Maggy McKay (Host): If you have a child who's fussy about their food, you know what a challenge every meal can be. So today, Dr. Sara Gould, Director of the Eating Disorder Clinic at Children's Mercy Kansas City, is here to talk about managing picky eating in your child and the signs that it may be something more.

Welcome to the Parent-ish Podcast, where experts at Children's Mercy Kansas City talk about the little everyday things parents experience with their babies, teens, and in-betweens. I'm Maggie McKay. Thank you so much for being here today, Dr. Gould.

Dr. Sara Gould: Oh, it's my pleasure. Thanks for having me on.

Host: Absolutely. Let's just start with what is the best way to introduce new foods and new meals?

Dr. Sara Gould: The best way to introduce new things into your child's diet is to do it early and often. Sometimes parents are nervous about what might come up, and it's important to provide the food without expectation that your child will eat it or eat much of it. As long as they're getting familiar with it, that's the initial goal.

Host: Okay. And let's say a child is insistent on not trying a new food, what's the proper response on the parent's end, and how do we keep our cool?

Dr. Sara Gould: Absolutely. So, take some deep breaths. One thing that's really important to remember through all of this is food isn't a fight unless we make it one. And so, we as parents can control that dynamic really well on our end, despite whatever emotions our kids are throwing out there at us. And so if a child is adamant that they are absolutely not trying this thing, accept it. Move on and keep serving that food, meal after meal, snack after snack. Because over time, what we know is that the more familiar we are with foods, even seeing them, smelling them, the more likely we are to accept them in the future.

Host: So, don't discipline them for not even trying a food.

Dr. Sara Gould: No. And part of that is related to our stress response. So, if children learn based on their experience that they're going to be asked to do things that are uncomfortable for them at meals, their stress response can actually interfere with their willingness to try new things and take a risk, and can turn off really important cues in the body like hunger.

Host: That makes sense. Should I feed my children different things during the same meal?

Dr. Sara Gould: If we're talking about different meals for different people, no. We would really suggest that every meal include at least one food your child is comfortable with and that everybody eats that food, just like everybody gets served the foods they are less comfortable with.

Host: What if there's a food I don't like, the parent doesn't like, but would like my child to try it? How should I go about that scenario?

Dr. Sara Gould: Sure. I love this question because we do know that there's a pretty high genetic component to our pickiness, which makes sense if you think about our taste buds, how our senses work, and then also how risk-taking we are, how open we are to new experiences in every realm, including with food. And so, one thing to remember is just be intentional.

So if you absolutely detest a food, is there a really good reason to expose your child to it? And there may be, it may be a very common food that they're likely to run into and it's been difficult for you to not be able to eat that food. And if that is the case, give yourself practice with the food. Most people, just as examples, don't like coffee or beer the first time they try them. Those are strong tastes. But with repeated experience, because they're so common around us, especially at different life stages, that folks grow to love it over time. And the same can be true not just for your child, but for you, if you are willing to allow yourself time and repeated practice with those foods.

Host: So, you know how perceptive kids are. They don't miss a trick. So what if they notice mom and dad don't like a certain food, but they're supposed to be eating it?

Dr. Sara Gould: Absolutely. I love it when that happens, actually, because it's a chance. If we as parents feel it's really important for our kids to be able to eat these foods, we have to be willing to do it ourselves. And so if we're eating the food and the child notices that we don't like it, what they are learning is that it is possible to tolerate foods that we would not choose on our own. And that's a really important skill as well.

Host: Dr. Gould, is it normal for a child to go through picky eating periods?

Dr. Sara Gould: Absolutely. It is developmentally normal, as in almost every child does it through those toddler and preschool years. And that's important. As kids are getting more mobile, reaching for more things, it's adaptive to be suspicious about putting new things in our mouths. There are a lot of things kids are running into that we don't want them to put in their mouths. And so, that period of time is really typical where we start asking questions, is when it's not contained to those developmental years.

Host: I knew a couple different kids, little kids, like under 10, who went through a phase where all they would eat was white food. If it wasn't white, they wouldn't eat it, which, you know, does not seem too healthy. How do you get around that?

Dr. Sara Gould: Absolutely. And that goes back to what we were saying earlier of include one of those white preferred foods in the meal, but also include all the rest, because we're continuing to give a kid practice. If you think carefully too, if we smell a food, we are almost tasting it. Those senses are very linked for us. And so if the food is on the table, kids are still getting that experience with it, even if they're not willing to eat it at that moment.

Host: Dr. Gould, what's the difference between picky eating and food aversions?

Dr. Sara Gould: Sure. So, picky eating, as we were saying, those periods of picky eating are very common and considered adaptive and appropriate. In those situations, kids usually are picky, but they're still hitting most of the food groups. They're still able to meet their nutritional needs as far as iron and vitamins, things like that, and they're still able to grow appropriately.

Also, if they are hungry, and their preferred foods are not available, they will generally still eat them. However, when we switch over into food aversions, often there's a really high intensity in reaction. They won't eat those foods despite being very hungry and often either growth and development takes a hit or social functioning does. They're not able to participate in the community, because they're so selective in the number of foods and types of foods that they'll accept.

Host: That's a very nice way of putting it, selective. So, let's say you have more than one child, and they have siblings. And at mealtimes, the one child is the picky eater and the rest are not. How do you help those siblings at mealtimes when they're addressing the picky eating sibling?

Dr. Sara Gould: Sure. So, the best way, just to back up a moment, to address picky eating during the meal is that planning ahead of time about what foods are going to be presented and keeping it calm. We also really need to remember that anything we pay more attention to, we're going to see more of. And so if a child is refusing, for example, to eat their peas, and we turn all of our attention to that child, then what they're learning is that we will drop everything for them as long as they don't eat their peas. Their sibling is also learning that. And so, the sibling, and we've seen this happen at times, may grow more picky in order to access some of that parental attention. And so, instead of going down that path, if we can back up and recognize that our kids see our attention as a really important resource, then we have the opportunity to attend to the child who is eating appropriately. And that may be drawing attention to the behavior of like, "I love it, your mashed potatoes are almost gone," or it may just be asking them about their day. And if we keep in the back of our mind what our other child, our picky child is doing, we might turn our attention back to them as soon as they pick up their fork, as soon as they make movement in the direction we would like them to go.

Host: Good point. Am I only enabling this picky eating behavior by only feeding my child what I know they like and will eat?

Dr. Sara Gould: So if we only present foods we know meet those very high standards or very specific preferences, then yes. What we see is, for example, if the child loves mac and cheese, and we feed them mac and cheese three times a day, what is going to happen is they're going to get sick of mac and cheese, and that is going to drop off of their list of accepted foods. And so, that is one really good reason to not only stick with their list of foods, is because that list will be can get shorter and shorter over time to where we're really stuck. The other reason goes back to what we were talking about of giving practice to those experiences and to those foods. And so, without the expectation that the foods will be actually eaten, it is really important to continue to serve that variety of food.

Host: What do you think about the strategy? You kind of touched on it. But when I was little my best friend just loved cheesecake, couldn't get enough of it. And so, I guess, one day her mom gave her a whole cheesecake and she ate probably half of it, I don't know, three-fourths, and never wanted it again. Is that a good strategy?

Dr. Sara Gould: So, it depends on what the goal is. Is the goal to never eat a food again or is the goal to open up and eat more foods? And so, that is what happens when kids are picking that cheesecake, for example, every time is eventually even our favorite foods we get in that place of like it's just not very interesting to me anymore. It's not satisfying in the same way. And so then, we go to the other shortlist items that we have versus the reverse.

Variety drives volume. And so if we can get a little bit of this, a little bit of that, and broaden out a bit, then we're more likely to keep all of those foods on our preferred list and even grow, because we're used to different kinds of things, we're used to different kinds of tastes, which means we're comfortable with foods that are potentially more similar to some of the new foods we might try down the road.

Host: Let's talk about warning signs. What do we look out for that indicate this might not just be picky eating?

Dr. Sara Gould: Absolutely. The biggest warning signs I would identify are, one, what is the intensity of that child's reaction? So, we have had kiddos who are not able to tolerate a certain food on anybody's plate at the table. And that feels pretty extreme, right? Like, there's a lot of distance between, "I can't allow it on the table" and actually putting it in my body. So, that's one thing to pay attention to.

Another is if the child is increasingly more picky over time, if we're noticing more and more foods drop off their list. Third is, has there been a sudden change? Was this a kiddo that was eating a pretty good variety overall, and suddenly that's cut down significantly? And ask questions about maybe why that is. Did they have a scary experience with food? Did they have a bad GI illness, where they had repeated experience that I eat and that I feel sick? Because that gives us clues on how to address that and get it back on track.

And the other area to attend to is the limited intake impacting growth, development, or those social experiences, those experiences in the community? And if any of those things are occurring, that would be the time to move from thinking about this as a normal, adaptive part of every child's life to something that needs a little bit more intervention or support.

Host: And how do you broach the topic with your pediatrician without them saying, "Your child's just being picky"?

Dr. Sara Gould: One tip I would give is, if possible, I would say try to address this privately with the doctor because of what we were talking about regarding attention. We don't want to give a lot of attention or have a child begin to identify as, "I'm a picky eater." That's really different from saying, "I'm a kiddo that has some picky eating sometimes." And patient portals and messaging systems really do help us do that, because I know it's hard to get those private moments during an actual visit sometimes.

It's also really helpful to give that provider specific examples, both of what's going on with eating and of the impact it's having. So, is it causing family conflict? Is it resulting in you turning down invitations to have dinner with friends because of how you expect your child to respond in those situations? Help that provider know if there are sudden changes or even slow changes over time. Help them know if you view your child's behavior as different from your experience with other children, your own or others, and help them know if you are worried. And if after all of that you feel that your child's doctor is not understanding what you are seeking to communicate in terms of your concern, it's okay to go ahead and ask for a referral for more specialty evaluation.

Host: Those are all really, really good ideas. In closing, Dr. Gould, is there anything else you'd like to add that you think parents need to know?

Dr. Sara Gould: One of the most important thing for parents, I think, is keep your brain on the long-term goals you have for your child, not just on this specific meal, because these really are experiences that add up over time, and one meal doesn't make or break anything. Doing that helps us keep our own emotions in check. It helps us treat a mealtime as a time not to convince our child to eat something, but to gain information about how can I set them up for more success next time and how can my child and I continue to move forward together.

Host: This has been so helpful and informative, because it really is a big problem when your child is a picky eater. So, thank you so much for sharing your expertise today.

Dr. Sara Gould: Absolutely. I appreciate being here.

Host: Again, that's Sara Gould. That concludes this episode of the Parent-ish podcast. For more parenting tips and tricks, visit us at parentish.org, where we help you celebrate the craziness and challenges of parenthood. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to the Parent-ish Podcast from Children's Mercy.