Monday, May 9, 2016

Tried and True Advice for Picky Eaters

One of the most common questions a pediatrician can be asked is about picky eaters.  I have given my “picky eater” talk at least once every day for the last two weeks, so I decided to make this the next topic to cover.  Interestingly enough, this talk is the same for skinny kids as well as those who are overweight or obese (though I am not fond of that word.) 

To clarify, the following is my opinion based on my experience and is not evidence-based or scientifically proven.  It has helped many children who are overweight stabilize and “grow” into their proper weight and it helps underweight children eat more variety and volume.  It is safe and I have not had any children starve while on this plan.  Obviously, if you are going to take my advice then please use good old-fashioned common sense when applying the principles below. 

First and most important, the child needs to actually be hungry.  In all honesty, they need three solid meals per day.  They do not need a constant barrage of crackers in Ziploc bags, dried fruit, yogurt tubes, and those squeezable packages while on the go.  Snacking frequently causes cavities and prevents children from experiencing actual hunger, setting them up for weight difficulties in the future.  I tell parents if there is a long period of time between lunch and dinner than a small snack is acceptable but it should follow the rules below. 

Second, it needs to be an event.  This means turn off the TV or computer, hang up the phone, put down the electronic device and sit down at the table. Preferably have the entire family sitting at the table whenever possible.   Food should only be eaten sitting down, not while walking around at the park.  Eating is such an enjoyable experience that we should teach little ones early to focus and enjoy it, even if a meal is three bites for them. 

Third, children model the behavior they see, so we should be eating a wide variety of foods from all the food groups.  Personally, I am a fan of families eating red meat because the most common nutritional deficiency in the United States in children is iron-deficiency, which can lead to learning problems later in school.  If you can get other iron containing foods into your child instead of meat, then go for it.  Bottom line, variety and modeling are the take-home points. 

Fourth, do not let your picky eater drink their food.  Our house rule is half the meal has to be eaten before the milk is poured.  I had to learn this one watching mine down a glass of milk and say they were full a few times before I got with the program.  We only serve water at the start of meals to make sure they do get some variety and not just the OJ in the morning and milk for the other meals of the day. 

Fifth, if they plain do not like it and will not eat it you have two options.  Either they miss that meal and eat the next one or come up with what I call the “back-up food option.”  I developed this after my oldest refused dinner for three nights in a row.  You might not believe anything else I write after you read this next sentence, so prepare yourself, a confession is coming.  Our family “back-up” is a 100% beef, no nitrate hot dog.  At least you know I am completely honest right? 

My oldest ate this every night for more than nine months until one day he finally ate the spaghetti we made for the family dinner and the rest is history.  I tell most families to pick one neutral “back-up option” and all the children will know they either eat what you have served or they get the same thing all the time as the alternative.  Do not change the “back-up food” over time because the end goal is not to encourage them to choose it repeatedly.  Instead you would like them to get tired of it and eat something else.  It will happen, believe me. 

Sixth, understand that some children love pureed foods and want to eat them until they are three.  Some children dislike pureed foods from the get go and love smashed avocado, banana and steamed vegetables they can hold in their tiny hands.   Every child has diverse taste preference and chewing abilities at different ages.  That is absolutely acceptable and completely normal developmentally.  

Finally, we should talk about snacks.  A snack should consist of something natural of which they are not particularly fond (i.e. not crackers, which is the #1 favorite food of most picky eaters.)  My favorite recommendations are celery and peanut butter, carrot sticks and string cheese, or apple and yogurt.  It should always include something with protein.  Remember, it is still an event and they should not be able to walk around while eating it.  Also, there should be at least two hours between eating a snack and then serving a meal to allow them to become hungry again. 

In closing, I would like to say there will be times when they are growing rapidly and times they are not.  Remember, puberty is just around the corner and food will disappear right before your eyes.  Sometimes a meal will be everything you put on their plate or truly just three bites.  A child’s appetite changes daily as do their nutritional needs.    They are much better at eating when hungry and stopping when full than we are as adults.  Let them experience what it feels like to be hungry, enjoy their food, and then feel full.  It is one of the many important lessons we teach children.  Allow them to learn it. 

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