I have a very active and curious 17 month old. He has been eating solid foods since he was 7 months old and ate everything I gave him joyfully. Lately he seems to be an expert in his own nutrition. He requests his favorite foods and snacks through the day and turns up his nose or simply spits out any food he doesn’t like or didn’t ask for. Oh how I sometimes miss the good old days of exclusive breastfeeding!!
Fortunately, this is part of normal development between ages 1 and 3. Toddlers are picky eaters by nature. They are not growing as quickly as they did as infants so they do not eat as much food. They are also often too busy practicing all their new skills (walking, talking, climbing etc) to sit in one place for an extended period of time so this can make mealtimes more challenging. Finally, they have learned that they can exert some level of control in their lives and choosing what and how much food to eat is a good place to exercise this newfound independence.
Picky eating may be of concern to parents if their child only eats certain food groups consistently or if their eating habits cause some difficulty in social settings. It is normal to want to ensure that your child is eating balanced meals and obtaining adequate nutrition. Small children can alternate from eating large amounts of one or various foods groups one day to eating nearly nothing on other days. It is often better to think in terms of a weekly nutritional inventory as opposed to a daily one.
PICKY EATING AND MENTAL/EMOTIONAL HEALTH
When picky eating affects a child’s functioning, however, it may be of greater concern to parents. A recent study performed by Duke University’s Department of Psychiatry and Behavioral Sciences examined the clinical significance of moderate and severe selective eating (SE) the academic term for picky eating in order to guide health care providers to recognize when SE is a problem worthy of intervention.
A sample of 917 children aged 24 to 71 months and designated caregivers were chosen as part of an epidemiologic study of preschool anxiety. Caregivers completed assessments regarding the child’s eating and related selfregulatory capacities, psychiatric symptoms, functioning, and home environment variables. They study revealed that both moderate and severe levels of SE were associated with psychopathological symptoms (anxiety, depression, attentiondeficit/hyperactivity disorder) both concurrently and prospectively. The severity of psychopathological symptoms seemed to worsen, however, as SE became more severe. Impairment in family functioning was reported at both levels of SE, as was sensory sensitivity in domains outside of food and the experience of food aversion.The researchers concluded that health care providers should intervene at even moderate levels of SE and suggested that SE associated with impairment in function should now be diagnosed as avoidant/restrictive food intake disorder, (ARFID) an eating disorder that encapsulates maladaptive food restriction.
According to the researchers, in severe cases, the introduction of new foods can elicit a reflexive gag response in the child. These children may also experience social impairment due to their insistence on eating only certain brands, textures or colors of food. Those landing in the severe range were reported to be more than twice as likely to have a diagnosable psychiatric disorder, such as depression or anxiety, and twice as likely to have behavior problems outside of home. Children who were unable eat outside of their homes were found to be seven times as likely to experience social anxiety. Those in the moderate range were reported to be more likely to show symptoms of ADHD and separation anxiety. Both groups were reported to nearly twice as likely to have symptoms of generalized anxiety disorder.
Despite these alarming statistics, the researchers stated that they did not want the results of the study to cause unnecessary panic among parents but instead to encourage parents to seek professional help if they are “truly struggling” and feel they have “tried everything” to diversify their child’s diet. These children may feel frustrated and their parents can feel blamed for their child’s behavior. It may be of little consolation to these families that there is little research on ARFID or on how to successfully introduce new foods to a picky eater. There is also no way of knowing which kids with grow out of this as a phase and which will not. So where does that leave us? Back to the drawing board of doing the best we can as parents, caregivers and healthcare practitioners. It is very important to note that the research does not show that picky eating causes psychological issues or vice versa. It shows that there is a correlation between the two. Some children who may seem difficult regarding food may actually have an innate heightened sensitivity to the world that includes intense experiences of tastes, textures and appearances of food. They may be sensitive and therefore more susceptible to anxiety and depression.
PICKY EATING AND PHYSICAL HEALTH
This type of research is meant to help parents understand that a child’s relationship with food is only one part of their overall development and paying attention to these patterns may help us identify the children who need specific interventions earlier in life. Besides mood and behavioral issues, picky eating may also be related to other developmental concerns including poor oral-motor skills, nutritional deficiency, weak digestive function and drug side effects.
Poor sucking, chewing and swallowing skills can cause gagging or terror by merely being near food. Teaching the child to use an electric toothbrush or to drink from a straw can strengthen oral-motor skills and greatly reduce eating anxiety. One may also want to consult with a speech or occupational therapist with oralmotor training for further treatment.
Long-term poor eating habits can create nutritional imbalances, which further reduce appetite or increase carbohydrates cravings. A good multivitamin can help address nutritional deficiencies alongside the offering of whole, nutrient dense foods. Liquid or chewable options are available or pills can be crushed and capsule contents opened and added to juice juices, if necessary.
Children with a history of digestive disturbances like reflux, colic, frequent antibiotic use, allergies, diarrhea, constipation, and low tone, often have a digestive system that is immature, inflamed or inefficient. These children may avoid eating because it often makes them feel uncomfortable. Digestion can be stimulated and improved through incorporating more whole foods and less processed foods in general. It may also be worthwhile to investigate possible food allergies or intolerance that can cause poor digestion and intestinal inflammation. Finally, natural digestive tonics like ginger, chamomile and mint may be helpful depending on the symptom picture. It is best to consult with a healthcare practitioner to decide on the appropriate testing and treatment in cases that do not respond to simple dietary changes.
Common stimulants like Ritalin (used to treat ADHD) decrease appetite. If stimulants are absolutely necessary, fit may be helpful to serve dinner foods for breakfast, the child may not eat much during the day while the drug is in the system. After school, you may serve a second nutrient dense meal and then have snacks and light foods later in the evening. Antibiotic use can also reduce appetite by disrupting the growth of healthy gut bacteria and promoting the growth of intestinal yeast. This can cause bloating and sugar cravings. Probiotics and fermented foods can help reestablish the gut microflora and decrease intestinal inflammation.
GENERAL GUIDELINES
Young children are learning about themselves and the world everyday. Giving them an opportunity to express themselves through their choices and trust their own intuition is a great gift and service to them. Here are few ways to help children develop healthy eating habits:
1. Facilitate positive experiences for children around food and mealtimes: A child is 35% less likely to engage in disordered eating, 24% more likely to eat healthier food and 12% less likely to become overweight if they participate in shared family meals. The ideal scenario would be to have a minimum of 3 meals a week where there is a focus on high quality food and family communication with minimal distraction. Shared meals should be joyful times when all members of the family can share about their day or experiences and feel connected to each other.
2. Maintain a routine of meal and snack times that works for your family
3. Avoid pressure feeding: Respect your child’s appetite or lack of one but continue to offer healthy foods with all meals and snacks.
4. Offer new foods frequently alongside favorite foods: It may take 1015 times of being exposed to a food before a child actually eats it!
5. Keep mealtimes short (1015 minutes) for active kids and allow them to excuse themselves when they are done: This promotes autonomy and selfconfidence around food choices and makes a child less likely to resent mealtime.
6. Have fun and be creative with meals. Kids may like a food prepared one way but dislike otherwise. They may also be more likely to eat a meal they help prepare.
7. Be a good role model: Eat a variety of foods and express your enjoyment of them.
References:
Journal of the American Academy of Pediatrics The Guardian Cornell University College of Human Ecology The New York Times Autism Research Institute Zero to Three The Mayo Clinic
Dr. Adeola Mead, ND is the Natural Choice Network's Healthy Living Content Coordinator. She is a naturopathic physician with a clinical focus on women's health and stress-related illness. Dr. Mead is passionate about using natural medicine education as a powerful healing tool for both individuals and communities.