Fred's son has a very limited appetite.

Posted by Barbara F. Meltz  October 24, 2012 06:00 AM

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I am a Father of a 4 year old, who's having trouble getting him to eat, period. When he does eat , it's Chicken nuggets, Cheese sticks, Pizza. Nothing really healthy. In the morning, it's such a battle to get him to eat his toast (it's the only thing I can get him to eat in the morning) but sometimes he throws it up. He'll start chewing it for so long that I guess it just liquifies and he'll throw it up. I am really worried, and honestly don't know what to do. He won't try anything new.

From: Fred, Palm Bay, FLA

Dear Fred,

Have you talked to your pediatrician about your worries? You need him/her to weigh in to make sure that there are no medical concerns about weight gain and growth. If your son is healthy in that regard, then could there be some medical problem that causes him to not want to eat? Does he need to see a specialist? Some kids have difficulty with the textures of certain foods. Some kids have food allergies that cause them to be literally nauseated by certain foods. Some kids have anxiety issues that translate to loss of appetite.

Hopefully, those problems will be ruled out. If they are, then perhaps you can put his picky eating in perspective. Meaning: (1) he's growing in spite of being a picky eater, and (2) Picky eaters are not born picky, they turn into picky eaters because we're enablers. So if that's what you've got -- a picky eater that you have unwittingly created -- find a strategy you can live with that will also deter his picky habits. Since this is a topic that's been addressed many times in this space, here's some reading that may help.

BTW. About him not being willing to try new foods? It's depends on who's defining "new." Most kids need to see the same food multiple times -- 10, 15, 20 times -- before they no longer consider it "new."

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13 comments so far...
  1. Maybe part of the issue is that food has been turned into a "battle" as the father describes it. Would it work better to say: "Here is your toast" and let him eat in peace instead of cajoling or begging or whatever happens? Does he eat his meals (for instance, dinner) with you? Serve him what you are having without comment and don't offer options just for him such as chicken nuggets, etc.

    Posted by mj October 24, 12 07:42 AM
  1. The picky-eater letters always have the same theme. "Chicken nuggets, Cheese sticks, Pizza." Why are kids so young being fed this stuff in the first place? It's addictive to kids. Unfortunately, little kids get food addictions just like teenagers and adults do.
    P.S. if he doesn't like toast, try hot cereal. Creamed rice takes two minutes or so. Once in the bowl, add some banana or apple slices, and pour a little milk over it. Worth a try.

    Posted by JeanneDark October 24, 12 10:34 AM
  1. Does your child have environmental allergies? I, along with a lot of my relatives, have environmental allergies that cause post-nasal drip, to the extent that there's loss of appetite, nausea, and gagging, particularly in the mornings. Until you know what it is, that it's normal, and how to control it, this allergic symptom causes a ton of discomfort, especially regarding eating. This would be something to have the doctor check out, but it's fairly easy to see with an open mouth and a flashlight.

    Posted by AP October 24, 12 10:53 AM
  1. I agree with the comment above. It shouldn't be a battle or much of a discussion. When things get sticky, I try not to differentiate anything except the task ahead. This is breakfast; We eat breakfast. The problem is once you start having certain ways of communicating with your child, it's more difficult to change direction. It is possible. Kids are adaptive. Your pediatrician is an excellent resource too. Good luck!

    Posted by Kalimah (mother to picky 3-year-old) October 24, 12 10:57 AM
  1. My daughter was a picky eater from day one....she is now nineteen and still picky...each year I asked the pediatricians for help, only to be told she would out grow it, I tried everything!....there is a new eating disorder being included on the eating disorder spectrum - Avoidant Restrictive Food Intake Disorder....this is finally something that makes sense and we are now able to see some improvement.

    Posted by KT October 24, 12 12:52 PM
  1. Many things could be contributing to your child's symptoms: acid reflux disease, gastroparesis (slow emptying stomach), food or environmental allergies, other gastrointestinal disorders (celiac disease, lactose intolerance, food intolerances) which cause restrictive eating and poor appetite, anxiety and then of course, a combination of some of the above. Sensory Intergration Disorder is another cause for restrictive eating...sometimes just the look of a food makes a kid want to throw up. Often times a child with G.I. disorder tends to have sensory issues... How do I know this? I have two children with a combo of the above conditions...My daughter sounds nearly identical to your son. Ask for a Pediatric G.I. consultation....you will probably get your child some help. Many people with acid reflux or gastroparesis (delayed gastric emptying) have little to no appetite in the morning. Often times, the only symptom is refusal to eat. You don't have to have the typical heartburn problem. Good luck!

    Posted by Elena October 24, 12 08:19 PM
  1. I don't buy the disorder thing (the post nasal drip is the only one that is somewhat plausible. I say this because if that is the case, why are chicken nuggets, pizza or cheese sticks not disruptive to his GI? My vote would be for the enabling. Until you can get him to eat new things regularly, I would say bargain with him. "You can have a chicken nugget if you have 2 bites of banana first" or something similar. Just to get him to try stuff and see it isn't so bad. FWIW - I wouldn't do this with a younger kid but since this kid is 6 he has been allowed to choose and manipulate for so long that the dad can't just immediately give him a plate of say, a steak and baked potato (or casserole, curry, whatever) and expect the kid to dig in. Good luck.

    Posted by CRC October 25, 12 12:59 PM
  1. What is your evidence that picky eaters are not born picky? How do you know that different taste buds don't taste food differently? Why would two children treated the same and offered the same foods be wildly different in what they will eat? Having been a picky eater as a child (and to a smaller extent as an adult), I believe food tastes different to different people. If adults have different preferences, why wouldn't children?

    Posted by Melissa G October 25, 12 01:31 PM
  1. Some people are pickier than others, but the parental reaction sure can exaggerate it. Same as the introvert who's a little shy, parents can draw them out a bit or they can reinforce it and it gets more pronounced.

    Posted by di October 25, 12 08:50 PM
  1. I don't buy into the disorder thing either. I mean many of them are made up anyway. Let's say kid fails a school test for example ..oh there MUST be some silly named disorder they can come up with for the kid!!! Rather than deal with the real issue there...the kid either didn't study or doesn't understand the concepts. Same sort of thing here. I have to go with the enabling it too!

    Posted by jd October 26, 12 06:56 AM
  1. Here's where this stuff starts: some parents make food and put it on the table and everybody from the age of one eats it. And some parents ask that one-year-old, "what do you want to eat?" and they cook what the kid reacts to (before the age of 3) or says (when they are fully verbal).

    One year old kids can absolutely tell the difference between baby food and real food. If they are not given the control of the menu then they LEARN to eat from the food put on the table and nothing else. They certainly have preferences, but that comes when they are 4 and can ask for carrots (please) instead of celery.

    And that is the ONLY choice that young children should be given: that they can choose from a plate of raw vegetables or raw fruit. Or yogurt vs milk. Or toast vs a bagel. Or sauce beside the rice instead of on top.

    NEVER EVER let the kid dictate the primary dish except for maybe one meal on their birthday, and you will find that children manage to eat the food that you prepare. And THEN such issues like gagging on specific foods/textures, or gluten or lactose intolerance, can be correctly assessed.

    When there is no normal baseline appetite, then you have to work to undo the lifetime bad habit. I recommend a good dose of reading about the beginning of Annie Sullivan's life with Helen Keller before every meal for the adults--because that is what you are trying to accomplish.


    Posted by Irene October 27, 12 06:49 PM
  1. NOVA recently had an episode about taste: the host learned that he had four times as many tastebuds as "normal" people. I have a family of super-tasters; one of them throws up if a piece of onion somehow gets in his food. Another one had additional problems with sinus infections and allergies so that many a breakfast was thrown up (no problems with eating most anything but...)You can enable a picky eater if it's some kind of power struggle but you can't remove super taste buds.

    Posted by Carol B. November 7, 12 12:17 PM
  1. I have 2 children, aged 5 and 2.5. I followed roughly the same approach with both, the 5 year old eats everything, loves fruits and veg. etc. The 2.5 year old eats carbs of all sorts, meats of all sort, but not a single fruit or veg. (well, he gets banana chips, freeze dried fruits etc. but refuses cooked or raw while foods) I do not, nor have I ever, served seperate kid foods. He's been evaluated for GI issues (none) and may have some slight sensory issues (though he eats a range of texture from oatmeal to porkchops, so I'm unclear how this can be so) We eat dinner as a family at least 4 nights out of 5, and I always eat breakfast with the kids. Recent progress includes leaving/allowing teh undesirable food on his plate.

    My point here is that all kids are different, and you can't force kids to eat , you can only provide good options, in a good environment and hope for the best.

    Posted by momof2 February 11, 13 11:58 AM
 
13 comments so far...
  1. Maybe part of the issue is that food has been turned into a "battle" as the father describes it. Would it work better to say: "Here is your toast" and let him eat in peace instead of cajoling or begging or whatever happens? Does he eat his meals (for instance, dinner) with you? Serve him what you are having without comment and don't offer options just for him such as chicken nuggets, etc.

    Posted by mj October 24, 12 07:42 AM
  1. The picky-eater letters always have the same theme. "Chicken nuggets, Cheese sticks, Pizza." Why are kids so young being fed this stuff in the first place? It's addictive to kids. Unfortunately, little kids get food addictions just like teenagers and adults do.
    P.S. if he doesn't like toast, try hot cereal. Creamed rice takes two minutes or so. Once in the bowl, add some banana or apple slices, and pour a little milk over it. Worth a try.

    Posted by JeanneDark October 24, 12 10:34 AM
  1. Does your child have environmental allergies? I, along with a lot of my relatives, have environmental allergies that cause post-nasal drip, to the extent that there's loss of appetite, nausea, and gagging, particularly in the mornings. Until you know what it is, that it's normal, and how to control it, this allergic symptom causes a ton of discomfort, especially regarding eating. This would be something to have the doctor check out, but it's fairly easy to see with an open mouth and a flashlight.

    Posted by AP October 24, 12 10:53 AM
  1. I agree with the comment above. It shouldn't be a battle or much of a discussion. When things get sticky, I try not to differentiate anything except the task ahead. This is breakfast; We eat breakfast. The problem is once you start having certain ways of communicating with your child, it's more difficult to change direction. It is possible. Kids are adaptive. Your pediatrician is an excellent resource too. Good luck!

    Posted by Kalimah (mother to picky 3-year-old) October 24, 12 10:57 AM
  1. My daughter was a picky eater from day one....she is now nineteen and still picky...each year I asked the pediatricians for help, only to be told she would out grow it, I tried everything!....there is a new eating disorder being included on the eating disorder spectrum - Avoidant Restrictive Food Intake Disorder....this is finally something that makes sense and we are now able to see some improvement.

    Posted by KT October 24, 12 12:52 PM
  1. Many things could be contributing to your child's symptoms: acid reflux disease, gastroparesis (slow emptying stomach), food or environmental allergies, other gastrointestinal disorders (celiac disease, lactose intolerance, food intolerances) which cause restrictive eating and poor appetite, anxiety and then of course, a combination of some of the above. Sensory Intergration Disorder is another cause for restrictive eating...sometimes just the look of a food makes a kid want to throw up. Often times a child with G.I. disorder tends to have sensory issues... How do I know this? I have two children with a combo of the above conditions...My daughter sounds nearly identical to your son. Ask for a Pediatric G.I. consultation....you will probably get your child some help. Many people with acid reflux or gastroparesis (delayed gastric emptying) have little to no appetite in the morning. Often times, the only symptom is refusal to eat. You don't have to have the typical heartburn problem. Good luck!

    Posted by Elena October 24, 12 08:19 PM
  1. I don't buy the disorder thing (the post nasal drip is the only one that is somewhat plausible. I say this because if that is the case, why are chicken nuggets, pizza or cheese sticks not disruptive to his GI? My vote would be for the enabling. Until you can get him to eat new things regularly, I would say bargain with him. "You can have a chicken nugget if you have 2 bites of banana first" or something similar. Just to get him to try stuff and see it isn't so bad. FWIW - I wouldn't do this with a younger kid but since this kid is 6 he has been allowed to choose and manipulate for so long that the dad can't just immediately give him a plate of say, a steak and baked potato (or casserole, curry, whatever) and expect the kid to dig in. Good luck.

    Posted by CRC October 25, 12 12:59 PM
  1. What is your evidence that picky eaters are not born picky? How do you know that different taste buds don't taste food differently? Why would two children treated the same and offered the same foods be wildly different in what they will eat? Having been a picky eater as a child (and to a smaller extent as an adult), I believe food tastes different to different people. If adults have different preferences, why wouldn't children?

    Posted by Melissa G October 25, 12 01:31 PM
  1. Some people are pickier than others, but the parental reaction sure can exaggerate it. Same as the introvert who's a little shy, parents can draw them out a bit or they can reinforce it and it gets more pronounced.

    Posted by di October 25, 12 08:50 PM
  1. I don't buy into the disorder thing either. I mean many of them are made up anyway. Let's say kid fails a school test for example ..oh there MUST be some silly named disorder they can come up with for the kid!!! Rather than deal with the real issue there...the kid either didn't study or doesn't understand the concepts. Same sort of thing here. I have to go with the enabling it too!

    Posted by jd October 26, 12 06:56 AM
  1. Here's where this stuff starts: some parents make food and put it on the table and everybody from the age of one eats it. And some parents ask that one-year-old, "what do you want to eat?" and they cook what the kid reacts to (before the age of 3) or says (when they are fully verbal).

    One year old kids can absolutely tell the difference between baby food and real food. If they are not given the control of the menu then they LEARN to eat from the food put on the table and nothing else. They certainly have preferences, but that comes when they are 4 and can ask for carrots (please) instead of celery.

    And that is the ONLY choice that young children should be given: that they can choose from a plate of raw vegetables or raw fruit. Or yogurt vs milk. Or toast vs a bagel. Or sauce beside the rice instead of on top.

    NEVER EVER let the kid dictate the primary dish except for maybe one meal on their birthday, and you will find that children manage to eat the food that you prepare. And THEN such issues like gagging on specific foods/textures, or gluten or lactose intolerance, can be correctly assessed.

    When there is no normal baseline appetite, then you have to work to undo the lifetime bad habit. I recommend a good dose of reading about the beginning of Annie Sullivan's life with Helen Keller before every meal for the adults--because that is what you are trying to accomplish.


    Posted by Irene October 27, 12 06:49 PM
  1. NOVA recently had an episode about taste: the host learned that he had four times as many tastebuds as "normal" people. I have a family of super-tasters; one of them throws up if a piece of onion somehow gets in his food. Another one had additional problems with sinus infections and allergies so that many a breakfast was thrown up (no problems with eating most anything but...)You can enable a picky eater if it's some kind of power struggle but you can't remove super taste buds.

    Posted by Carol B. November 7, 12 12:17 PM
  1. I have 2 children, aged 5 and 2.5. I followed roughly the same approach with both, the 5 year old eats everything, loves fruits and veg. etc. The 2.5 year old eats carbs of all sorts, meats of all sort, but not a single fruit or veg. (well, he gets banana chips, freeze dried fruits etc. but refuses cooked or raw while foods) I do not, nor have I ever, served seperate kid foods. He's been evaluated for GI issues (none) and may have some slight sensory issues (though he eats a range of texture from oatmeal to porkchops, so I'm unclear how this can be so) We eat dinner as a family at least 4 nights out of 5, and I always eat breakfast with the kids. Recent progress includes leaving/allowing teh undesirable food on his plate.

    My point here is that all kids are different, and you can't force kids to eat , you can only provide good options, in a good environment and hope for the best.

    Posted by momof2 February 11, 13 11:58 AM
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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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