September 2009 Issue

No Peas for Me! — Helping Parents Combat Kids’ Picky Eating Behaviors
By Lindsey Getz
Today’s Dietitian
Vol. 11 No. 9 P. 40

A child secretly shoves her peas beneath a pile of mashed potatoes when told she must finish all of her vegetables. Another feeds his carrots to the family dog under the table. These are familiar and even laughable scenarios that often play out on television shows and in movies—and perhaps even more so in everyday life. Yet, for many parents, their child’s picky eating doesn’t seem so funny. They worry about daily nutritional needs and wonder if the behavior is something about which they should be concerned. If you have clients asking about their children’s picky eating habits, you should be prepared to offer them helpful advice and able to recognize the signs that the situation may be more serious.

While a child’s refusal to eat certain foods may stress parents, picky eating is, in most cases, a normal part of development. In fact, what’s often considered difficult behavior may actually be unavoidable human nature. Humans are biologically programmed to be cautious about new foods until it’s confirmed they are safe to eat. This is especially true of bitter foods, which people instinctively shy away from since poison has a bitter flavor. Unfortunately, many vegetables also have a bitter taste. As a result, a child shuddering or making a horrible face the first time he or she tries a new vegetable is a very normal reaction.

Parents need to realize that persistence counts, even though the initial reaction will likely be negative. “It can take as many as 20 different attempts at introducing a new food before a child will even try it,” says Amy Podmolik, MS, RD, CD, CDE, of UW Health, the academic medical center and health system for the University of Wisconsin. “In order to feel comfortable eating something, the child often has to become familiar with it. So make sure the food is visible. Maybe just have it on the table and available to them. The problem is that so many parents offer something, the child rejects it, and then it never shows up again.”

Of course, it’s not always the taste that turns kids off from particular foods. It’s often the texture, says Linda Piette, MS, RD, a pediatric nutritionist and author of Just Two More Bites! “Texture, the tactile dimension of food when it enters the mouth, is important because it determines how hard or easy a food is to eat and because some children are surprisingly sensitive to it,” she wrote in her book.

Since the move from liquids to solids can be a large leap for young children, Piette recommends that parents make movements from one texture to the next in very small increments. She includes a “Food Texture Progression” chart in her book that shows the normal texture steps children make as they learn to eat different foods. Liquids progress from thick to thin while purées progress from watery to pastelike, then smooth to gritty, and finally to thick and lumpy. Next, a child should move on to “crunch and crumble” foods, which are dry solids in uniform texture that dissolve when wet (think Cheerios) and then on to moist solids (like bananas). This progression continues until children are eating all foods, often not until after the age of 3, when they are able to eat the final food category of hard solid foods (eg, nuts, popcorn, raw vegetables). The key for parents to remember as their child progresses is to take it slow, gradually introducing new textures and not surrendering at the first sign of rejection.

There will be cases in which a child will simply never accept a certain food. As long as their refusal doesn’t involve all foods, it’s generally not a problem. A child may reject asparagus, but as long as he or she doesn’t refuse all vegetables, parents shouldn’t feel tremendous concern. If they have made many attempts to introduce a food that their child continually rejects, they should consider giving up the fight. “If there’s something that’s extremely unpalatable for a child, whether it’s the texture, odor, or taste, parents eventually need to respect that and move on,” says Podmolik. “It may happen that there are just certain foods the child will never like. If it’s clear the child finds that particular food completely repugnant and the parents keep pushing it, they risk ruining a feeding relationship with that child, and a good relationship is so important when it comes to introducing new foods.”

When There’s More to It
In most cases, picky eating is a normal part of development. But it’s important to note that there are times when there’s something more going on. It can often be a challenge for dietitians to recognize whether the child’s picky eating is more than a typical developmental behavior based on a parent’s account alone. Many parents can be overly concerned about or even exaggerate the symptoms of their child’s eating habits. But it is important to pay attention to potential signs that there’s more to the child’s behavior than fussiness.

One way to gather some helpful data from your clients is to ask them to make a list of all of the foods their child is eating. “A picky eater may accept 30 or more different foods,” says Maggie McHugh, MS, RD, CDN, cofounder of Eating for You (and baby too), Inc. “If the child is accepting less than 20 foods, the parent and dietitian should be concerned the behavior is beyond being picky. Some problem feeders may only accept five to 10 foods.”

McHugh adds that there are some other telltale signs that RDs shouldn’t ignore. “A problem feeder may gag or vomit at the sight of food without even touching or tasting it,” she says. “Also, if you were to put a new food on the plate of a picky eater, they would likely ignore it or whine, but the problem feeder would not eat anything on the entire plate because of that food being there. Problem feeders may also reject mealtime altogether.”

Besides serious behavioral or psychological issues that need to be addressed, food allergies and digestive problems are two other and more serious reasons why kids may be turned off by foods. “The kids most likely to be fussy eaters are those who suffer intestinal reactions soon after eating a problem food,” wrote Piette in Just Two More Bites! “Intestinal reactions include vomiting, nausea, stomach cramps, indigestion, and diarrhea.” If a more serious behavioral or psychological issue or a physical complication is suspected, it’s important to work closely with the parents, and perhaps even the family doctor or allergist, to resolve the issue so that normal eating can resume.

Tips for Parents of Picky Eaters
Since many parents who come to you in need of professional advice do not have a child with a more serious problem, it’s helpful to have some tips and tricks you can share with them. Getting their child to try new foods can often feel like a chore, but parents can make that challenge easier by using certain strategies. Consider sharing some of the following advice with those clients who are struggling with a picky eater at home.

1. Don’t become a short order cook.
If a child is refusing to eat certain foods, parents may be tempted to provide a separate meal, but that only gives in to the behavior. “Giving your child too many options for meals only complicates matters,” says McHugh. “I work with so many parents that are so concerned with their kids’ eating that they’ll give them anything. Kids are smart. If they know you’ll make them something else they already like, they’ll never take the opportunity to try new foods.”

2. Make mealtime a sit-down event.
When kids are constantly eating on the go, they get used to fast-food items and other foods that can be easily taken on the road. These typically do not include a variety of fruits and vegetables. Plus, getting kids used to eating meals at the table gives them the opportunity to try new foods. “When my grandson sits down for a formal meal, he’s a great eater and will try new foods,” says Podmolik. “But if he was offered those same foods on the run, he wouldn’t try them. When you make mealtime a sit-down event, it also allows more learning and interaction to happen about the foods being eaten, something that couldn’t happen if you’re always eating on the road or not as a family.”

3. Plan your snacks.
Allowing kids to graze all day long is an easy way to ensure that they won’t be hungry when it comes time for dinner. And a child who’s not hungry is definitely not going to be willing to try new foods. “Separate snacks from meals and make snack time a planned, sit-down event,” advises Podmolik. “When there’s not a plan to the end of the snack is when the problems occur.” A good planned snack to recommend to parents may be a measured baggie of trail mix or one stick of string cheese. And there should be at least an hour or two between a snack and a meal to allow time for the child to become hungry again.

4. Don’t make a big issue of it.
Try to help your clients realize that they need to relax a little. Besides raising their own stress level, making a big fuss over a picky eater can be unproductive. “Parents and professionals aren’t always aware that you should never talk about a child’s eating behavior in front of them,” warns Piette. “Even before they can talk, they understand that they’re getting attention. If a child realizes that refusing a food gets them a lot of attention, they’re going to keep doing it, especially at a younger age. At that age, they love any attention they can get.”

5. Make it fun.
Sparking kids’ interest in eating new foods could be as simple as reading to them. McHugh recommends three books that may specifically help kids with the idea of trying new foods: I Will Never Not Ever Eat a Tomato by Lauren Child, The Seven Silly Eaters by Mary Ann Hoberman, and the classic Green Eggs and Ham by Dr. Seuss. McHugh also says parents can try to make the experience of trying foods fun by turning it into a game. “Consider making it ‘Red Day,’” she suggests. “You and the kids have to wear red all day and pick out a red fruit or vegetable from the grocery store.” McHugh adds that involving the kids in choosing the foods, and maybe even helping to cook them, can also spark their interest and is another way to build familiarity with a new food.

6. Hide the ingredients.
Parents can easily get their kids to eat more fruits and vegetables by hiding them in foods they already enjoy. It’s becoming a popular method with parents who want to avoid the stress of pleading with their picky eaters. In fact, author Missy Chase Lapine’s cookbook The Sneaky Chef: Simple Strategies for Hiding Healthy Foods in Kids’ Favorite Meals has recently topped the best-seller list. In it, Lapine teaches parents to conceal puréed fruits and vegetables in some kid-friendly favorites (see sidebar for some sample recipes). While it’s a great way to get kids to fulfill their daily servings, it’s important that parents recognize that this should not be their only approach to encouraging healthy eating. Kids need to acquire a taste for fruits and vegetables alone so that they don’t grow up avoiding them.

“Sneaking in extra servings of fruits and vegetables is a great way to boost the child’s daily quantity and give parents some peace of mind,” says McHugh. “But it’s still important to encourage kids to try new fruits and vegetables on their own.”

Provide a Fresh Perspective
Though picky eating is a normal part of development, there’s no question that it can be a frustrating stage for parents to overcome. And while parents may be exhausted by their fussy eaters by the time they come to you, hopefully you can refresh them with some new strategies. Healthy eating has lifelong importance, and the earlier kids can learn to embrace their fruits and vegetables, the better.

— Lindsey Getz is a freelance writer based in Royersford, Pa.


Super Sneaky
If your clients are struggling mightily with getting their kids to meet their daily fruit and vegetable requirements, The Sneaky Chef: Simple Strategies for Hiding Healthy Foods in Kids’ Favorite Meals may be a helpful book to recommend. The book starts out with a series of “make-ahead” recipes that can be produced in larger quantities and then stored until needed. These recipes are the healthy additions that will give a nutritional boost to some traditional meals and include various fruit and vegetable purées, typically named after their color.

We’ve included two recipes that make use of the make-ahead recipe for White Puree. They’re so yummy that the kids will never recognize the secret ingredients hidden inside!

White Puree

Makes about 2 cups

2 cups cauliflower, cut into florets
2 small to medium zucchini, peeled and roughly chopped
1 tsp fresh lemon juice
3 to 4 T water, if necessary

Steam cauliflower in a vegetable steamer over 2 inches of water, using a tightly covered pot, for about 10 to 12 minutes until very tender. Alternatively, place cauliflower in a microwave-safe bowl, cover with water, and microwave on high for 8 to 10 minutes until very tender.

While waiting for the cauliflower to finish steaming, start to pulse the raw peeled zucchini with the lemon juice only (no water at this point). Drain the cooked cauliflower. Working in batches if necessary, add it to the pulsed zucchini in the bowl of the food processor with 2 T water. Puree on high until smooth. Stop occasionally and push contents from the top to the bottom. If necessary, add the rest of the water to make a smooth puree.

Double the recipe if you want to store even more, which can be done in the refrigerator for up to three days, or freeze 1⁄4-cup portions in sealed plastic bags or small plastic containers.

Nutrient Analysis per 1⁄4 cup:
Calories: 14
Protein: 1 g
Carbs: 3 g
Total Fat: 0 g
Sat Fat: 0 g
Trans Fat: 0 g
Cholesterol: 0 mg
Sodium: 11 mg
Fiber: 1 g


Masterful Mac ‘n’ Cheese

Makes 4 to 6 servings

1⁄2 lb macaroni (preferably whole wheat blend)
1 1⁄2 cups milk
1⁄4 to 1⁄2 cup White Puree
1⁄2 tsp salt
2 cups grated low-fat cheddar cheese
Optional extra boost: 2 large eggs

Preheat oven to 375˚F. Butter a 9-inch square baking pan. Bring a large pot of salted water to a boil over high heat. Add the macaroni and cook according to the package directions until firm and slightly undercooked. Drain and set aside.

In a large bowl, whisk the milk with the White Puree and salt. If using eggs, whisk them in with the milk mixture. Put half of the macaroni into the baking pan and top with half of the cheddar cheese. Next layer with the rest of the macaroni and then pour the milk mixture over the top, finishing with the last of the cheese on top.

Bake casserole 30 to 35 minutes or until golden and bubbly.

Nutrient Analysis per serving (based on 6 servings with 2% milk and 1⁄4 cup of puree; with 2 eggs in parentheses):
Calories: 271 (295)
Protein: 17 g (19)
Carbs: 33 g (33)
Total Fat: 10 g (11)
Sat Fat: 6 g (6)
Trans Fat: 0 g (0)
Cholesterol: 32 mg (102)
Sodium: 530 mg (554)
Fiber: 3 g (3)


Camouflage Joes

Makes 6 to 8 sandwiches

1 T extra-virgin olive oil
1 medium onion, pureed or very finely chopped
1 lb lean ground beef or turkey
1⁄4 tsp salt
1 can (10 3⁄4 oz) tomato soup, condensed
1⁄4 cup ketchup
1⁄4 to 1⁄2 cup White Puree
4 to 6 hamburger buns (preferably whole wheat)

Heat oil over medium heat in a deep skillet or earthenware pot. Cook the onions until they are slightly translucent and then add the beef, stirring to break it up, cooking about 5 minutes until the beef is no longer red. Add the salt, tomato soup, ketchup, and White Puree. Reduce heat to low and simmer about 5 to 10 minutes, stirring occasionally until the ingredients are well combined. Ladle generously over warm hamburger buns.

Nutrient Analysis per serving (based on 8 servings with 5% fat ground beef and 1⁄4 cup of puree):
Calories: 216
Protein: 16 g
Carbs: 25 g
Total Fat: 6 g
Sat Fat: 2 g
Trans Fat: 0 g
Cholesterol: 35 mg
Sodium: 560 mg
Fiber: 3 g

— Recipes used with permission from The Sneaky Chef: Simple Strategies for Hiding Healthy Foods in Kids’ Favorite Meals