Transcription:
Nutrition in Toddlers: Managing Picky Eaters

Bill Klaproth: Many parents are concerned about nutrition, especially with picky eaters. How frustrating is that. So how do you avoid the power struggles and help the picky eater in your family eat a balanced diet? Here to talk with us about nutrition in toddlers and managing picky eaters is Dr. Lila Monahan, a pediatrician at Southern New Hampshire Health. Dr. Monahan, thank you so much for your time. So, are picky eaters created or are they born that way?

Lila H. Monahan, MD, FAAP: That’s a great question. Like a lot of things in medicine and development, it’s a little bit of both. There are definitely temperamental differences in toddlers that may make them a little more likely to be picky eaters, but it’s also a very normal developmental stage that most children will go through, going into a picky stage. We call them food jags, and they're very common in the toddler years.

Bill: Okay. That’s good to know. So, most kids do go through this, but parents still are concerned about nutrition. I’ve got to feed my child, which is only normal. So, they may they turn to things like hey I'm going to force you to eat this food, or make sure you finish all the food on your plate. Is that good thinking or not?

Dr. Monahan: We really encourage parents to do a couple things. One is adopted from Ellyn Satter, who has multiple books on nutrition and kids. It’s called division of responsibility where the parent is in charge of what they're serving, when they're serving, and where they're serving. The child is in charge of what to eat or whether to eat. If parents can keep that division of responsibility in their head, then that can help setup a good relationship both with the parents as well as with the child and good. An example of that is a family is making a meal. Somebody coined the phrase, and I'm not sure who, “one family, one meal”. So rather than short order cooking and giving a meal that just they’ll eat, the whole family is served the same plate of healthy food. Then with that division of responsibility, the child is going to eat some of it. They may eat all of it, they may not eat any of it. So rather than giving in to that picky eating behavior, just trusting the child that they're going to get the nutrition they need.

We know that the more you narrow the choices of a child who’s a picky eater to those foods that you know they like, and it’s a natural instinct. It absolutely makes sense. Why should I feed my child something that I know they're not going to eat? What it actually does is it actually makes that picky eating stage last longer and be harder to break. So, if a child is constantly seeing healthy foods and they whole family is getting the same meal, then they will break out of those picky stages much sooner than a child who gets a traditional child diet.

Bill: Great information. So, if the child doesn’t want to eat, don’t force them and don’t narrow the food choices. So, if my child is pushing the plate away. “I don’t want to eat this mom or dad. I'm not eating this.” Then they don’t eat. Is that kind of it? Because eventually they're going to get hungry and they're going to want to eat. Is that kind of the philosophy behind that?

Dr. Monahan: Yeah, exactly. Without coaxing them to eat, without being at all punitive, just kind of matter of factly give them a little cue that says, “Well if you don’t eat now, we’re not eating again until X.” So, if it’s lunch time, you tell them until after we go to the playground and mommy comes home from work or whatever. Then when they're invariably hungry later, there are a couple strategies. Some parents will have put away the meal that the child didn’t eat and bring it back out. Some parents will just say, “Well that’s too bad that you're hungry now. The good news is we’re going to have dinner in X amount of time or after we read this book or that kind of thing.”

We always, as pediatricians, reassure parents that a typically developing child will not starve themselves. It can feel very difficult as a parent to not give the child the food that you want them to have or not to see them intake the food that you want them to eat, but they really will grow up healthily if parents are presenting a variety of healthy foods and not bribing or cajoling or otherwise trying to get a child to eat.

Bill: I wish I would have met you 20 years ago Dr. Monahan because my wife and I became short order cooks. I think to this day my son still has a limited appetite for certain things. So where were you 20 years ago Dr. Monahan? You were just talking about bribing with desert. A lot of parents do that. “Eat your broccoli and you'll get dessert, you'll get cake.” That is a no-no, right?

Dr. Monahan: It is, it is because what it does is it puts way too much power into non-nutritious highly palatable foods like cookies and cakes and candy and things like that. Because basically a child learns, oh this must be really special stuff because I have to do something else to get it. Then number two, it encourages children to not listen to their own signals of fullness or hunger to be able to get that desired reward. So, it seems counterintuitive, but what we actually recommend with things like dessert is making it not contingent on anything. It shouldn’t be a reward for good behavior. It shouldn’t be a reward for having had a bad day. It shouldn’t be a reward for eating your broccoli or your lean protein. If the family is going to choose to serve dessert, it’s just served.

If it’s a small portion, a child is not going to “fill up on dessert” and not eat their other foods. They may only eat the dessert, but it’s not because they're full from the dessert. It’s because they didn’t like everything else being served and decided, again division of responsibility, “I'm just eating the cookie.” They're going to be hungry later, and they're not going to starve themselves. I've done this in my own house and it’s much easier said than done. It’s very counterintuitive to sit there and go ahead and give the cookie as part of the meal, but it really does work.

Bill: It certainly sounds like it. You said earlier, don’t narrow the food choices. Offer a variety. How should we go about introducing new foods to a child?

Dr. Monahan: So really, right from the get-go, the younger children are when they're introduced to different flavors and textures and tastes, the more readily they’ll accept them as they get older. So, families will often say I don’t give them anything spicy or anything like that. But we know from just even cultural context, there’s some cultures that spice is a part of all of their cooking, or a lot of their cooking, those babies and toddlers grow up with spice in their diet. They like spice in the beginning. There’s nothing wrong with spice.

Likewise, we recommend just even when babies, before they're toddlers when they're first being introduced to solid foods, we have parents go slowly one thing at a time. We also recommend letting the baby put their hands in the food because the hands of a baby at six months—which is when we usually introduce solid foods, naturally go to the mouth. So, they're learning about tastes and textures that way. So basically, good nutrition all along, variety, and it also takes… Studies have shown that it can take 10/15/20/25 different introductions of the same food before a child will develop a taste for it. So not giving up. Just keep serving it over and over and over again.

Bill: That’s very good to know. We also hear about other strategies. Make meal time fun and recruit your child to help with meal preparation. Any quick thoughts on that?

Dr. Monahan: Absolutely. Those are excellent, excellent strategies. Have the child come to the grocery store with you. They get to pick the vegetable of the day or the fruit of the day. You know that kind thing. Have them, in a developmentally and safe way, help prepare meals. Families who have a little garden, whether it’s small or really big, and have the kids involved, those kids tend to love their vegetables because they're growing them.

Bill: I love that. That is so cool. Lastly, you’ve got us on the right path Dr. Monahan. Thank you so much. Do you have any other resources to share with us to help us in this journey with our picky eaters?

Dr. Monahan: I absolutely do. So, first is a wonderful website sponsored by the American Academy of Pediatrics. It’s www.healthychildren.org/growinghealthy. All one word. There are categories on there for babies, toddlers, and preschoolers for the parents. It’s a very interactive website. You get tips from experts as well as tips for common questions as well tips from parents who’ve been through this. I highly recommend playing with that website. Then there are several books I really like. One I alluded to, How to Get Your Child to Eat (But Not Too Much) by Ellyn Satter. Another one is Give Peas A Chance: The Foolproof Guide to Feeding Your Picky Toddler. That’s by Kate Samela. Then the final one is helpful for babies on up. Raising a Healthy, Happy Eater: A Stage by Stage Guide to Setting Your Child on the Path to Adventurous Eating. That’s by Nimali Fernando and Melanie Potock.

Bill: Give peas a chance. I love that. That’s so cool. Well Dr. Monahan, thank you for your time. If you need those books and resources again, this being a podcast, just hit stop, rewind a little bit, and you'll hear all of them again. Dr. Monahan, thank you again for your time. For more information, please visit snhhealth.org. That’s snhhealth.org. This is Simply Healthy, a podcast by Southern New Hampshire Health. I’m Bill Klaproth, thanks for listening.