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How to help parents of picky eaters

Contemporary PEDS Journal, July 2022,

Address concerns that a child is not eating a balanced diet through education, reassurance.

Approximately 60% of children go through selective-eating phases at some point in their childhood—most often during the preschool years.1 The fact that most children go through this phase doesn’t make it any less worrisome for parents though.

Pediatricians can help parents through this phase by offering resources, support, and education.

The first step in addressing this problem is to educate parents on the normal phases of childhood eating. The prevalence of picky eating during the preschool years—primarily between the ages of 2 and 5—has led experts to believe that being choosy about foods is a normal developmental behavior for many children. Increased selectiveness about food choices occurs around the same time as other independence-seeking behaviors and usually fades as children move into the elementary school years.1

In most cases, these children do well nutritionally despite being picky about foods. One study found that most children—73.8%—who were considered picky eaters fell into normal weight ranges, whereas approximately 13% were considered underweight and 13% were considered overweight.2

Picky eating behaviors usually diminish on their own as children age into the elementary years; however, the older children become while continuing these behaviors, the more worrisome the behaviors become. Research indicates that picky eating that extends into later childhood is often associated with later diagnoses including the following3:

  • Obsessive-compulsive disorders
  • Attention-deficit/hyperactivity disorder
  • Sensory processing disorders

Before a diagnosis is made or treatment begins for picky eating, researchers note that most parents go on their own journey of acceptance, adopting various positive-food parenting strategies to help their picky eater branch out to try to other foods.3 These can include involving children in food shopping, selection, and preparation or encouraging food play.

Helen Coulthard, PhD, a developmental psychologist specializing in food behaviors at De Montfort University in Leicester, United Kingdom, said sensory play with both food and nonfood items can be a helpful tool when it comes to sensory processing issues. It can also be used to check for more severe food-restriction problems because some children will find food items so anxiety triggering and disgusting during play that it serves as a red flag for more severe problems.

“Those are children with extreme food aversions, where they only eat 1 or 2 types of food,” Coulthard said. “But usually any type of sensory play seems to work well because they get in contact with different substances without the pressure to eat.”

Children who eat a very limited selection of foods are generally the ones who trigger the most concern, but it’s surprising how kids can eat a meager selection and amount of food and still get proper nutrition, she added. Humans have evolved to eat the amounts we do, she explained, but the actual types and amounts of food children need to grow may surprise some parents.

“Sometimes it looks like they are refusing a lot, but they are still eating enough to be healthy and grow,” Coulthard explained, adding that she encourages families to allow children to serve themselves at mealtimes when possible. “If a child is eating very few foods, you can do blood testing and things to check their nutrition, but often they end up choosing foods that give them just enough of what they need.”

When this isn’t the case, Coulthard suggested that parents be encouraged to wait out their child’s eating habits and offer supplements or vitamins as needed.
“It’s a really difficult issue because often worry just makes the problem worse,” she said. “Some of the problems associated with a very restrictive diet are when people are older, so it’s almost like you have to play the long game. And part of that is to take the pressure off and accept.”

Some studies have even documented the circular negative effect that parental pressure can have on picky eating habits. For this reason, it’s important that pediatricians assess parental feeding practices and experience perceptions as well as the behaviors of the picky eater.

“Children are acutely aware of their parents’ goals, emotions, and practices at mealtimes,” concluded one study on feeding dynamics. “In light of these parental expectations, children develop their own strategies for navigating food refusal, negotiating with parents, and overcoming dislikes. This study highlights the need to listen to children and work with them to develop meaningful, relevant, and effective eating interventions.”4

This study and more illustrate the need for education—and often reassurance—for parents dealing with picky eaters.

Pediatricians may also want to share the following tips for parents tackling picky eating outside a medical or psychological diagnosis5,6:

  1. Start having “no pressure” meals without urging “one more bite” or using guilt or threats to encourage eating.
  2. Allow children to eat when they are ready or offer an option to return to eat at the next mealtime.
  3. Offer meals and snacks at timed intervals, with “open” and “closed” hours for the kitchen to establish a schedule so that the child knows what to expect and when. This can help ensure the child comes to the table hungry.
  4. Have a set time and place to eat meals.
  5. Set the menu for a nutritionally balanced meal. Don’t cater to the child’s likes and dislikes, but do offer options and be straightforward about them and expectations (ie, no dessert without a nutritious meal).
  6. Make mealtimes fun with child-friendly dishes or utensils.
  7. Repeat foods that are refused at first. It can take 15 times of trying things before a child agrees to try or like a new food.
  8. Teach children about nutrition and what food does inside their bodies.
  9. Model healthy eating behaviors.
  10. Don’t place blame (on parents or children) for picky eating, and seek extra help if needed.

References:

1. Cunliffe L, Coulthard H, Williamson IR. The lived experience of parenting a child with sensory sensitivity and picky eating.Matern Child Nutr. 2022:e13330. doi:10.1111/mcn.13330

2. Angraini DI, Arisandi R, Rosa E, Zuraida R. The relations between “picky eating” behavior and nutritional status of pre-school children. IJND. 2021;9(1):49-55. doi:10.21927/ijnd.2021.9(1).49-55

3. Schwarzlose RF, Hennefield L, Hoyniak CP, Luby JL, Gilbert KE. Picky eating in childhood: associations with obsessive-compulsive symptoms. J Pediatr Psychol. 2022; jsac006. doi:10.1093/jpepsy/jsac006

4. Wolstenholme H, Kelly C, Heary C. ‘Fussy eating’ and feeding dynamics: School children’s perceptions, experiences, and strategies. Appetite. June 2022;173(1):106000. doi: 10.1016/j.appet.2022.106000

5. Feeding a picky eater: the dos and don’ts. Children’s Hospital of Philadelphia. October 31, 2019. Accessed June 6, 2022. https://www.chop.edu/news/dos-and-donts-feeding-picky-eaters

6. Solve picky eating: 11 tips for parents of picky eaters. Kids Eat in Color. Updated August 2021. Accessed June 6, 2022. https://kidseatincolor.com/picky-eating/