I Don’t Want to Eat That! When Picky Eating Becomes a Problem

Picky Eating

When children reach toddlerhood, it sometimes seems like a switch has been flipped. Our precious infants suddenly become independent and bossy with their favorite word being, “No!” Many children around this age also develop very ‘selective palates at meal times. We hear often, “I don’t like that,” or “I don’t want that,” and we know he or she just ate that food yesterday! Most of these behaviors are considered typical development for toddlers, but, sometimes, the issues can stretch a little farther and be a significant problem for toddlers. Many children are labeled ‘picky eaters’ and are weighed on a scale often with the pediatrician talking about how they are not growing well or are not on the growth chart, which can make parents worry. Or perhaps some parents are already struggling at meal times and worried that their child will need significant medical intervention just to eat. Within this article we will look at when toddler feeding habits become a problem, simple strategies to try at home, and when to seek professional help for a ‘picky eater’.

Eating is a learned behavior and is established by the time children are 6 months old, if they are typically developing. At this time in development children learn to eat well, learn to not eat, or learn to eat just enough to quell their hunger. There are many medical diagnoses that can affect feeding in infancy and well into toddlerhood. Some of the main ones include gastroesophageal reflux (GERD), dysphagia and aspiration, and delayed oral motor skills. Imagine if every time you ate or drank you were slowly swallowing small amounts of food and liquid into your lungs, or were experiencing painful reflux each time. What if you could not manage the food in your mouth well, and you felt like you would choke each time you ate? You would probably associate these horrible feelings with eating and decide it might not be worth it to eat, which is what happens with some children who experience those issues in infancy. Many children with feeding problems can also be typically developing but do not eat well and are given a diagnosis of ‘failure to thrive’. These children are usually maintaining a weight that is under normal limits for their age, or worse, losing weight. Keep in mind that children who are not on the standard growth chart, but show slow weight gain and growth, may be okay as long as they are showing a consistent increase in their curve when plotted on a growth chart.

picky eatersIt is also important to recognize that emotions can run high at the table when your child will not eat. Parents often feel like a failure and can be easily frustrated. We often use bargaining or enforce strict rules for children to encourage them to eat, and sometimes the happy mood we started dinner with turns quickly to a battle. We are all human and will do whatever it takes to ensure our children are healthy. When we are upset, afraid, or threatened, our sensory system kicks into gear and we enter into a fight, flight or fright mode. This is a reflex that actually turns our appetite off so our bodies can use our energy for protective means. Many children experience this reaction when exposed to food or stressful situations surrounding foods and thus are physically not hungry, even though they may not have eaten for hours.

Many children are labeled ‘picky eaters’ when there are really two categories of children with feeding issues: picky eaters and problem feeders’. There is a huge difference between the two. Most of the time, children who are just picky will eat more than 25 foods routinely, even though they may eat a food one day and not the next; they will eat that food again once presented on another date. Picky eaters can tolerate unfamiliar foods being placed on their plate even though they might not eat said food. Picky eaters also are able to eat foods in various textures such as smooth like peanut butter or pudding, crunchy like crackers, and soft like cheese or meats. ‘Problem feeders’ are children who may have a significant feeding problem. These children only eat 20 foods or less routinely, and often when they dislike and refuse a food one day, they will not resume eating it when offered on another day. Problem feeders are unable to tolerate unfamiliar foods on their plate and often get upset, throw foods on the floor, or run from the room screaming and crying. Problem feeders also have difficulty eating various textures of foods, resulting in gagging or choking, and often times are seen only eating one texture, such as smooth or crunchy.

There are three huge myths that parents often hear from others when their child won’t eat. It is important to recognize that these are not true and to understand why so parents can continue positively in their quest to get their child to eat.

Myth #1: Children will eat when they get hungry.

picky eatingIf a child is a problem feeder and has not learned to eat well by age 6 months for any reason, they most certainly can and will starve themselves. A child who has a limited diet and eats certain foods usually does so for a specific reason. These reasons can range from fear of foods, not having age appropriate oral motor skills to handle the foods, or experiencing a medical reason to turn away from food, such as reflux or dysphagia. Because of these reasons, a child will only eat their favored foods and will abstain from others, so if that child is not offered any foods they favor, they will not eat new ones. It is important to continue to offer a child’s preferred foods when offering new foods to ensure they will eat something and obtain nutrients.

Myth #2: When children do not eat, it is a display of bad or controlling behavior.

Behaviors are a normal part of a child’s development and are often how they explore their world and figure out social rules among other children and adults. Every behavior has a meaning and a message, and when children refuse to eat, medical professionals and parents should question WHY? What is this behavior telling me that I am not picking up on? Most of the time, the answer is not that this child just wants to make his parents angry, but the answers, again, range from fear of food, medical reasons, or oral motor skills that are not age appropriate for the child. It is important to recognize these behaviors, seek answers and respect the message a child may be giving you. If they refuse a food, it is okay to accept no as their answer.

Myth #3: It is not okay to play with your food.

picky eatingIt is perfectly age appropriate and normal to play with your food. Play is how children learn about their surroundings and toys/items in their world. Playing with food is just the same. Food play helps them learn how food works and breaks apart in their mouth, how it might feel in their mouth, and other textural properties that can help describe the food. Playing with food also presents food in a non-threatening manner and gives a child a sense of control over their environment when exploring new foods. So, if your child begins to play with his or her dinner, encourage them and you may even want to join them to make a social connection and encourage tasting of those foods.

By implementing some simple changes in your routine at home, you may be able to encourage your child to try more foods and subsequently eat more foods. Here are some easy ways to implement changes at home in meal time routines:

Above all else, REMAIN CALM!

It is very easy to become upset and engage in a battle at meal times, and often parents report that when their child does not eat, they feel like a failure because they are not providing a basic need for their child. We learned earlier in this article that when emotions run high at the table, children can often enter into a fright, flight or fight mode and, subsequently, turn off their appetite, resulting in not eating anything. The best and often most difficult thing a parent should do is remain calm throughout the meal. When your child refuses to eat or pushes food away, brush it off and tell them it’s okay. If you do not give a huge reaction to your child’s refusal, they will remain calm. By remaining calm you are helping to build trust between you and your child. Easier said than done, but you can also utilize more strategies to make this easier.

Create a new routine prior to eating and at the end of meals

Give your child gradual warnings to prepare them for how much time they have before sitting at the table for dinner. Encourage them to wash their hands at the sink and make it fun. Use different soaps, splash in the water, use different towels to dry off, and go sit at the table AS A FAMILY. Everyone should sit down together to eat, and remain at the table until the meal is finished. Children learn from example, and what better way to learn about eating than from parents and siblings. After the meal is finished, encourage your child to help clean up by throwing food away and bringing their cups, utensils, and plates to the kitchen to be washed. Make this fun by singing songs or turning it into a game.

Involve children in basic meal prep

picky eatingChildren love to be helpers and by helping with basic meal preparation, they feel involved and get frequent exposure to foods in a non-threatening way. Have your child put food items in a pot/pan before it goes on the stove or in the oven, have them stir and mix foods together, and have them pour ingredients into a bowl. Talk about the foods while doing this: describe them, touch them, and even taste them, if appropriate and if your child wants.

Change how your family talks about food

Food can be described in many ways other than “it tastes good” or “it tastes bad.” Talk about colors of foods, textures of food (crunchy, smooth, wet, and dry), temperature of foods, and different tastes of foods (salty, sweet, tangy, and spicy). It is also a good idea to start using ‘you can’ statements instead of giving demands to children such as ‘eat that’. By giving a ‘you can’ statement, you are fostering independence and affirming their ability to make a choice for themselves. Some examples might be “You can eat lima beans with your fork” or “It’s okay; you can put the lima beans on your napkin.”

Serve meals ‘home-style’

I know it seems like more work and extra mess, so don’t try and do it for every meal served, but one to two times a week serve family meals from serving bowls and plates on the table. Everyone should eat the same meal that is prepared, and if you are worried about your picky eater or problem feeder, make sure at least one food on the table is one they eat regularly. Everyone serves themselves what they want to eat and passes to the next person at the table. Children who are picky eaters can have the option to serve a new food onto their plate or a separate plate/napkin on the table. This still encourages them to interact with food in a non-threatening way and enables them to make choices about their food.

Offer a spare plate or area for non-preferred foods

Many times a child’s first reaction to a food they do not want to eat is to throw it on the floor. Give your child another option such as a spare plate or napkin, or teach them to push the food to the middle of the table away from them. They can serve food to the spare plate or napkin, or cover the food with the napkin while it remains on the table. This still encourages them to interact with food while giving them choices and a sense of control. If your child continues to throw food on the floor, re-enforce the notion that food stays on the table, and use your ‘you can’ statements to give them other options.

Play!

picky eatingA child’s profession during these ages is play, and this is how children learn best. This again presents food in a non-threatening manner and helps children get over fears and anxieties about food and eating. Encourage your child to engage in pretend play with kitchen centers and play foods. They can feed other people, stuffed animals, and dolls as well. At the table it is perfectly normal to get messy and play with food. Children can be encouraged to touch foods, kiss them, lick them, hold them above their heads and engage in imaginative scenes, such as a hot dog wrapped in a napkin cape becoming Superman. I was able to get my picky eater to eat plain white rice by ‘snowing’ it into our mouths. As a mom of multiples, it’s hard to let go of the cleanliness and order, but when it comes to learning about food, I encourage you to be fun and messy.

It is normal for toddlers to be selective about many things as they learn and grow, and exerting control over feeding is a very common occurrence. However, it is not normal for children to refuse to eat, prefer to only drink to get nutrition, eat less than 20 foods, experience weight loss and/or not be able to tolerate being in the same room as food. These children may be problem feeders and may benefit from feeding therapy. I encourage parents who think their child may be exhibiting signs of being a problem feeder to open up a dialogue with their pediatrician and possibly seek a feeding evaluation from an occupational or speech therapist. Hopefully, by implementing a few changes and seeking help, you can return to a peaceful and happy meal time at home.

megancarpenterMegan Carpenter has been an occupational therapist for 7 years with 5 years of experience in pediatrics at United Cerebral Palsy of Greater Birmingham (www.ucpbham.com ). Megan is married and is also a mother of 3 year old twin girls who constantly keep her busy but fill her life with much joy. Both of her girls experienced severe reflux as infants, and as a result, Megan has turned her professional focus to pediatric feeding, eating and swallowing. Megan can be contacted at mcarpenter@ucpbham.com with any questions related to the information in this article. For more articles by Megan on Twiniversity, click here

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