Picky eater drives parents over the edge

Posted by Barbara F. Meltz  August 31, 2009 06:00 AM

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Hi Barbara,
My daughter is almost 17 months old and has always been very fussy about food. Mealtimes are a struggle and even though I know that we shouldn't force a child to eat it would sometimes come to that because she just wouldn't take anything and her doctor would show us how her percentile was dropping. She was in the 33rd percentile when she was born and now she is under the fifth. But she is a happy, very active, sassy and bright baby who is developmentally up to date. Currently she won't take any milk or vegetables. The only thing she seems to eat, and that too very little, is bread and fruits. This often entails me or my husband singing or dancing or trying anything possible to distract her while the other tries to slip some food in her mouth - exhausting as you can imagine! Should we keep this up or should I just completely leave it up to her once I have offered her food. (PS - She also has a lot of trouble pooping probably because she doesn't like to drink either and doesn't eat enough...)

From: Mili, Boston

Hi Mili,

Maybe I'm reading too much into this, but I get the sense you are not getting enough help from your pediatrician. You know you can change pediatricians, right? Right?

In consulting with Brunswick, Me., pediatrician & picky-eater specialist Will Wilkoff, author of "Coping with a Picky Eater," his first bit of advice was to go back to your pediatrician and ask for more information. He has found that constipation and picky eating often go hand in hand.

"You get into a vicious cycle," he said in a phone interview. "The child doesn't want to eat because she's full of poop, and she doesn't want to poop because it hurts."

(The second most common cause of picky eating is over-drinking, which keeps her from getting hungry. But it doesn't sound like that's a problem here.)

The other question for your pediatrician is this: Is he/she concerned about any aspect of her health? It's not unusual for a child to drop in percentiles at about this age, but because this is a significant drop, Wilkoff would want to know that the pediatrician is confident there's no underlying medical issue.

Assuming that's established, his advice is to present your daughter with a balanced diet and leave it up to her to eat or not. "Put a balanced, healthy diet in front of her and let her pick off it and trust that her natural appetite will take over," he said.

No dancing around, no coaxing, no pleading. That adds tension to mealtime and that make the problem worse. "The fact of her eating or not needs to be a non-issue."

Here are Wilkoff's other recommendations: (1) Be sure the food on her plate is in appropriate bite-size and that she can manage it on her own; (2) Establish meal-time rules prior to the meal time. The best rule: "If you want more of something, you need to finish everything else on your plate first." If she doesn't want to, there's no negotiation; she can leave the table.(3) Make mealtime a pleasant social occasion with no tension, enjoyable company and no discussion of food. (4) Don't make special food for her. If she doesn't like anything, oh well.

For those times when she eats nothing, be patient and calm and continue not to make an issue of it. "Over a period of several weeks, it will balance out," he said.

Here's the other thing: Don't give up! Don't stop presenting the balanced meal just because she isn't eating. And don't resort back to your acrobatic tactics. The danger in those tactics is that they can lead to disordered eating which is what leads to eating disorders.

"Even at this young age," Wilkoff said.

One other tip: evening is often when children eat the least. "Front-load the diet with good variety at breakfast and lunch and lower your expectations for dinner," he said.

For more on picky eaters, click here for a column I wrote, and here, for a story in yesterday's New York Times.

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2 comments so far...
  1. This reminds me of an episode I saw on "Mystery Diagnosis." The child was a picky eater and practically demanded the addition of salt to anything and everything. I don't recall the diagnosis, but I do recall it was definitely an underlying medical issue that manifested itself as picky eating. His body craved salt, and therefore, he put it on everything.

    Find a new pediatrician. Or at least ask the one you have to explore the possibility of an underlying medical issue. With such a large drop in percentile, you should be concerned that there is a possibility that it's not just about taste; it could be that her body is more incontrol of what she wants than her mind.

    Posted by could be more than just picky-ness September 1, 09 02:05 PM
  1. It's as though you were writing about my daughter, who at her 18-month check up (she's ten years old now) had failed to gain an ounce from 12 months. Our pediatrician sent me to meet with a nutritionist who gave what I alway thought was ridiculously contradictory advice: get her to more vegetables, and, at the same time, more calories. I was sure (and remain sure) that I could do one or the other, but not both. The pediatrician sided with more calories, so out came the carnation breakfast shakes with extra heavy cream, "re-buttering" her bread, etc. She had constipation issues as well. What really helped us turn the corner was using orange-flavored chewable fiber supplements, a routine we kept up for a least a year, until the "poop avoidance" was long forgotten. Someone advised me that vitamin supplements that contain iron might also lead to constipation, so we switched to an iron-free chewable.

    I do feel I have to question the advice to establish a "clean your plate" before you get anything else rule with a child this young. Can a toddler really be expected to comprehend this rule? Mine would have readily gone to bed hungry and miserable before eating her vegetables.

    My daughter is very bright, and very prone to taking on "control issues" -- even as a 18-month old I could envision a propensity for eating disorders down the road, so I decided not to engage in the battle over food. A year or so of a less-than-ideal diet did not harm her. She has missed only a few days of school in five years. Now she is a happy and active fifth grader (still willful, but able to concede to reason) who eats not absolutely everything, but a very good variety of foods -- tonight it was tacos with meat, cheese, lettuce, avocados, onions and salsa--but no diced tomatoes for her. She is slim, and has stayed at the 10th percentile mark that she "slipped" to at a year and half.

    I have to include one more plug -- if your daughter is like mine, she might really take to eating rice and beans, or just beans alone. They are a great source of fiber, a good value, and a good size for little ones who eat with their fingers. She still loves chick-peas or kidney beans straight from the can, and loves to "sneak" a few while I am cooking.

    Good luck!

    Posted by gastrogal September 1, 09 08:52 PM
 
2 comments so far...
  1. This reminds me of an episode I saw on "Mystery Diagnosis." The child was a picky eater and practically demanded the addition of salt to anything and everything. I don't recall the diagnosis, but I do recall it was definitely an underlying medical issue that manifested itself as picky eating. His body craved salt, and therefore, he put it on everything.

    Find a new pediatrician. Or at least ask the one you have to explore the possibility of an underlying medical issue. With such a large drop in percentile, you should be concerned that there is a possibility that it's not just about taste; it could be that her body is more incontrol of what she wants than her mind.

    Posted by could be more than just picky-ness September 1, 09 02:05 PM
  1. It's as though you were writing about my daughter, who at her 18-month check up (she's ten years old now) had failed to gain an ounce from 12 months. Our pediatrician sent me to meet with a nutritionist who gave what I alway thought was ridiculously contradictory advice: get her to more vegetables, and, at the same time, more calories. I was sure (and remain sure) that I could do one or the other, but not both. The pediatrician sided with more calories, so out came the carnation breakfast shakes with extra heavy cream, "re-buttering" her bread, etc. She had constipation issues as well. What really helped us turn the corner was using orange-flavored chewable fiber supplements, a routine we kept up for a least a year, until the "poop avoidance" was long forgotten. Someone advised me that vitamin supplements that contain iron might also lead to constipation, so we switched to an iron-free chewable.

    I do feel I have to question the advice to establish a "clean your plate" before you get anything else rule with a child this young. Can a toddler really be expected to comprehend this rule? Mine would have readily gone to bed hungry and miserable before eating her vegetables.

    My daughter is very bright, and very prone to taking on "control issues" -- even as a 18-month old I could envision a propensity for eating disorders down the road, so I decided not to engage in the battle over food. A year or so of a less-than-ideal diet did not harm her. She has missed only a few days of school in five years. Now she is a happy and active fifth grader (still willful, but able to concede to reason) who eats not absolutely everything, but a very good variety of foods -- tonight it was tacos with meat, cheese, lettuce, avocados, onions and salsa--but no diced tomatoes for her. She is slim, and has stayed at the 10th percentile mark that she "slipped" to at a year and half.

    I have to include one more plug -- if your daughter is like mine, she might really take to eating rice and beans, or just beans alone. They are a great source of fiber, a good value, and a good size for little ones who eat with their fingers. She still loves chick-peas or kidney beans straight from the can, and loves to "sneak" a few while I am cooking.

    Good luck!

    Posted by gastrogal September 1, 09 08:52 PM
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Barbara F. Meltz is a freelance writer, parenting consultant, and author of "Put Yourself in Their Shoes: Understanding How Your Children See the World." She won several awards for her weekly "Child Caring" column in the Globe, including the 2008 American Psychological Association Print Excellence award. Barbara is available as a speaker for parent groups.

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