Reprinted from the April 2011 edition of GGMG Magazine. GGMG is a club of 4500 Moms in San Francisco (www.ggmg.org).
— By Vicky Keston
“No. I want milk cereal.” Your toddler forcefully slides his plate away, catapulting it over the edge of the table. You made another home cooked, nutritious meal that your toddler refuses to try, even though he loved it last month. You picture your future adult child eating only pizza and mac and cheese and worry about a future of obesity, type II diabetes, heart disease and more.
For mothers who have picky eaters, what can you do today? And for those mothers who are just starting solids, what should you keep in mind as you introduce your child to different foods?
What is picky eating?
According to both the Dr. Sears Baby Book and many experienced moms, picky eating is a normal toddler phase. Your toddler may want nothing but peanut butter sandwiches one week and binge on tangerines the next. While eating tremendous amounts one day and virtually nothing on another may cause your heart to ache, the overall weekly calorie intake is the most important factor. So if you’re frustrated about what your child consumes on any particular day, think about it as one day out of a period of a week.
Picky eating ranges from typical toddler suspicion of new foods to severe feeding issues. According to Stephanie Hsai, a feeding therapist at the CPMC Feeding Clinic, “A picky eater is a child you accepts around 30 foods. A problem feeder is a child you accepts around 20 foods.” If your child is anything like mine, you’re already jotting down your list of basics: peanut butter, jelly, bread, pasta and goldfish. Some of this will depend on personality, as mom Lisa Danielpour can attest: “My older son would only eat kid food from day one, while my younger son loved everything. But even my younger son had a picky phase in elementary school when he started eating in the school cafeteria.”
While some children grow out of picky eating, most moms wonder whether they should seek professional help in the interim. Noelle Cochran of Symbio suggests that children who have severe feeding issues most likely have experienced feeding problems since infancy. Get advice if you feel stuck, if the situation has lasted longer than 3-6 weeks and seems to be betting worse, not better. Gag and reflux problems are usually longer term and can require assistance so trust your gut on whether it’s a phase or something more significant.
For children who need interventions, Stephanie Hsai, a feeding therapist at the CPMC Feeding Clinic, looks at three major issues: weight problems, poor variety or texture difficulties. Some clinics, like CPMC, pay close attention to a child who is below the fifth percentile for weight, especially those experiencing substantial decline after transition to solids. Other physicians focus on the consistency of the weight percentile; if your child has always been fifth percentile, then there’s likely no need for concern. According to Dr. Sears, other signs of nutritional deficiency include brittle hair, nail or teeth, loosely attached skin, dull eyes, cracked lips, bleeding gums, bowed legs or swollen feet.
For picky children, there are some things you can try at home. And if you need outside help, seek the advice of a professional.
What can you do at home?
First and foremost, don’t make eating a battle, or you will lose. Surely you know this, but how many times are you tempted to trade Dora for a brussels sprout? Children pick up on our tension, and we never win a power struggle over food.
Give your your child healthy choices and involve them in feeding decisions. As stated in Child of Mine: Feeding with Love and Good Sense by Ellyn Satter, “You (as parent) are responsible for the WHAT, WHEN and WHERE of feeding. Your child is responsible for the HOW MUCH and WHETHER of eating.” Respecting and creating space for your child to have a choice in feeding themselves is key to avoiding a power struggle.
Most experts recommend family meals so that your child can learn from you. Allow him to steal food from your plate, and serve him a plate with small portions of healthy foods since larger portions can overwhelm your child. Ms. Hsai suggests letting your child feed you so that he can be involved. Once your child is able, ask him to help prepare meals by adding ingredients to the mixing bowl, pushing a button on the food processor or standing on a chair to watch you cook. If you have time and space, start a vegetable garden or mini-garden in a window box together.
Dr. Sears recommends a nibble tray with healthy snacks cut into attractive shapes, such as apple moons, avocado boats, banana wheels, o-shaped cereal and broccoli trees. Don’t forget dips, such as hummus, yogurt or guacamole.
Vegetables tend to be tastier sautéed versus steamed, and sauces are an old trick for camouflage. My personal favorites are marinara or peanut sauce. Many moms hide vegetable purees in pancakes. Consider your child’s temperament when choosing foods, advises Ms. Cochran. Some children experience taste more strongly and will need milder foods. Also consider whether a major life change, such as a new sibling or move, is contributing to the problem.
Stacy Passman, GGMG mom of three, recommends a play date with a good eater around the same age or slightly older, as peer pressure can sway the picky eater. Ms. Hsai suggests a picnic, either outside or even indoors with a sheet and stuffed animals, as a reset to allow a positive experience with food.
Many toddlers prefer to self feed and most love to feed their parents. GGMG moms in our forums recommend fun finger foods like slices of French toast, pancakes, short pasta (such as penne or ravioli) and o-shaped cereal. Pouches from Plum Organics and Ella’s Kitchen are often successful as well. For the child still learning to use the spoon, Greek yogurt is an easy practice food because it sticks to the spoon. Favor whole grains like whole wheat bread, pasta and brown rice which have high amounts of fiber, protein and vitamins.
While most children go through a picky stage, lots of variety, lots of choices and creating a positive eating atmosphere free of struggles goes a long way.
“First and foremost, don’t make eating a battle, or you will lose.”
Introduce a Variety of Solids
Remember that whatever strategy you choose, most children go through a picky stage. However, most experts do suggest that you expose your children to many textures and flavors from the onset. Ms Hsai suggests allowing your child to play with the food to learn about texture and enjoy the process. To that end, my mother (and many grandparents) suggests using two spoons, one for you and one for the baby. Even babies like to have some (perceived) control.
Many families start with purees. You can purchase them in the store, but you can easily make them at home. Williams Sonoma makes the Beaba Babycook, but a hand held or standard blender can do the same job at a lower price tag. Make large quantities and freeze them in ice cube trays. Making your own purees also allows you to control the texture and reduce the amount of preservatives needed.
Many GGMG moms suggest pureeing something similar to what you’re eating for dinner, so that your child can enjoy the same complex flavors as you do. Bland is not the ideal. My son enjoyed pureed zucchini, sautéed first in olive oil. Many moms swear by adding herbs and spices to add flavor; others skip the seasonings so that the child can taste subtle flavors. It can take several tries before a baby will like a food, so try again later if he rejects it at first.
Other moms avoid rice cereal and skip directly to vegetables, avocados and other purees. While cereals are fortified with iron, there are alternative sources like black strap molasses or meats. Whichever order you choose, be sure to introduce a variety of flavors.
An alternative practice is Baby Led Weaning (or BLW), which skips the purees in favor of whole foods. During family meals, the baby is encouraged to eat with her hands, and the food on her plate is a size that’s easy to pick up with her whole fist, typically at least 2 inches long. Typical first foods include broccoli florets (favored for its natural handle) and bananas. Playing with food is as important as eating. Throughout the process, the baby leads the way, both in the amount of solids consumed and the amount of breastmilk or formula. While this method may be messier, spoon-feeding is never super neat.
Ms. Cochran suggests considering your child’s temperament when choosing a method. Some babies have strong initiative and will want to do it themselves. Other babies won’t eat unless you feed them. If your child has texture issues, then purees are better.
With any method, watch out for allergenic foods and consult your pediatrician if you suspect a reaction. Waiting three days between new foods is typical advice for pinpointing allergies. Also beware of choke hazards, such as hot dogs and grapes, which should be sliced lengthwise for safety. Avoid salt and processed (table) sugar. Offer a sippy cup of water with all solids to avoid constipation.
Most of all, do what you can to take the pressure off and remember to have fun because your child will pick up on any negative feelings you are experiencing. If you think eating solids can be fun, so will he.
The Baby Book, Chapter 13, by William Sears and Martha Sears
Child of Mine: Feeding with Love and Good Sense by Ellyn Satter
Baby-Led Weaning: The Essential Guide to Introducing Solid Foods-and Helping Your Baby to Grow Up a Happy and Confident Eater by Gill Rapley and Tracey Murkett
Cooking for Baby, Williams Sonoma/Lisa Barnes
Baby Led Weaning (www.babyledweaning.com)
Resources in San Francisco:
CPMC Feeding Clinic, an interdisciplinary center with feeding therapists, gastroenterologists, a nutritionist and psychologist. Accepts insurance. Hsai offers a parent workshop called “My Mealtimes, Make It Fun.” (415.600.2378)
Noelle Cochran and Lele Diamond of Symbio, offer feeding therapy and other behavioral consultations (www.symbiosf.com).
Jennifer Katz, Speech Therapist in Noe Valley does 1:1 feeding therapy. Accepts insurance (www.katzspeech.com).
Dr. Meeta Patel specializes in children with severe problems (www.clinic4kidz.com).