What to Do About Picky Eaters

By Howard J. Bennett, MD

I talk to parents about “picky eaters” every day. Selective eating is not unique to western cultures. According to Benny Kerzner, a pediatric gastroenterologist at Children’s National Medical Center, up to fifty percent of parents throughout the world report their children were problem eaters at some point.

Although some infants are more adventurous than others, “picky eating” typically starts at one to five years of age. In most cases, this is a normal behavior that will lessen as a child reaches middle school. Nevertheless, it’s worth exploring why these attitudes develop and what parents can do to minimize the struggles that occur during mealtime. There are three ways that selective eating presents.

  • The child does not eat enough.
  • The child eats a limited variety of foods.
  • The child is resistant to trying new foods.

Caloric needs change in early childhood

Babies gain more weight in the first year of life than the next two years combined. As a result, infants need more calories than toddlers relative to their size. As a parent, your job is to prepare meals for your child and make sure he eats in a safe environment. It is your child’s job to determine how much he eats at any particular meal.

The following points provide additional insight into why toddlers often eat less than babies:

  • Because jarred foods are watered down, they contain fewer calories per volume than table foods. Therefore, toddlers do not need to eat as much table food to get the same calories as they did from baby food.
  • Some children prefer to graze rather than eat big meals. From a calorie perspective, it’s acceptable to have five small meals per day rather than three larger meals, which is the recommended feeding schedule for children.
  • Milk contains lots of calories. Sometimes children will not eat because they drink too much milk. In general, they should drink between 16 and 24 ounces of milk per day.
  • Juice fills children up and contains little nutritional value even if it is 100% natural fruit juice. Children do not need juice, but if you use it, be sure to dilute it with lots of water.

Portion sizes in young children

It’s normal for children to vary how much they eat from day to day. One day they may eat two or three big meals while the next they barely eat at all. When you consider your child’s eating habits, you should look at what he consumes over the course of a week.

A rule of thumb that is often quoted is that children need one tablespoon per year of age for each food group they eat per meal. This means a 2-year-old needs two tablespoons of meat, vegetables, grains and fruits at a meal. To put this into context, four green beans are about two tablespoons.

Parents often serve larger portions hoping their children will eat more even if they do not finish what’s on their plate. While this approach appears logical, it can work against you if a child is at an age where he is asserting his independence. It’s generally more effective to give smaller portions thereby allowing him to ask for more. Instead of saying “You need to finish your dinner,” you end up saying, “Would you like some more?”

Why children resist new foods

Infants develop a preference for sweet foods at a young age. Despite this fact, most of them eat a variety of foods once spoon-feeding has begun. However, some infants are more tentative about adding new items to their diet. This can occur because they do not like how a food tastes or because it is harder for them to make transitions.

Many parents find that toddlers enjoy a “white” diet that consists of milk products, pasta and other carbohydrates. There are two reasons for this. First, these foods are bland like the pureed foods they were given as infants. Second, these foods are sweet. Milk contains lactose (milk sugar), and saliva contains chemicals that begin to digest starches when they are chewed. That’s why a cracker tastes slightly sweet before it’s swallowed.

As children get older, they may resist new foods because they prefer to eat the same things over and over. The concept of eating something because it is good for you does not resonate with most children.

Sensory food aversions

Children often complain that eating certain foods makes them feel sick. This happens because some foods have a smell, taste or consistency that bothers them. Research has found that some people have more taste buds than others. According to Irene Chatoor, a child psychiatrist and expert in eating disorders at Children’s National Medical Center, children with food aversions are more sensitive to the physical and sensory properties of what they eat. As a result, certain foods not only taste bad, but also can be unpleasant to chew and may even gag the child. Children often generalize about food, so if one green vegetable leads to a negative reaction, they may reject all green vegetables in the future.

Parents sometimes have difficulty understanding this phenomenon because it’s unusual for adults to have a dramatic, negative reaction to something they have eaten. If you try a pungent food from another culture, you may better appreciate what it feels like when a child is unable to swallow a mouthful of something he considers “disgusting.”

Ironically, sensory food aversions run in families. If a child has this issue, there is a good chance one or both of his parents had the same problem growing up.

Avoid eating struggles with your child

Children are sensitive to their parents’ emotions, but they don’t always react the way you’d expect. If you offer your child dessert as a reward for eating certain foods, he will be less inclined to eat those foods in the future. If you get upset when your child does not eat, his eating behavior will usually get worse, not better.

It’s natural for parents to talk and interact with their children during mealtime. This is what makes family meals a warm, bonding experience. However, if you sing, dance or use the TV to get your child to eat, he will learn that you are willing to go to any length to get him to finish a meal. In time, he will become more and more resistant to your efforts.

Research studies have shown over and over that a healthy child knows how much he needs to eat. If parents stay out of the struggle, children will eat to maintain a normal growth for them. If parents go overboard to make them eat, the opposite will happen.

The best way to reassure yourself that your child is healthy and growing well is to ask your doctor. Doctors keep growth curves on patients that show that they are growing normally. It helps to remember that some children are genetically destined to be shorter and leaner than others.

Why it’s hard to be relaxed if you have a “picky eater”

For most parents, feeding babies is a loving, emotional experience. Whether infants are bottle or breastfed, there is a special closeness that develops during feeding. These feelings continue as babies start solid foods. However, after months of interacting with a baby who eagerly accepts spoonfuls of pureed food, it’s disconcerting to have a toddler on your hands who has his own opinions about what and how much he wants to eat. 

When a child rejects food, it’s not uncommon for parents to feel like they are being rejected as well. You may not be aware of this on a conscious level, but feeling rejected can make it harder to deal with a picky eater. It can also bring up feelings from your own childhood, especially if you had eating issues with your parents.

There is one more factor to keep in mind as children enter their selective eating phase. When your child was a newborn, there’s a good chance the doctor asked you to wake the baby every few hours to feed. This was recommended because newborns sometimes sleep through feedings if they have not yet learned how to respond to their hunger signals. Doctors stop asking parents to wake babies once they are gaining weight, however, this early experience often “sticks” with parents, especially moms. If parents do not accept that toddlers and young children will eat when they are hungry, this early feeding experience might unconsciously create an eating problem in the other child.

Techniques that encourage children to try new foods

Because I’ve been a pediatrician for a long time, I’ve heard lots of tips one ways to get children to eat. Here are some of the strategies parents use.

  • Force a child to stay at the dinner table until he finishes his meal.
  • Add fruit and yogurt to smoothies. (Avocado and cooked baby spinach can also be used because they have a bland flavor.)
  • Hide small amounts of vegetables in soup, sauces, and burgers, etc. (Cooked carrots, cauliflower and baby spinach are the easiest to hide.)
  • Employ the two-bite rule. This means a child must take two bites of a new food before saying he doesn’t like it.
  • Encourage children to go to the grocery store and help with meal preparation.
  • Make eating an adventure. Mashed potatoes can be formed into mountains. Broccoli can become magic trees in the forest. Sandwiches can be cut into funny shapes. (A number of books have been written using this approach.)

My experience has been that some techniques work better than others, and I’m not fond of forcing children to sit at the table until they have “cleaned their plate.” In addition, some children respond to most interventions while others resist everything a parent tries.

Medical conditions that cause feeding problems

The majority of selective eaters are healthy children who grow well and do not need dietary supplements. However, there are medical conditions that may be associated with feeding problems.

You should seek professional help if your child’s feeding struggles are taking a big toll on the family or he has any of the following symptoms:

  • pain with swallowing
  • food gets stuck on the way down
  • recurrent vomiting
  • food rejection that began after a frightening episode of choking
  • losing or not gaining weight
  • coughing, choking or wheezing after eating or drinking
  • extreme sensory food aversions

Originally published on the Washington Post’s Parenting Blog

November 2015