Many of you, I'm sure, have experienced or are experiencing a "picky eater." I get the question "How do I help my child eat what we eat?" almost as much as the "My child doesn't talk yet but do I really have to take her to a therapist?" question. Hopefully some of this information may be helpful for you with your kids.
Background:
There are two types of "feeding disorders" (official term dysphagia), mechanical and sensory. Children can have one or both of these disorders. Sometimes, an aversion may be developed as a response to a physical condition, such as reflux, allergies, or indigestion. These issues should be consulted about with a doctor, as well as considering appropriate diet modifications.
Mechanical dysphagia is less common in children, but all children go through the learning stages of it-this is called "learning to eat." :) Children older than age 2 (possibly even at 18 months) who still drool excessively, have difficulty keeping food in their mouths as they chew (especially piecey food like rice or cooked vegetable bits), or cannot physically chew foods as solid as pretzels, pasta, or chicken nuggets would possibly fall into this category. Certainly, any regular coughing or choking during feeding is of concern as well.
Sensory dysphagia is more along what most people call "picky eaters." For some children, it is so severe that they cannot be in the presence of food without feeling sick. You may be able to relate to that from pregnancy where even the sight of a particular food made you feel so averse to it you had to look away. So, naturally, you avoid that food until it looks good to you again. Sensory dysphagia involves any smell, sight, touch, or taste of a food that produces a negative reaction or aversion in a child.
What can I do about it?
Mechanical dysphagia is best treated by a speech pathologist trained in feeding, and who will train you to work on it at home. Sensory dysphagia may require professional help in the most extreme cases (ie vomiting, persistent refusal of food with subsequent weight loss and malnourishment as a result). However, for picky eaters, usually you can make some small modifications at home to help your child get past it.
1. Evaluate your family's eating habits
Start with looking at what your family eats. Do you eat a lot of one kind of food? Do you have regular mealtimes? How much of your foods and snacks are high in sugar? My favorite thing is parents who complain their child won't eat at mealtimes, and it's because they get a huge snack RIGHT BEFORE dinner? Of COURSE they won't eat if they just had 10 Oreos. Do you do this? Children, just like adults, can easily set their bodies to know when it's mealtime. Just because they're hungry as you're cooking doesn't mean that they need a snack. It just means they smell dinner and their bodies are getting ready to eat. Are they drinking lots of juice, which is sweet and yummy, AND fills their tummy before they can eat anything?
2. Familiarize the child with food:
Starting with sight and touch, have the child experience foods that he/she is averse to. Have him/her help in the kitchen with preparation, let the child play with the food in perhaps a messy way. For example, if your child doesn't like foods with mixed textures (ie, pasta with meat or veggies, casseroles) let them have some dry rice/pasta, and pieces of whatever else you put in it and let them play with it in play dough or something else that could mock sauce. This will help their eyes and hands adjust to the idea of multiple textures in foods (thus eliminating 2 sensory pathways). Be sure to talk about how it feels in your fingers, what different "treasures" you can discover in your mudpile, and praise the child for touching the foods. If you can use the actual food, it is even better. As the child explores the food with their hands, they will become somewhat "desensitized" to it, and may even sneak a bite of something they find. This should definitely be encouraged.
3. Don't be afraid to use flavor!
As adults, we don't always like things with bold flavor, but children do not have as developed olfaction as we do. Sometimes, they can't even taste what is in their mouth. If your child likes sweet, try adding cinnamon or nutmeg to oatmeal, yogurt, pancakes, on toast, to warm milk-anything! If your child likes salty, add curry, paprika, chili powder, or garlic to anything-even what you wouldn't think to put it in (like oatmeal or pancakes, macaroni and cheese). If you cook a dish with any of those spices in it, add extra to your child's serving. The flavor will draw them to it, and drown out anything about it they may not like.
4. Build on what they like
Many parents say, "Well, they really like all these foods..." GREAT! Use them! If they like something, combine it with something they don't like. You may think it's weird to put cereal on spaghetti or ice cream on broccoli, but if it works for them-let them do it! It gives them a sense of control over what they're eating. It also bridges the gap between "will eat" and "won't eat" without you having to make everything "will eats." Ketchup, cheese, syrup, and ranch dressing can become your best friends with almost any meal. Either put it on top, or if they like to dip, give them a dollop and let them do whatever makes them happy. As they begin to eat the new food with more regularity, you can place conditions on it, such as "Eat this one piece first, and then I'll put cheese on it." You can also say, "This first, and banana next." Even very young children can understand that. See #5 below to see varying stages of "forced" eating.
I have tried a few of those pureed vegetable recipes made famous by Jerry Seinfeld's wife. To be honest, I'm not impressed. First, I just didn't like them. Second, I think it is very important to not DISGUISE the unliked food so much that the child is unaware of what they're eating. This is my personal opinion-I don't know that research anywhere supports or disproves it. It can be very easy to add some chopped broccoli or spinach to macaroni and cheese. If your child is like one of mine and doesn't like whole chicken, it can be chopped small and put in mashed potatoes or smothered in ketchup. But the original food is still there, so he knows he's getting chicken.
5. Always force "just one bite"-or not
For some kids who absolutely cannot tolerate a certain food, it is unreasonable to make them eat one bite. That is just going to make a psychological block to the food, and make their aversion worse. In these instances, use this hierarchy:
-touch with hands
-touch the food to their lips
-touch the teeth
-touch the tongue
-touch the tongue for several seconds
-hold the food in the mouth for several seconds, and spit out
-chew the food in the mouth and spit out
THEN, you make the child eat one bite and swallow it. As appropriate you increase the bites. It may sound silly to go through the steps, but I promise this works. Remember to moderate quantities, and they realistically may not eat all you give them. The general rule of thumb for a minimum is 1 tablespoon of each food for each year of age (ie, a 2 year old should do 2 T each of veggie, main dish, and side dish), or somehow a total of 6 T for the meal.
6. Make meal time FUN!
Most of all, there shouldn't be pressure at meal times. It should be a fun time. Some of the best things to do with picky eaters is play with their food. Yes, goes against all manners we have ever learned, but it makes eating seem more like something enjoyable to do when the child doesn't like to do it to begin with. Use cookie cutters for sandwiches, let them choose shapes for pancakes (that you have snuck apples or peaches into to give them varied texture), use food coloring, make sculptures out of pasta or mashed potatoes, throw in some goldfish and make them swim in the tomato soup. There are so many ways to make meal times more enjoyable for the child-which in turn, should make it more enjoyable for you.
7. Praise
Honestly, eating a variety of foods is something we expect our children to do. So, when they do anything that is a major step in broadening their repertoire, STAY CALM! Be sure to give praise, but don't break out in dance and song. They need to know they've done something good, but not be treated like they've won the Olympics because it is EXPECTED for them to eat the food you prepare for them. A quiet, "I am very proud of you for eating that" or "I love the way you held that in your mouth" will give them the appropriate encouragement. And you can anticipate, "I am excited to see you do that again another time."
There is SO much more to this, but this should give you a good start on getting the picky out of eating. If you have specific questions, feel free to email me. Good luck!