Joey (Host): It is a common issue for parents. So we're discussing Picky Eating in Kids. Our guest is Dr. Schumann Bick. He's a pediatrician with Novant Health. This is Meaningful Medicine, a Novant Health Podcast, bringing you access to leading doctors who answer questions they wish you would ask from routine care to rare conditions.

Physicians offer tips to navigate medical decisions and build a healthier future. Thanks so much for joining us. I am Joey Wahler. Hi there, Dr. Welcome.

Sumon Bhowmick, MD: Hey Joey. Thank you so much for having me. It's really nice to be here with you guys.

Joey (Host): Same here. We appreciate the time. So this is something that touches. Many parents, as we said at the top, picky eating something nearly every parent will encounter at some point in some form or fashion. Right? So what would you say is considered doctor quote unquote normal when it comes to kids eating habits and when should parents start to pay closer attention?

Because maybe it's not.

Sumon Bhowmick, MD: Yeah, that's a great question and one of the most important ways that we kind of delineate what's normal as to when to get your concerns is also has to do with how old you are. Where to start as far as introducing new foods and working from there. So to me, the conversation changes during each checkup, which is why it's always so important to come in for your usual checkups during infancy and, when you're a toddler.

Things like advancing diets, introducing new foods, offering a lot of different things. If we disagree with something and come back to it later, those things make a big difference. But typically around. Toddler two to four years of age. That's when we start to see a little bit more of that concern about, well, my child is becoming a little bit more finicky with their eating.

You can offer a lot of different stuff when they're first starting it out and then it kind of will regress in some instances.

Joey (Host): Yeah, I can speak from experience right here and now because my wife and I have a three-year-old daughter and she already is expressing what she likes, doesn't like as much. The good news is there are certain healthy things she likes, like vegetables. She loves cucumbers, but sometimes she'll be so concentrated on the cucumbers.

She doesn't eat her chicken. So what do you do when they're kind of, I mean, hence the word picky when they're picking and choosing what they want and what they don't.

Sumon Bhowmick, MD: That's always a constant struggle and I'm no stranger to this either. I have three children and twin boys that are now 10 years old. My daughter's eight, and so navigating our way through that can be a bit of a minefield sometimes. Picking and choosing what we are trying to determine is.

A good way to approach this versus maybe not so beneficial. And so, to me one of the things that kind of stick out to me when they're a certain age is their participation. You wanna get them in the mix, try to get them to become part of the, process of getting it. I keep thinking back to that old movie Oliver Twist, where they have the kids just getting the food just served to them and just moving down the row when you don't have a lot of choice in the matter, it makes it a lot more difficult it can be a source of possible even, resistance and a way for them to show their independence by.

Refusing the food that's been given to them. So get them in there when they get older, take 'em to the grocery store, have a garden that you can plant things in so they can see where the food is coming from. Engagement is a really important way of working on good eating habits. And so, the example that you had earlier about eating one versus the other.

That's a real common thing. You don't wanna force it, but you wanna make sure that they know that there's, options here and that you don't want them to feel certain kind of, punishments or different types of neglect for eating certain foods. So you keep trying, I say it with my patients all the time, you'll win the war, but you'll lose a lot of battles along the way.

Joey (Host): It certainly makes sense. So what are some of the most common reasons that kids start to become selective or resistant to certain foods in the first place? 'cause you mentioned toddler age is a big turning point. That's obviously when kids start to have opinions about a lot of things for the first time. Right.

Sumon Bhowmick, MD: Yeah, that's a great question. And you know, one of the things that I feel like makes a big difference is you are a product of your environment. So it is important that they see what the rest of the table is eating as well. So if we eat one thing and the kids eat something else, or if we're not gathering around a table and having a meal, eating from the same family style, these are just subconscious ways of just cultivating good table and nutrition culture, You wanna make sure that everybody's on the same page about this is what we're having for dinner tonight. There's a term that gets used a little bit that I learned not too long ago called food Jag.

And a Food Jag is basically where you get. Painted into a corner. So there are these kids that are just mac and cheese and chicken nuggets, every single meal over and over and over again. And that's what is considered a food jg. And we try to avoid those things by having the children, the parents, everybody kind of involved in the process of what we're eating, taking the.

Guesswork out of the nutrition knowing that we eat it. But it's tough. Kids will give you, you know that they eat something every day and then one day it's on a plate that they don't like or it's the wrong time and then all of a sudden they don't like it anymore. And you just have to take that with a grain of salt.

 You chalk it up to the next time around because the next time they'll eat it. Great. It happens in my house all the time.

Joey (Host): And along those lines, doctor, do you. Recommend trying to get a toddler out of the high chair and into at least a booster seat, if not into a regular chair around the table, to create that more equal footing. ASAP.

Sumon Bhowmick, MD: It is that, yeah, I would tell you that there is a good amount of some benefit for them trying to join the. Unit, the family unit, right? They wanna do the things they want to eat off of your plate. That happens a lot of times in my family too. The food that they have in front of them doesn't look good, but they see what somebody else is having, especially the parents.

They want to try that. So get 'em in there. And I think, we wanna make sure that there's a little bit of some guidance, but a lot of discovery. We need these young kids to smear the food all over their face, knock the bowl around, mix it up with the spoons and stuff. It's messy. But it helps you get more integration with your sensorium.

You get a little bit more feeling of the tactile the consistencies of these foods, and that helps them not feel so restricted.

Joey (Host): And speaking of restrictive kind of leads me into my next question, which is how do you go about from your experience guiding families through these mealtime challenges without adding pressure or anxiety around food? Because I would imagine the last thing you want a kid to think or feel when they sit down at the table or in a chair is, oh, here we go again.

I'm gonna be made to do something I don't want to do. You don't want it to be a production, right?

Sumon Bhowmick, MD: That's exactly right. So it's a bit of some, magician type of mentality where it's a lot of just, look over here while we do something else. So one of the things that we don't want to do is make a mountain out of a mole hill, and this comes early. We talk about our day, we talk about the best part of our day.

We talk about what we did. We talk about all of the different things we're doing while we're having our meal. So you're just kind of eating and it's just happening. It's the ritual of nurturing your body. We try to make sure that we take as much of the onus off of the actual. Active eating so we can focus on the stuff That's actually really important but again, it's hard because it happens early.

We try to set these things early. So if you're dealing with this already now, when you have these finicky and these picky eaters, then it's a little bit of some web untangling that we have to do, and that's where we may need some help with some, further assistance.

Joey (Host): so a little end around then to use a football term, right? A little uh, slip of hand. How about at what point parents should talk to their pediatrician, like yourself about this picky eating, and what kinds of things do you look for during that visit?

Sumon Bhowmick, MD: Yeah. So that's a huge topic of our conversations is what we call anticipatory guidance. Checkups are fun and they should be fun because we're talking about the stuff that's happening every day. Sick visits are not as fun because we're talking about what's going wrong. The checkups are always a good time because we get to visit and talk about what's new that we're doing.

Are we doing new things with our walking and talking and do we put our clothes on and what are we eating that's different? And so it's a conversation that we have as soon as these babies are coming to the clinic for the first time. 'cause it may not necessarily be what are we eating, but how frequently are we eating and what time are we eating?

Do. We have a pretty good standard there because children really do very well when you have a lot of routine, the bedtime routine, the nighttime routine, the feeding routine, all of those things, you set your clock by it. And so in my experience, you see a lot more benefit with the eating and with the day to day when you know that six o'clock is this bath time, is this o'clock.

Story time is this o' clock, and then we keep things moving. So it's like you can't get too caught up on all of the details if you're just continuing to move through your day. And so when it comes to what age that we start walking about finicky eating and picky eating, well, one of the things that we do at every checkup is we check their growth.

 Infants get their head size checked, their height checked or their length checked and their weight. And as you get past age two and up, then it's mostly length and weight. Now, what we tend to see with those growth parameters is when you have problems with nutrition, the first one of those measurements that tends to fall off, you would imagine is weight. And that's true, and that's something that fluctuates quite a bit. We are all familiar with that. That doesn't stop in childhood. Our weight fluctuates all the time. We try to do the best that we can to keep it as consistent, but we want our kids to keep growing and gaining weight the right way.

When it gets to the point where we're getting more concerned about their nutrition than the other two parameters can fall off. Things like their vertical. Velocity, their height, velocity, and of course their head size. These are signs of malnutrition and this is where the conversation really needs to be focused on.

What are we doing to keep ourselves in a position where we are putting as much of our attention towards getting balanced, nutrition moving forward? But it happens at every checkup, and the growth parameters help us dictate where we need to continue the conversation and focus it.

Joey (Host): So how can parents tell the difference between a typical picky eater and a child who may have a feeding disorder or some sort of underlying issue?

Sumon Bhowmick, MD: So the. Different factors that can affect that come from so many different places. And again, we live in a time where the amount of restrictive diets and food allergies and intolerances really start to present themselves a little bit more. And so I. As we learn more about the family history, are we living in a home where we have specific food avoidances?

Do we live in a home where based on the family or the culture that we avoid certain foods, these things can lend themselves to more parameters that maybe restrict us. Is there people in the family that have gluten intolerances or food allergies? So the younger ones don't get these types of foods because we're all trying to eat the same things.

Using that history and having that ongoing conversation in addition to monitoring their growth and their development and having that conversation about what else are we seeing, what they're eating? Do they break out into a rash? Are they having a hard time with acid reflux? Do they have increased bloating, gassiness, diarrheas, things like this, physical symptoms that are associated with this can lead to problems with nutrition.

Look, if you eat something and it causes you to have a reaction to it and you go anywhere else to eat, there are foods that look similar to this or foods that are the same, but prepared a different way. And the anxiety starts to get set in. And you're gonna have kids that may want to go to the birthday party but are unable to because they're too nervous or too scared because the last time that they had a piece of birthday cake, they ended up with digestive problems.

And so, there's a lot of different moving pieces there. We talk about it at every visit to make sure, but mainly are there physical symptoms? Is the growth being affected and are there limitations in the home?

Joey (Host): Couple of other things for you. First, you touched on this earlier, but what role exactly does growth tracking, which you've mentioned and nutrition assessment, play in deciding next steps for kids? Because kids may be in a period, am I right, where they're starting to get bigger or in a period where they're not growing as much, but it may not necessarily be tied to what they're eating?

Right.

Sumon Bhowmick, MD: Exactly right. When we have our checkups, one of the things that I make sure that I review with the family is the growth chart. And just by seeing what the chart looks like, you get an idea. So, for example, the first six months of a baby's. Life. They don't do much in that. They're not walking and talking and singing and dancing.

They'll do all that stuff soon. But what we're trying to do is just get the calories to grow and develop so the muscles get stronger so they can utilize them. So if you look at a growth chart, they're definitely on a much higher trajectory for the weight gain. Then it starts to fan out and we can start looking at all the different percentiles.

and after age two, we're on the. What I call the big kid growth chart, and this is the one that we monitor from age two all the way up to 18, 19, 20 years of age until they're done with pediatrics. And so when we have that, you get an idea of where the growth spurts are. Obviously during adolescence you have a little bit of a tick up.

Girls tend to have that earlier than boys, but boys tend to grow the most. And so these are things that we have these conversations with our families as the years progress. And so they play a big role as far as just being able to get an idea of where you are on the roadmap. But the understanding is that none of these things are.

Etched in stone. there's a lot of fluctuation that can change. Kids grow real quickly. That doesn't necessarily mean they're gonna stay on that trajectory. It all depends on the other factors involved with their development, their nutrition, their sleep, their physical activity. All of those things play a role in it too.

So it's a a much larger scope than just one specific parameter, like a growth chart.

Joey (Host): In summary here, if you could give parents joining us one piece of advice to help them navigate this stage with patients and also to remain confident that everything will be fine, what would it be?

Sumon Bhowmick, MD: Well, I want us to keep in mind that this is kind of like tending a garden. There is no one way. It's not set it and forget it. You are always working on things. And to me, one of the best ways to tend the garden is to have having gardeners and people at different levels.

The children have to be a part of it, and we get them involved because we learn about food, we learn about nutrition, we learn about all the different roles that food plays. What are the good choices? What are the bad choices, the way that we approach food. 'cause nutrition is such a. Cultural cornerstone for so many people that we want to focus on what it is that means balanced nutrition.

A conversation that I have with families all the time is that I want to make sure that they understand that there's not really such a thing as bad food. It's about balance. And so if you eat certain things. Some of those things, like if one of the comparisons I make is if you have a balance and one side is the foods that we eat some of the time, that's like putting a bowling ball on one side, and if you're eating your fresh fruits and veggies and whole grains and leading proteins, that's like putting marbles.

On the other side, well, if you put enough marbles, you will balance out, and that means you can have these things from time to time. But that's where we have to really focus our conversation and getting them involved, having them being an active participant in their wellness is always gonna pay dividends no matter what.

What stage they are in their development because if they know how to make food for themselves, if they know what healthy choices to make, if they know where to go in a grocery store to pick up certain things, these are only gonna put them in a position to empower them to make good choices for the upcoming years and for when they're done being in pediatrics.

Joey (Host): Absolutely. Well folks, we trust you are now more familiar with Picky Eating in Kids. Dr. Bick, valuable information indeed for all of us. Thanks so much again.

Sumon Bhowmick, MD: Thanks again for having me. It was a really good experience. Thanks a

Joey (Host): Same here. For more health and wellness information from our experts, you can visit healthy headlines.org. To find a physician. Please visit novant health.org. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks so much again for being part of Meaningful Medicine, a Novant Health Podcast.