Eating. What’s not to love? Whether it’s a gooey, cheesy slice of pizza or a warm cookie fresh out of the oven (yum!), let’s face it -humans love to eat. Little humans, ehh not so much. Little ones can be incredibly stubborn when it comes to eating, especially when they’re toddlers. What three year old didn’t go through a phase of just eating her go-to; whether it was mac-and-cheese, hot dogs, or PB&J. Many parents have said the words “picky eater” in reference to their child’s eating habits, but it’s important to know the differences between your run-of-the-mill picky eater versus your problem feeder.
Problem feeding is not a normal part of child development. Feeding problems are estimated to occur in up to 25% of normally developing children and in up to 35% of children with neurodevelopmental disabilities. A common definition for feeding problems is “the refusal or inability to eat certain foods.” Feeding problems can lead to serious medical issues such as malnutrition, dehydration, and impaired intellectual, emotional and academic development. Because of these potential impacts on the child’s development, early recognition and management are critical.
The table below can help you determine if your child’s eating skills are following a normal trajectory or further evaluation is needed:
|Eats a decreased variety of foods, usually around 30 foods||Eats a restricted variety of food, usually 20 or fewer foods|
|Foods lost due to “burn out” (i.e. one too many hot dogs = refusal) are typically incorporated back into the child’s diet after about 2 weeks||Will eat food over and over again like a picky eater but once they burn out, they will not incorporate that food back into their diet|
|Can tolerate new foods on their plate, will touch or taste a new food even if they aren’t really excited about it||Crying/screaming/melt-down mode if a new food is on their plate and will not tolerate touching or tasting|
|Eats at least one food from most food group textures (e.g. crunchy, soft, puree, etc.)||Refuses entire categories of food textures|
|Will eat a food after being exposed to it at least 10 times||Will not try a new food after 10 or more exposures|
|Sometimes reported as a “picky eater” at pediatric wellness visits||Persistently reported as a “picky eater” at pediatric wellness visits|
What to do if you suspect your child is a picky eater:
- Always eat with your child. Eating is a social experience! If your child is expected to eat alone he may feel left out or neglected. (“Why do I have to eat if no one else is?”)
- Stick to a routine. Give your child three meals and two snacks at the same time each day (or about the same time each day, let’s be realistic here). Offer juice or milk with his meals, not in between, to avoid filling up his tummy and decreasing his appetite. Offer water in between meals to quench his thirst.
- At meal times, always offer him one to two preferred foods (i.e. hot dog, chicken nugget) and one new food. When he sees his preferred food, he will feel more comfortable with his plate. Try to make the new food something you’re eating as well.
- Always talk positively about food! Even if you don’t like something, do your very best not to talk negatively about it. For example, “Mmm, these sweet potatoes are so yummy!” NOT “Ugh, these potatoes are mushy and gross!”
- Make it fun! Get some different dips out for his chicken nuggets – ranch, BBQ sauce, ketchup, mustard! Cut sandwiches out with a cookie cutter. Use food coloring. Serve breakfast, for dinner!
- Have your child help! Let him pick things out at the grocery store. Have him wash the vegetables or fruit. Let him mix up the batter.
What to do if you suspect your child is a problem feeder:
- Contact your pediatrician and explain what you’ve been noticing about your child’s eating habits.
- Your pediatrician may refer you for a feeding evaluation run by a multi-disciplinary feeding team (speech therapist, occupational therapist, nutritionist, physician, psychologist/behaviorist) to determine if in fact your child has a feeding disorder and next steps.
- Sisson LA, Van Hasselt VB. Feeding disorders. In: Luiselli JK, editor. Behavioral Medicine and Developmental Disabilities. New York: Springer-Verlag; 1989. pp. 45–73.
- Palmer S, Horn S. Feeding problems in children. In: Palmer S, Ekvall S, editors. Pediatric Nutrition in Developmental Disorders. Vol. 13. Springfield: Charles C Thomas; 1978. p. 107–129.
- Feeding problems in infancy and early childhood: Identification and management
- Debby Arts-Rodas, Diane Benoit
- Paediatr Child Health. 1998 Jan-Feb; 3(1): 21–27.
- Toomey, Kay. Copyright 2000/2010. Picky Eaters versus Problem Feeders.