Photo by Martin Cathrae

After a lovely holiday hiatus, I am back, as promised, with part two in the series on feeding toddlers.  Today I’ll focus on kids who are choosy.  For this post I lean on professional experience.  We have no shortage of patients in our practice whom one could describe as “picky eaters” or who are sometimes diagnosed with “feeding problems”.  I have trouble with the diagnosis “feeding problems or mismanagement”, as it comes up in our electronic medical record.  Why?  Well, and this hopefully serves as a bit of comfort, toddlers who are picky eaters are pretty much the norm.  It is, in fact, an expected developmental stage.  If you have a toddler who refuses dinner, but then begs for chicken nuggets, this post is for you.  If you have a toddler who only takes two bites at each meal, and then runs off to play, this is for you.  If your child seems to refuse all vegies, this is for you.  If, on the other hand, you have a child with true “failure to thrive” or difficulty gaining weight and growing well, please consult with your pediatrician, as I won’t be addressing those problems here.

And so, a few tips for parents of kids in the picky crowd.  As I mentioned last post, check out Child of Mine: Feeding with Love and Good Sense by Ellyn Satter. Her division of responsibility works well for picky eaters. In short, parents decide what, when, and where to eat. The child decides how much and whether to eat. Here are some ways to implement these ideas with a toddler who is choosy.

• Parents decide what to eat. I have met many families who become so worried about their child not eating that they become “short order cooks”. Parents end up making two or three types of dinner each night in order to placate particular palates. There are a number of problems with this approach. The first is obvious. It takes a lot of extra time and effort to make a number of different dinners each night. Most parents don’t have this kind of time. Secondly, it is not good for your child. Offering a special meal each night, catered to their desires, teaches them to continue to be picky. Offer balanced meals, with a mix of protein, grains, and vegetables. Offer new, interesting foods. Remember it can take 15-20 times of offering a certain food before your child may accept it and grow to like it. To encourage this, and make mealtime less of a battle, offer a new food paired with a familiar favorite.

• Parents decide when to eat. Set three meal times and 1-2 snack times per day. Eat dinner together as a family. Avoid snacking throughout the day and avoid filling drinks. Kids will be even less likely to want to sit down for lunch if they are already full of juice or milk.

• Parents decide where to eat. All meals and snacks should be eaten sitting down in a high chair or at the table. If a child starts throwing food or wants to leave the table, the meal is over. Don’t follow them around with a spoon trying to get in a few more bites.

• Child decides how much and whether to eat. Again, this is the toughest part for parents to accept. Trust your child. Young children, even picky ones, are following hunger cues. You have done your part by offering a variety of healthy foods.  Don’t force your child to clean the plate. They may eat all of one food, and none of the rest. They may take one bite of each thing. That’s okay. Try again next time. Avoid turning mealtime into a battle or making deals with your child to get them to eat more. Avoid saying things like, “oh, that’s a food you don’t like”. Teach them how to refuse food politely. Think in the long term. Kids might have hungry days and not-so-hungry days. As pediatricians, we think about growth over months and years, not (usually) by days and weeks.

• A couple extra thoughts. Many parents of picky eaters ask about vitamins. One thing to know up front is that vitamins will not increase appetite. The American Academy of Pediatrics does not routinely recommend vitamins during middle childhood, if the child is eating a relatively balanced diet and growing well. If you are concerned about lack of intake of certain vitamins and minerals, over the counter multi-vitamins (such as liquids or chewables) are generally safe. They must, however, be taken in the recommended dose. They are medications, and should not be treated as candy. Consult your pediatrician for advice more specific to your child. Finally, try not to give well-marketed, high calorie liquid supplements (e.g. Pediasure) in place of food (unless recommended by your child’s health care provider).

Why is this important?

Offering interesting foods of all different shapes and colors and flavors very early in life is an important parental responsibility. If we don’t, we only make it more difficult for our kids later in life. A good example of how this can play out is in the current debate about nutrition in schools. The importance of good nutrition in schools is clear, as many children eat two meals a day in the cafeteria. Much has been made of the overall poor quality of school breakfast and lunch, everywhere from Jamie Oliver’s Food Revolution, to grassroots efforts in many cities and states (including my own home state of Wisconsin). Interestingly, though, it is not only the food that has to change. It is the students’ palates. Recently, the LA school district revamped their school lunch program and they are finding that it is difficult to get children to eat the newer healthy food. Hopefully, with time and thought, we can make healthier food on a large scale that tastes good. But, we must also introduce children to these foods earlier in life, so they’ll be more likely to accept them later.

Finally, be kind to yourself. When a child doesn’t eat a meal that a parent has lovingly prepared, it can be hard. It doesn’t make you a bad parent, or even a bad cook. For most children, picky eating is a phase that will pass. If it doesn’t, or poor appetite seems to be affecting your child’s growth and development, talk to their doctor.

What feeding strategies have helped you to avoid mealtime battles with your toddler?