Helping your picky eater

A guide to navigating feeding difficulties in children

By Almida Reodica, MD

Every parent has been in this sort of situation, sometimes losing sleep over what dish will at least be tried by their child, hoping against hope something will be eaten with gusto. In a recent study of more than 4,000 children, three out of 10 have been found to be picky eaters.

Who’s a picky eater?

Generally used to characterize children who eat a limited amount of food because of strong preferences, and a reticence to try new food, a picky child may fall into one of the following categories:

  • Misperceived: Often mistaken by parents as having inappropriate selectivity, it may be a normal behavior termed as neophobia or a fear of new food. This behavior may begin at the end of the first year of life, and peaks between 18 to 24 months but eventually resolves. These children will accept new food, even bitter-tasting ones, only after repeated exposure of up to 15 times.
  • Mildly selective: These kids consume fewer food than their peers and tend to try the same number of food as non-problem eaters but like fewer of them. Repeated exposure to food they dislike doesn’t lead to acceptance. These children often grow and develop normally and have adequate energy or nutrient intakes.
  • Highly selective: These children limit their diet to less than 10 food items. They may have problems with sensory food aversions, a refusal to eat whole categories of food related to taste, texture, smell, temperature and or appearance. This condition may interrupt the development of normal oral motor skills, and these children may have accompanying sensory manifestations such as adverse responses to loud noises, bright lights, and texture on skin.
  • Selective due to an organic condition: These children are selective because of a medical condition such as hypersensitivity, or a developmental delay that makes it a challenge to progress into a wider variety of food flavors and textures.

How does a child become a picky eater?

The environment plays a significant role in taste and eating preferences of children. When taste and texture milestones are delayed because of factors that prevent kids from gaining opportunities to master these skills, they can become picky.

  • Low variety of flavor consumption during pregnancy and breastfeeding. The flavors and aroma of food derived from what a mom eats are transmitted into the amniotic fluid and breastmilk. These flavors are said to have a strong influence on taste preferences and food acceptance as a child grows older.
    Evidence shows that babies of mothers who drank carrot juice during the last part of pregnancy enjoyed carrot-flavored cereals more than those whose mothers didn’t drink or eat carrots. A varied diet in breastfeeding moms also produces more flavor exposure which may help explain why breastfed babies are less picky and more willing to try new food. This means that poor diet variety during pregnancy and not breastfeeding may be associated with picky eating.
  • Approach to complementary feeding. Children should be introduced to complementary food not later than 6 months of age, with progression of flavors and texture having the goal of providing family table food by a child’s first birthday. If a 1-year old child is still being offered pureed vegetables with no exposure to other food groups or to textured food, then certain milestones have been delayed which may persist as picky eating.
  • Genetics. Even if you’ve done all you can to avoid picky eating, there are just some kids who will have strong preferences due to genetics. Early preferences for sweet flavors have been observed in some newborns, and bitter tastes are innately disliked—behaviors linked to the self-preservation of our hunter-gatherer ancestors, associating most bitter compounds as possibly being toxic. This has been said to be the mechanism by which neophobia becomes protective—as children avoid the ingestion of potentially poisonous substances. This information tells us that some highly heritable traits may be due to genetics and not entirely based on parental practices.

Avoid developing picky eaters by:

  • Eating a wide variety of healthy food during pregnancy to introduce flavors to your growing baby
  • Breastfeed to expose your baby to a variety of taste
  • Start complementary food not later than 6 months of age
  • Offer structure during mealtimes as soon as complementary food is introduced
  • Progress diet variety and texture as your child grows with the goal of offering family food by the first birthday

Develop better eaters by:

  • Understanding most picky eaters are misperceived and simply have neophobia or have mild selectivity.
  • Structuring mealtimes with a 2- to 3-hour interval between meals
  • Avoid grazing or snacking in between meals, offering only water in between
  • Being good role models during mealtimes
  • Offering new food item 15 different times before giving up
  • Moving on to another food item that can substitute the nutrients in the disliked food, if it isn’t accepted after repeated exposure,
  • Considering professional help especially if family dynamics or nutritional status is compromised

Mealtimes should be happy events for the family, it just takes time, persistence and consistency—and children will learn how to be good and healthy eaters. HT


References:
1. Cardona, Cano, et al. Int J Eat Disord 2015;48:570-9. 2. Kerzner B, et al. Pediatrics 2015;135:344-53. 3. Chatoor I, et al. Pediatrics 2004;113:e440-7. 4. Mennella JA, et al. Pediatrics 2001;107:E88.