Picky Eaters: Normal or Pathological?

Last month, I had the opportunity to be the expert on the Becoming Mom blog on the Ask the Expert feature. The question was, "How do you know if your picky eating toddler is just exhibiting normal picky behavior or if you need professional assistance?"

Here is my response:

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:

• 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
• shows signs of sensory issues, including intolerance of certain textures, sensitivity to sounds, light, or other stimuli
• oral-motor problems involving the jaw, tongue, cheeks and/or swallow mechanisms
• history or symptoms of severe food allergies
• history or symptoms of gastrointestinal problems
• 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

• 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.
• 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.
• 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.