Parents often watch with delight as their baby tries everything from asparagus to avocado for the first time. That doesn’t always last for long.
“Parents will say, ‘My kid is a great eater because they’ll eat every fruit and vegetable,’ but it’s a bit of a honeymoon period because picky eating starts around age 15 months,” says Yale New Haven Children’s Hospital pediatric gastroenterologist Danya Rosen, MD, Assistant Professor of Pediatrics at Yale School of Medicine.
Families don’t have to struggle alone. Various resources can help address the causes of picky eating and ensure kids are getting the nutrients they need.
What causes picky eating?
There are many reasons why toddlers become picky. Growth slows down around age one and kids no longer need the same number of calories they previously needed. It’s also developmentally appropriate for toddlers to want to exert control over their surroundings. Often food intake is one of the few places where they can be in charge.
Sometime underlying medical issues include constipation, which is common in toddlers, reflux or an allergy can contribute to picky eating. Kids with sensory concerns may have difficulty trying new foods or eating in certain environments.
Avoidant/restrictive food intake disorder or ARFID is a rare diagnosis that falls outside the category of common picky eating, in which patients will only eat very select foods. Both can lead to nutritional deficiencies, impact growth and development.
Help with picky eating
Parents concerned about picky eating should first speak with their pediatrician, who can evaluate their child’s growth and make recommendations for the next steps. Dr. Rosen sees patients at the Pediatric Specialty Clinic in Greenwich in a monthly feeding clinic that includes an evaluation with a speech language pathologist (SLP), and a pediatric dietitian.
“We can get a detailed look at a child’s intake and compare it to what their estimated needs are,” said Yale New Haven Children’s Hospital clinical dietitian Jacqueline Ballou, MS, RD, CDN, who works alongside Dr. Rosen. “That can be very reassuring if a parent is worried about protein or iron or certain nutrients. We can order labs and try and bridge the gaps either with foods toddlers like or with supplements.”
“It is hard if you have a child you need to feed and they don’t want to eat or they’ve very limited and it can make meal times stressful,” said Dr. Rosen. “Seeking help sooner rather than later is helpful because we help provide some strategies to reduce some of that stress.”
Even with clinical support, picky eating will not be reversed instantly.
“It’s a marathon, not a sprint,” said Yale New Haven Children’s Hospital pediatric dietitian Kristen Smaldone, MS, RD, CSP, CD-N. “When meeting with families It’s about providing foundational education and support while providing different opportunities for kids to engage and explore.”
Addressing picky eating at home
Exploring food in a stress-free environment is crucial as parents work with their kids at home. To achieve this, look for opportunities to make mealtimes a positive experience. Eat together as a family when you can, allow kids to “play” with their food, and serve dishes “family style” in the middle of the table so they can pick something they like themselves. Some other tips include:
- Offering new or more nutritious foods at snack times if dinner is a battle.
- Reduce how much a child is grazing on snacks throughout the day to ensure they’re hungry for meals.
- Incorporating veggies in dishes can help get some extra nutrition, but parents should continue to offer foods in their whole form.
- Offer veggies with dips such as guacamole, ketchup or ranch to give kids an opportunity to interact with their food.
- Create opportunities to engage with food outside of mealtimes such as creating a vegetable garden or going to the grocery store together.
- Don’t forget to celebrate small victories.
“Some of the early wins that I see in making these changes would be kids wanting to come to the table for dinner as opposed to avoiding it or not wanting to sit down,” said Ballou.
With time, parents may be surprised by the changes they can achieve.
“It’s not about perfection, just consistency,” said Smaldone. “The goal is positive mealtime experiences and positive food exposures. Meet the child where they’re at. The second we pressure; it tends to backfire.”
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