a “variety” of foods, what we are seeing is children that are eating fewer and fewer fresh fruits/vegetables/meats and are only expanding their diets to accept an increased number of highly processed foods. But on the other side of things, that does not mean we should serve a child a food so outside of his/her comfort zone that they would rather eat cardboard over what you have given them. There is a balance. And there are a few simple ways to facilitate improved eating habits for any child:
Stop the grazing
In feeding therapy, we use the term “grazing” when a child snacks or eats small meals/portions throughout the day instead of separate, “scheduled”, and larger portioned meals and snacks. A child should be eating on a general schedule of a meal/snack every 2-3 hours during the day; this often looks like breakfast/snack/lunch/snack/dinner and sometimes a small snack after dinner. Grazing prevents a child from ever experiencing a true cycle between being hungry and being full and decreases daily caloric/nutritional intake.
- Establish general meal times and stick to them
- Don’t allow any snacking on foods or heavy liquids between meal/snack times; Only allow water between meal/snack times
Reduce the amount of milk (including chocolate milk, pediasure, etc.)in your child’s diet
Many times a child that is a selective/picky eater is making up for calories not eaten by drinking increased amounts of milk (etc.). Relying on milk for the primary source of caloric intake after 12m of age is counterintuitive for many reasons, including poor hunger/full cycles, nutritional imbalances, delays in oral motor skill progression, and perpetuation of food restrictions. If a child is full from drinking heavy liquids, they will not be hungry and will have decreased motivation for eating. Most children will snack on their favorite foods regardless of feeling full or not, especially if they do not have a great sense of what feeling hungry/full is like. But imagine going to the grocery store after a large meal…walking up and down the aisles, only the items you know you will eat or do eat regularly end up in the buggy. Now imagine going to the grocery store when you haven’t eaten in hours and are SO hungry…everything looks and sounds amazing and everything goes into the buggy. Trying to get a child to eat well and to try new things when he/she is full or satisfied from drinking milk is like going to the grocery store with a full belly.
- by 2 years of age, a child should not have more than 16oz (2cups) of milk (etc) per day
- If needed, wean the child from excess milk throughout the day by cutting out 1-2 full cups from middle of day and begin reducing the others by 1-2oz every couple of days.
- Replace with water as needed for liquid intake throughout day
- Serve milk with meals/snacks, but do not allow guzzling of milk. If a child cannot limit self to 1-2 sips every so often during the meal, remove the cup from them after taking 1-2 sips and place out of their reach; give back intermittently if eating well. If this becomes a battle, give small amounts in a medicine cup every so often during the meal.
- Do not give milk as a replacement for not eating well during a meal
Stop being a short order cook
So many parents prepare what the child “orders” for each meal of the day. Unfortunately, a child is not capable of making sound nutritional choices and that is part of our duties as parents to help them to learn. As the parent, you decide what is being served.
- A parent/caregiver can give 2-3 choices that the parent has predetermined as being appropriate choices, but anything outside of those choices is not an option for that meal.
- Ex: “for lunch we are having ham and cheese sandwiches (known food child will/can eat, but may not be their favorite); would you like grapes or apple slices with yours (both are favorite fruits of the child’s)?”
- Can alter portions of meal to better fit child’s preferences or needs, but should eat some form of what the family is eating (ex: family is eating tacos with meat/cheese/tomato/lettuce/avocado on crunchy shells; child gets cheese quesadilla with one triangle of quesadilla containing cheese +meat, 1 small piece of tomato on the side, and some diced avocado with salt on the side; also given preferred vegetable of corn.)
Do not give replacement foods
Parents often have a habit of pulling out the child’s most favorite food as a replacement when a food or meal is refused. Parents want to make sure their children are fed and taken care of, so will give whatever food is necessary just to make sure the child eats and is full. However, this perpetuates the negative meal time behaviors and does not promote positive/healthy eating habits.
- Get comfortable with knowing that if a child chooses not to eat foods that you know they like or are capable of eating, that is ok. We cannot force a child to eat (**do not ever force food into a child’s mouth!). Skipping a meal every so often will not be harmful to most children and most will make up for calories missed during their next meal.
- If a child refuses served foods, do not serve/give any additional foods until the next scheduled meal time (i.e. no late night snack because he/she is hungry after refusing dinner)
- If a child initially refuses dinner, you can leave foods available for up to 30min-1hr. If child determines they would in fact like to eat their dinner, he/she may sit back at the table and finish THE SAME MEAL he/she was presented with at the original dinner time. (*only for dinner, not other meals refused during day due to time needed between meals for maintaining schedule and adequate intake overall)
Don’t create a habit of the child eating alone or away from the table
It is difficult for a child to focus on the meal and the foods if he/she is up and walking around, eating from the plate as they walk by occasionally, or is always eating in front of a TV/IPad/screen. A child needs modeling of positive experiences of eating a variety of foods from parents and siblings, needs positive social engagement while eating, and needs to remain seated for safety with foods as well as focus on what he/she is eating. We want a child to be aware of what he/she is eating and not zoned out, eating mindlessly.
- Establish habits of eating at a table (child’s table, kitchen bar, family dining table)
- Establish habit of eating without screens and eating with others (even if parent is only snacking off of the child’s plate and is there mainly for social interaction during child’s meal)
- Establish habit of eating full meal together as a family, at the table, at least once per week
- The child’s meals should last 15-30min (depending on age of child)
- When eating with the family/others, a child (around 3yrs+) should be expected to sit at the table until everyone (within reason) is finished eating. Younger children should be expected to stay even after they have finished, but would not be expected to stay the length of the adults’ meal.
- Refrain from removing young children from high chairs when they are fussing/throwing a fit to get out; redirect in attempts to calm prior so meal is ended on positive conditions and not because of crying.
- Require older children to sit up and face forward (no escaping meal by turning around backwards) during the meal, even if they choose not to eat.
While these recommendations are general foundational strategies for establishing positive food/eating habits, some children will require additional intervention. If a child often gags or vomits on foods, consistently refuses eating for several meals in a row if not provided with a specific food, has severe constipation or GI difficulties due to poor eating habits (or that cause poor eating habits), accepts fewer than 15-20 foods, and/or is losing weight due to poor intake, a professional evaluation from trained feeding therapists is essential. If a child requires a nutritional supplement such as pediasure in order to maintain weight or gain weight, a feeding evaluation is essential in order to assess and correct the underlying difficulties. Regardless of where you and your child are on the feeding journey, these recommendations are a great place to start. Establishing healthy eating habits when a child is young is the best way to facilitate life-long healthy habits and promote overall health and wellbeing.
**note: these recommendations are not meant to replace the recommendations made by a child’s personal feeding team. Children with specific medical conditions may not be appropriate for following these recommendations.
Kenley Smith, MOTR/L is an occupation therapist at Beyond Therapy in Ridgeland, Ms. Kenley has worked as a pediatric therapist since graduating from the University of Mississippi Medical Center in 2012 with her Master of Occupational Therapy degree. Prior to attending UMMC, Kenley attended Mississippi State University where she received her bachelor’s of science degree in Kinesiology, Clinical Exercise Physiology. Kenley enjoys working with children of all ages and loves having the opportunity to help each child and family reach their goals; her special interests are in feeding therapy, reflex integration, sensory processing, and other foundational approaches. Kenley lives in Brandon with her husband, Tyler, and their twin girls, Allison and Callum.