What Should I Do If My Child Is A Picky Eater?

The other night my son absolutely insisted on mac and cheese (one of his few, uh, acceptable entrees). And it couldn’t be that “healthy” natural organic kind. It had to be the neon orange kind. He’s sensitive to colors and textures and can spot that other stuff from 50 feet away.

Because we talk about healthy and unhealthy things at home a lot, he agreed to eat some broccoli (bear with me, folks – this green food took over 5 years to happen. It was not easy and I consider it a huge victory that will likely be short-lived).

My daughter refused all the broccoli and all the fruit. Not havin’ it.

My son ate 3 pieces of broccoli, two bites of neon orange, licked every ranch molecule off the plate, and then asked for the 4-month-old Oreos in the pantry.

Yogurt ranch for the win.

They both drank milk. Score. Protein.

Dad worked late. Two working parents. We didn’t sit at the table together today.

There was a lot of talking and distraction by: counting to 100, temporary tattoos, our cats howling, and arguing about what 6+6 equals (9, in case you didn’t know). Also someone threw a strawberry and someone cried because there was no “real dessert”.

Even your pediatrician worries about her kids’ nutrition, and even your pediatrician doesn’t follow her own rules sometimes. And this picture doesn’t represent what my kids actually got in their stomachs. And every meal looks different at my house.

I used to be that childless pediatrician who always said, “I’m never gonna have the kid that only eats a couple of things! My kid is going to eat a wide range of nutritious foods! I’m a pediatrician, for crying out loud!”

Then God and Mother Nature got together and decided I needed to be taught a lesson, and gave me my firstborn child. Cue the Uncrustables.

There is no topic I talk about more in my office than picky eating. Well, maybe poop. But seriously - you’re all worried about it. And you should know that you’re not alone.

GENERAL INFO:

• Picky eaters are often children who are sensitive to their surroundings, to tastes, and to textures. Some are anxious kids in general. Some have sensory problems and are sensitive to other things like loud noises, certain smells or how clothes or shoes feel. Some are children on the autism spectrum. These kids may have heightened awareness of these senses, thus making new foods a challenge.
• Most kids who are picky are “just normal kids” though.
• The majority of kids I see who are picky will grow up to be TOTALLY NORMAL AND FUNCTIONAL EATERS (shout-out to my sister Christina who used to only eat cereal and Fritos as a kid and who now makes quinoa and kale salads for fun.)
• Picky eating may be pre-programmed in us. Think about it. Maybe we are avoidant of bitter things (like some vegetables) in our youth in order to self-preserve? Caveman toddlers needed to know to avoid the poisonous plant or fruit, which often had a bitter taste. This might be a partial explanation for why so many kids are picky.
• It is very normal for children, especially toddlers, to only eat the same thing for awhile. My daughter lived on blueberries and yogurt for a solid two weeks once, even though other things were offered to her.
• It is very normal for small children to only eat a few bites of food some days, and eat giant meals on other days.
• Milk is a great source of protein for picky kids. An 8 ounce glass of milk has 8 grams of protein in it. Try to keep it below 20-24 ounces a day for your picky eater though. Kids who just depend solely on milk for nutrition and avoid other foods can get anemic.
• Giving your picky kiddo a multivitamin with iron daily is a great idea. It's not gonna be as good for them as the nutritionally dense veggies and fruits are, but it won't hurt.

WHEN DO I WORRY?

• If a child completely refuses an entire food group, I worry. If they shun all dairy, I worry they won’t get enough calcium for their bones. If they refuse all fruits and veggies, I worry that they’re gonna get constipated or have a nutritional deficiency (these typically only develop in the most severe cases and over the long-term).
• If a child is extremely picky and is a very small kiddo, I worry.
• If they are losing weight, I worry.

Most picky eaters are your run-of-the-mill “chicken nugget and mac and cheese” type. They gag sometimes with new foods, and often don’t want to stray from the 10-15 foods they’re “OK” with. The majority of your kids will fall in this category.

But some kids are extremely picky. These kids may have something called Avoidant Restrictive Food Intake Disorder (ARFID). The diagnostic criteria are here.

If your child meets any of these criteria, it’s best to talk to your pediatrician. Your kiddo might need therapies that can help with introducing new foods and could benefit from seeing a nutritionist as well to assure they’re getting the nutrients they need.

“Children Will Eat If They’re Hungry”

Yes, this is true. When I moved dinnertime from 5:30 to 6 p.m. in my house, there was a noticeable difference in how much they ate and how little they whined for snacks later on in the evening. But remember the other things that fill our kids up – sometimes that little handful of Goldfish crackers an hour ago was all that was needed to keep their dinner hunger cues away. Sometimes a cup of milk before the meal will cause lunch to end in a meltdown. Snacks and milk are fine if your kiddo needs them and is an easy eater, but I just wanted to open your eyes to how easily a picky kid’s hunger can be satiated so you can better understand the food refusal.

Healthy portion sizes for kids are typically much smaller than parents may think. Protein should be the size of a child’s palm (meats, fish, beans). Veggie/fruit portion – what they can grasp with two fists. Pasta or bread? One fist. This may change depending on a growth spurt or more hunger that day due to exercise. But it illustrates how little they may need sometimes. 4 green beans. 2 apple slices.

Kids are very good at knowing how much food they need to eat. In fact, they’re better than us at it. You put me in front of a box of donuts and I’m gonna eat way more than I need because…donuts. Small kids are great at stopping when they’re done with being hungry. They don’t loosen belts or overstuff themselves. In fact, I often guide older, overweight kids to watch their younger siblings when they eat – small kids usually stop eating when the hungry goes away, not when they feel really full.

Along those lines, don’t force kids to “finish your plate.” In a day and age when kids are bigger than ever, this is just antiquated and unhealthy. Give them small portions and allow for seconds if they’re having a hungry day.

Dips. Sauces. Do it. It’s fun, and different. Use Greek yogurt to make the creamy ones. Throw onion soup mix in there, or a ranch spice packet. Try hummus. Try salsa.

New illustrated plates. Fun spoons. Twirly straw for that veggie-packed smoothie. Kids love special stuff like that. And might be more willing to try something new if it’s fun.

I know it’s enticing, but try not to use dessert as a “reward” or “bribe.” It sort of sets the stage for associating sweets/treats with success. And we’re reinforcing that what was on the dinner plate isn’t as good as the dessert.

Again, remember that some kids do sit on the edge of the eating spectrum in the “severe” zone. ALWAYS talk to your pediatrician if you feel like your kiddo might be really struggling. If he’s small, eats fewer than 5-7 things, throws up and gags on a daily basis, or has very high anxiety with food, ask for help! Feeding therapy is wonderful. Our dietitian and nutritionist friends are so helpful to doctors and parents alike. We can get through it together as a team!

I barely scratched the surface here. Please speak up in the comments if you have any other advice or ideas!

Lettuce romaine calm,

Dr. Diane Arnaout