Ask The Expert : Picky Eaters – Perfectly Normal or Pathological?

Kathleen 2I am so thrilled to have Dr. Cuneo for my first “Ask the Expert” post writing about a subject near and dear to my heart. Most of you know that Jasper is an extremely picky eater, but you may not know that I’ve been on the fence about whether or not his picky eating habits are just an extreme of a normal toddler behavior or something potentially more serious that I need to seek professional help for.

Please feel free to leave questions for Dr. C in the comments, and as always I want to hear if you have other issues that you think either she can speak to or any other issues you’ve been struggling with so we can do a Mommy SOS or invite another Expert to address.

Without further ado, I give you Kathleen Cuneo, Ph.D. !

How do you know if your picky eater is just exhibiting normal picky behavior or if you need professional assistance?

The toddler period presents huge changes in development in many areas.  Feeding in particular presents several challenges for parents.  The once eager eater who opened his mouth for everything you presented on the spoon is now much more likely to reject foods and have a hard time sitting still for meals. Toddlers do not grow at the same rapid pace as infants and their food intake drops off significantly. Toddlers by definition are often on the move.  They are busy exploring their world and testing limits with their parents.  They frequently become skeptical of new foods and reject foods that they formerly seemed to enjoy. They may love something one day and reject it the next. And I’m describing typical toddlers! If your toddler has underlying sensory issues, food allergies, or oral-motor difficulties, the challenges will be much more complex.

Signs you may need intervention

While feeding the typical toddler can be tricky, feeding some children can be greatly overwhelming.  For most toddlers, employing the strategies described below will address many common feeding challenges. For others, however, more intensive intervention may be required.  You may want to consider exploring evaluation and treatment options if your child exhibits the following:

  1. has growth or weight issues, i.e., is not gaining weight, is losing weight, is gaining weight rapidly, or is not holding steady on their own growth curve
  2. shows signs of sensory issues, including intolerance of certain textures, sensitivity to sounds, light, or other stimuli
  3. oral-motor problems involving the jaw, tongue, cheeks and/or swallow mechanisms
  4. history of severe food allergies
  5. history of gastrointestinal problems
  6. history of feeding tube use

Strategies for dealing with the “typical” picky eater

While “typical” picky eaters may not require direct treatment or intervention, often their parents need some guidance and/or coaching to help them develop effective feeding strategies.  One of the most important strategies for dealing with typical picky eaters is to apply Ellyn Satter’s division of responsibility. In short, Satter states that parents are responsible for the what, when, and where of feeding toddlers, while toddlers are responsible for whether or not they will eat and how much they will eat from what they are offered from their parents. Her book, Child of Mine: Feeding with Love and Good Sense, discusses this model in detail.

Children’s meal and snack times should be structured and occur at predictable times.  While the temptation is to offer your children food that you know (or at least hope!) they will like, it is important to keep offering a variety of foods.  Build on and expand from what they do usually eat and like, but keep adding to your offerings. It’s also important for parents to sit and eat with their children rather than to just serve them separately. Value family meals and implement family-style service, including at least one item that your child usually likes.

Children usually need multiple exposures to a food before they will eat it.  It’s important to understand that there is a progression of food acceptance, ranging from just seeing it on the table all the way up to eventually putting it in their mouths and swallowing.  It’s also important to look at your child’s nutritional intake over the course of a week or so and not just one meal.  Have patience and respect your child’s individual pace as they grow to become a successful eater.

Common mistakes to avoid

  1. Avoid “food handouts” in between scheduled meals and snacks. This will undermine your efforts to have your children come to the table hungry and ready to eat.
  2. Avoid being a short order cook and catering to your child’s limited menu.  While your motivation may be to help ensure that your child will eat something, what often happens is that your child will accept fewer and fewer foods.
  3. Avoid nagging or pressuring your child about eating.  This can create an unnecessary power struggle over food and eating and lead to poor eating behaviors.

Kathleen Cuneo, Ph.D. is a psychologist, parent coach, and mom. Her mission is to empower parents to find their own parenting voice and develop strong connections with their children. Her free report, “30 Things You Can Do To Raise Self-Confident, Compassionate Children,” is available at www.drcuneo.com.  Dr. Cuneo is also the director of Dinner Together, LLC which offers consultation to families seeking to have more frequent, successful family meals and deal with the challenges of picky eaters. Sign up for her free e-newsletter at www.dinnertogether.com.

For more information about Kathleen’s Events, please visit:

http://www.drcuneo.com/Kathleen_M._Cuneo,_Ph.D./Kathleen_M._Cuneo,_Ph.D.___Events.html

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jbhat says:

Luckily, our first kiddo has always been game to eat anything. He ASKS for broccoli. I’ll keep this advice handy for our new little one. Thanks!

Shane says:

I’ll add a quick comment about spitting up and sickness. G has reflux and has been on meds since about 12 wks old. It’s been under control for long time, but when he was sick last month it got worse. After talking w/ my sis (2 kids w/ BAD reflux), she said her kids always had reflux flare ups when they were sick (didn’t really matter what type of sickness either). We talked to our pedi and upped G’s meds during his sickness period and it was better.

I had no idea to consider a reflux flare up during a cold. Hope it helps anyone else w/ reflux impacted kids.

Molly,
Definitely follow up on your concerns with your pediatrician. I don’t know how long your child has been spitting up after meals. It could be temporary and related to a passing illness, but it could be a sign of something else. Definitely follow up!
Kathleen

Molly says:

How timely! We are starting to have major issues with DS not wanting to eat anything and truthfully, my DH and I are starting to get nervous. I just don’t think he is taking in enough nutrients or calories! He puts plenty of food in his mouth and we think he has swallowed it but two minutes later he spits it ALL out. He does this at almost every meal. I don’t understand why he just won’t swallow it! At the same time he doesn’t ever show us signs of being hungry. He never cries or whines. If we are eating a snack he will move his mouth up and down as if he is doing the “biting” motion so we will give him something. I think we have started a bad habit of giving him whatever he wants because we’re so afraid he is hungry. I can tell this is going to be a big issue for us. I plan to talk to our pedi about it at his 18-month appt. in a couple weeks.

There’s some great information here! We’ve started to experience some mild pickiness, and I’m afraid I’m on my way to being a short-order cook for a toddler who will only eat yogurt and peanut butter sandwiches!

I will definitely take a look at the Child of Mine book at my library and see if I can apply it at home.

Sorry to hear you’re having trouble with Jasper’s eating habits. I hope it’s nothing serious!

Kimberly says:

Great info, thanks! :)

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