We have two very special guests helping to answer this week's feeding questions. Jenny McGlothlin and Katja Rowell, MD are the authors of the brand new book, Helping Your Child with Extreme Picky Eating, and their backgrounds as a speech pathologist and family doctor make this book an amazing resource for families struggling with mealtime. And really, since most of us are new to feeding little ones when we have our first child, it's a wonderful resource for any parent! You will hear me mention the book now and then as it's one that I will reference often, but let's get right to work with this week's questions.
From Jenny and Katja:
First, some general thoughts. This is the beginning of a long process for many parents: learning to trust their child’s growth and appetites and how best to support them. For the parents asking these questions and those reading this post, the first questions have to be: What are you worried about? What is your underlying fear? Are you worried your child is too small? Not getting good enough nutrition? If you have a worry, get it checked out. Think your child doesn’t get enough protein? Chances are he gets more than enough and you can relax. The point is to figure out what you are worried about, and then find out if you need to worry (or not) from a book, a doctor, or dietitian. If you don’t need to worry, you can direct your energies to more productive things like supporting your child’s eating. If a problem is discovered, like an oral-motor delay, then you can get that addressed. Studies suggest that between one and two-thirds of all young children will be described as “picky” in early childhood.
When there is a challenge and a worried parent, who often gets little support and even poor advice, sometimes parents and children find themselves in a dynamic that is unpleasant (battles, crying…) and that doesn’t help children learn to eat. We call this the “Worry Cycle.” Our goal is to provide information so parents can understand all aspects of this cycle and become empowered to turn this around and support their children to enjoy eating enough variety of foods to support healthy growth. With more severe feeding challenges where growth or emotional development are impacted, there is usually something that makes one child more difficult to feed than another: reflux or other conditions that make eating or digesting painful or uncomfortable, prematurity-related issues, muscular disorders, oral-motor delays or sensory considerations that make eating difficult, and temperament and personality. Each answer below will cover aspects of the steps we cover in the book from our STEPS+ approach. Strategies are applicable to all of the readers who submitted questions, and siblings can be fed the same way as well!
*These are complex issues and this post is not meant to replace individual evaluation but is meant as general information.
Q: Sweet potatoes are the only veggie my son likes pureed or whole. Now he's going through a phase where some days he'll only eat pureed food, some days he'll only eat whole foods. Is this normal?
Many things that are typical of the toddler phase may feel strange when it comes to eating, growth, and development. For example, growth slows after the rapid growth of infancy, and appetite can fall off as well. Some meals may be just a bite or two and that’s okay!
When it comes to kids and eating, some days your child’s “normal” looks anything but— loving food one day, pushing it away the next. If he is going back and forth, this is likely “normal.” Trying to make sense or rationalize what young children do around food, much less rationalize WITH them to try to get them to eat more or different foods than they want is an invitation to battles and frustration.
With that said, your question hints at a few opportunities. If you’re worried about nutrition, and your son enjoys a nutrient dense food like sweet potatoes, the temptation is to serve them at every meal. The problem is, what happens when he goes off sweet potatoes? Relying on one or two wholesome foods the child eats also limits his exposure to new tastes and textures. Here are some thoughts to help support him.
Family meals: Around one year of age is the time to transition to having him join you at meals if he isn’t already (they can do this as soon as they are eating solids). What foods are you eating and enjoying? Is there a way to modify them to his skill level? Can you serve foods like acorn squash, or regular mashed potatoes that have similar characteristics (color or texture or preparation) to sweet potatoes? Can you fork-mash or puree the green beans you love? Do you enjoy a variety of tasty foods? Does he see you enjoy them? Letting him see the adults he loves and trusts enjoy foods is a key first step.
Flavor: Many recipes for older infants and toddlers recommend no salt or sugar or seasoning. If you enjoy foods with garlic, salt, broth, herbs etc, toddlers can as well. One client whose son was very picky as a young toddler didn’t want him to ‘get a taste’ for salt or sugar and served his food plain. When I encouraged her to mash the oven-roasted squash she was having for dinner that night, with a dash of salt, brown sugar and smidge of butter, he dug right in!
Appetite: Almost all children can go a few hours between meals, and they should have that opportunity to develop an appetite. If a child is grazing, nibbling a few Goldfish crackers, or taking a few sips of milk, it can dampen appetite. Work towards having sit-down meals and snacks about every 2-3 hours with only water between.
Q: My daughter is allergic* to milk so I struggle coming up with recipes for her because everything has cheese! Also she is so picky, I have a hard time finding things for her to eat and I want her to try a variety of foods!.She is 16 months and lunch and dinner are battles every day. She does great at breakfast but it is all downhill from there!
The fact that there are battles is an indication that something is amiss. There are two issues here. First is that you want her to eat a variety of foods and she isn’t yet. Trying to get a child to eat more variety invites pressure and pushback. What you are doing doesn’t feel good, and you can already sense that it isn’t helping. Allow that desire for happier mealtimes to help guide you and your daughter.
What is it about breakfast that makes it go so well? Is she able to eat foods she prefers? Does she have more of an appetite since it has been a while since dinner? Are you less focused on what she is eating (and how much) as you get the day underway?
Why do you battle? Are you trying to get her to eat one more bite? Two more? Some cucumber before her pasta? Stress and anxiety make her less likely to want to try new foods. Not pressuring her at all to try or eat a new food will actually help her appetite. Most battles happen when the lines of the “Division of Responsibility” are blurred. Your jobs with feeding (as pioneered by Ellyn Satter) are to decide when, where and what you will serve. Your child decides how much to eat (and whether she does!). Always include at least one accepted food. It may be hard at first not to try to get her to eat or try at least a bite.
The second issue is coming up with foods to serve that don’t contain dairy. Dealing with allergies makes feeding children more challenging, but not impossible. Sit down and write down every food she has eaten in the past, including varieties of crackers, and rotate these into meals and snacks. Try to find recipes with familiar foods that you want to try as well. When she sees you excited about meals, that will help her have a more positive attitude. Ask friends on Facebook for their kids’ favorite dairy-free recipes, or have a potluck and ask everyone to bring a dairy-free food to share.
Note from Amy: Check out Rice Bowls, Slow Cooker Black Bean Soup, One-Pan Red Curry Chicken, Veggie-Loaded Marinara Sauce, and Soft-Baked Honey Cinnamon Chickpeas.
*Is it a true allergy? Some parents think that their children are allergic when it is a lactose intolerance. In those cases, lactose-free milk, hard aged cheeses, some yogurt, and even chocolate milk are more readily tolerated. Additionally, some children grow out of an earlier sensitivity and even allergies. Check with your doctor for more detailed information. If you have to eliminate more than one food group, meeting with a pediatric dietitian can confirm that you are meeting your child’s nutritional needs.
Q: My 1 year old son will only eat things he likes the appearance of (ie. he likes cheese & he likes bread but won't try a quesadilla or grilled cheese bites). Loves fruit but will only eat it in a certain form. Is there a good way to encourage him to try new things before he turns them down? I'm making things I know he likes, he just won't even try it unless it's in a certain form so his food intake is starting to get limited.
Toddlers go through a phase called “neophobia” or fear of new things, and this shows up very dramatically in their preferences around food. Your son has developed some favorites, and he enjoys them the same way every time—this is normal. He can trust that he will like them because they appear to be the same; change the appearance or combine it with something else, and you might as well be serving beetles! Mixed consistency foods like the ones you describe can be challenging for children for a couple of reasons:
1.) They are harder to manage from an oral-motor perspective. The chewy quality of melted cheese that has cooled can be more difficult to chew and has a completely different sensory quality in the mouth than the two separate foods. Other combined foods (think casseroles) require lots of oral gymnastics to chew and swallow without getting tripped up.
2.) The child can’t understand that the combined food is just that— his two favorites combined into one (yummy) new food. The novelty is off-putting and he immediately shuts down.
It sounds like your son is taking this situation into his own hands and controlling what he can, which is what he actually puts in his mouth. What is a toddler’s favorite word? NO! He will say that every time if he feels pressured to eat something he isn’t ready for. Have you considered serving foods family-style? Try putting the separate foods alongside the combined foods on the table just within reach, and don’t put anything on his plate. Put out the fruit that he enjoys beside 1-2 new fruits cut in the same way, or cut some of his favorites in different shapes. Offer him the serving plate and allow him to choose what he wants from the foods you provide, and you will likely see a quick shift in his resistance for the better. Eventually, if you are enjoying family meals with the foods that you want him to eat, he will recognize these as ‘safe’ foods and will try them on his own terms and at his own pace.
Want more of the awesome feeding advice from Jenny and Katja, check out their book Helping Your Child with Extreme Picky Eating.