Caitlin Whyte (Host): If you have a toddler or an older child, you know all about these: picky eaters. Whether it's ice cream for breakfast or chicken tenders for every lunch, our toddlers can get a little feisty when it comes to meal time. Joining me for some guidance on picky eaters is attending physician in the Division of Pediatric Hospital Medicine and General Pediatrics, Dr. Tali Caronia.

 This is Maimo MedTalk. I'm your host, Caitlin Whyte. Well, doctor, let's start off with a bit of a why here. Why do kids get so specific and picky when it comes to what they want to eat?

Dr. Tali Caronia: Well, toddlers are at that interesting age where they have very little control over what happens in their lives. They have lots of grown ups telling them lots of things to do. And basically, the only things they really have true control over is what they eat, when they go to the bathroom, and when they go to sleep. And eating is kind of the thing they do most often during the day and at night. And so, that's the easiest thing for them to pick a battle over. So, this is basically them trying to define who they are and take control in a situation where they have little to no control at all.

Host: Gotcha. So, we're starting to see this around like a toddler age. Is it pretty common? Should I be concerned about, you know, just the way I'm doing things or is this something that's happening to a lot of other families at dinnertime?

Dr. Tali Caronia: So, picky eating is probably one of the most common concerns and complaints that I hear from parents of this toddler age, probably starting at around two years when they start to exert their independence. And picky eating is one of these things that can develop if not addressed early. So, any kid has the potential of picky eater. It has do more with parental strategies and how to prevent that from happening rather than enabling behavior that allows them to be picky. So, in theory, any child can become picky, but also any child can become unpicky as well.

Host: Well, I'd love to break into two things that you mentioned there, you know, enabling and then tips and tricks that we can do to keep dinner from being such a battlefield. So when you say enabling, I mean, what are some things that maybe parents do that they don't really realize is feeding into the pickiness?

Dr. Tali Caronia: So, allowing children to not eat certain foods and then eventually relenting them and giving them the foods that toddlers prefer. Toddlers, we all prefer certain foods, fried foods, sweet foods, yummy foods, salty foods, foods that we know aren't good for us. But as adults, we can decide not to eat certain things because we know of the health value of certain things. Toddlers have no idea, so they obviously want what is most tasty to them, which is chicken nuggets, french fries, candy, chips, chocolate milk, like everyone else in this world. And so, for parents to eventually give them what they know they'll eat instead of encouraging to eat the food that's served is part of what I mean by enabling that problem.

I always say a child's not going to starve themselves, they will eat. But by giving in and allowing the children to make decisions over what they want to eat, knowing that those aren't necessarily the best or the healthiest choices are what enables this behavior. And toddlers are also incredibly smart, and so consistency is the key. If they know that holding out will eventually mean that they get what they want, they will hold out indefinitely for that. And so, I think not letting them, the toddlers, have control over the situation. First and foremost, as this podcast is called, Who's The Boss, is remembering who the boss is in their situation. Kids are only as picky as we let them be. It's kind of the way I think about it. If you don't let them to be picky, they're not going to be picky. Obviously, aside from children who have developmental issues, texture issues, we're of course sensitive to those things.

Host: That is a very good point. Well, let's get into the other side of the issue here. How can we really stand our ground as parents and guardians and, you know, stop mealtime from becoming such a heated environment and maybe encourage our kids to be a little less picky if they really are, you know, one of these really picky, picky eaters?

Dr. Tali Caronia: Well, the first step is always to role model the behavior you wish to see in your child. And that goes for eating nutritious foods, a variety of foods. That goes for discipline. That goes for how you control your temper, your behavior, how you treat other people in the world. So, the first thing first is recognizing that children are going to mirror what they see. So, if you yourself are a picky eater, then already that sets up this paradigm for the child to be a picky eater as well. So, the first thing is to role model that behavior from an early age. "Look at all the foods I'm eating. I'm eating fruits and vegetables and some whole grains and some fish or some meat or some lentils or some beans. and I love everything on my plate." That would be the first step, is to role model.

The other part is just to be consistent and make the message clear. "This is what's for dinner, okay? Here are the things that we're expected to eat on this plate. You don't have to eat everything on the plate. You can still allow the toddler to choose what they want, but basically this is what's for dinner. "If you don't want to eat it, don't eat it. When you're hungry, let me know." Setting up that consistent model every single day, this is how it's going to go. Children and adults are creatures of habit, and they're creatures of consistency and rules. And so, once they learn this is how it's going to go, this is a routine, you don't give them a chance to deviate from that.

There definitely can be snacks and treats. You know, you don't have to be a zealot or a tyrant about any of this, but to generally be consistent. And what's really important, especially for many of our families, our multi-generational, multi-family unit household, is everyone is on the same page. If mommy says you have to eat, you know, what's on your plate, but daddy is sneaking you chocolate milk, you know, or grandma's giving you candy on the side, it doesn't work. It's about consistency, role modeling, every single person at the dinner table being on the same page.

Host: Well, I'd love to ask about nutrition. You know, if we're facing a kid who's really only eating mac and cheese or won't pick up a vegetable, you mentioned kids aren't going to starve themselves, they're going to eat. But when should we start to get concerned? "Oh, he's really only eating noodles," "Oh, he's really only eating ice cream." What should the baseline nutrition be if we're dealing with a picky eater?

Dr. Tali Caronia: Right. So, you know, in general, you have to be smart, you have to be clever and you have to have patience. So, kids aren't necessarily going to chow down on spinach and broccoli. I understand that. Adults, most of us probably wouldn't do that either because let's face it, some of these things don't taste as good. But you have to be sneaky, you have to be creative, and you have to learn how to hide things. So, making smoothies with vegetables, chopping up vegetables and adding it, blending it into meat if you make hamburgers or turkey burgers. There are healthy noodles that are made out of lentils. You know, there's rice made out of cauliflower that you could mix in proportion. Like, you have to be creative, and you have to be sneaky about it sometimes. But there are ways to incorporate healthy options into less healthy options so that it makes it a sort of a more ideal situation.

And so, what we want to promote is fiber, fruits, vegetables, whole grains, not a ton of saturated fat and foods that are rich in iron, because that's important for brain development. And so, there's being creative, offering the same things over and over again. Kids love colors. Kids love shapes. Making things in kid-friendly shapes, getting dinosaur cutouts of fruit, making kebabs of things, things that look fun. Kids are smart, but also, if you're sneaky enough and if you're clever enough, you may be able to even sneak some things in there without them knowing about it.

Host: I love that. Some great ideas there, doctor. And as we wrap up here, on that note, you know, if we're dealing with a picky eater, when should we head to the doctor? What Would be like the next step if our kids are just not eating?

Dr. Tali Caronia: Anytime you suspect any kind of pickiness as a result of a medical problem. So, are they losing weight? Are they in pain when they eat? Do they have loose stools? Do they have blood in their stools? Are they always fatigued or low in energy or pale? Then, the picky eating is affecting their overall medical health

With a thriving child who's a normal weight, then you can go to your pediatrician for support of how to address the picky eating. Maybe check some labs to make sure they're not getting anemic or having a low red blood cell count, because they're not getting enough iron in their diet. Perhaps start a multivitamin for a child who really limits certain food groups. But really, the reasons to get concerned are the ones that I mentioned before. If it's really affecting the child's overall health and well-being, then that's a red flag to see the pediatrician to address any of those issues.

Host: Absolutely, doctor. Well, just some great info here for an incredibly frustrating issue, but thank you so much for being with us. You can call to make an appointment at 718-283-3640. Or you can visit maimo.org. If you found this Maimo MedTalk podcast helpful, please share it on your social media channels. And to listen to additional episodes of Maimo MedTalk, please visit maimo.org. Thank you so much for joining us today on Maimo MedTalk. I'm your host, Caitlin Whyte.