I’m excited about the newly released book: Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion and Feeding Disorders. Katja Rowell has teamed up with Jennifer McGlothlin to fill a real void out there for struggling kids and parents. Their book is research-based, extensive and written in a supportive way. But instead of me going on about it, I asked the authors to answer the most frequent questions I receive from parents.
What is the telltale sign(s) a child’s picky eating is extreme and not just the typical eating stage that many children go through?
Perhaps the most important sign is the child’s attitude around eating and food. Does she get overly upset about new foods, or entire food groups? Is she missing out socially because of food? Is your family meal a battleground or negotiation session rather than a time to enjoy each other and share food?
Has your preschooler never eaten a single vegetable or fruit? Does your toddler gag regularly or have trouble chewing or manipulating foods in his mouth? Does he pass on all meats except those that require little chewing (think nuggets)? Has he struggled from the beginning or did he eat well until 18 months and then begin whining for favored foods? Does he seek out or avoid certain sensory qualities: only wanting spicy or salty foods, or preferring crunch and avoiding soft, moist foods? These are all indications that parents may be dealing with more than typical picky eating.
There is almost always an underlying reason that starts a child and his parents down the path of feeding difficulties. We encourage parents to gain a deeper understanding of where their child is coming from and have divided common challenges into five basic categories— from the child’s point of view.
- Medical: “It hurts! It doesn’t feel good!”
- Oral Motor: “I can’t”
- Sensory: “I don’t like how this feels/tastes/looks/sounds. I’m uncomfortable.”
- Temperament and Mood: “I don’t want to! I want to do it my way.”
- Negative Experiences: “I’m scared _______ will happen again.”
Generally, if a parent is spending a lot of time and energy trying to get a child to eat more or different foods, then it is likely more than just typical picky eating.
I often hear from parents that they have tried the soft approach (DOR) and more forceful types, only to throw in the towel. Can you describe your approach for dealing with extreme picky eating and what realistic success looks like?
We believe strongly that pressuring, bribing, and coercing is counterproductive for the overwhelming majority of children. The Division of Responsibility is the foundation of our STEPs+ approach, with the what, when, and where up to the parents and the child choosing whether and how much to eat (always with at least one safe option available). However, if a child is panicking or gagging around new foods, or is “underweight”, this feels hard to put into practice. Our book explains in detail how to make the transition with 5 key steps to support a child’s eating:
Step 1: Decrease stress, anxiety (yours and your child’s), and power struggles
Step 2: Establish a routine
Step 3: Enjoy pleasant family meals
Step 4: Build skills in “what” and “how” to feed
Step 5: Strengthen and support oral motor and sensory skills with specific therapy based tips at home.
Parents may have a hard time letting go of bribing, or pushing ounces or vegetables. It all boils down to trust, and parents can have a hard time trusting their children to eat well— understandably! Many parents have been told that their child “can’t” sense hunger, or that “only neurotypical” children can be trusted with eating. This is not supported by research, and many children have never had the opportunity and support to tune in to appetite.
Parents need to be encouraged to respond to their child’s unique needs while nurturing and facilitating progress, even with more than one challenge. For example, we suggest ways to wean from distractions like iPads, how to introduce and bridge to new flavors and textures, how to ease a child into a routine if he’s used to sipping Pediasure all day… Our strategies are centered around relationship-building, feel better than fighting over every bite, and won’t feel like therapy!
For children with medical, oral motor, or sensory challenges, involving a skilled feeding therapist to help your child build skills can speed up progress. We review different therapy approaches, how to find a therapy partner, and red flags for counterproductive therapy.
Parents who are unsure of the process, or who want their child eating five new foods by Friday will likely be disappointed, throw in the towel and resort to pressure. If anxiety and gagging are entrenched, or there has been a lot of pressure and even force-feeding, the healing process takes months (occasionally years). If parents only follow parts of the approach, while still forcing certain foods, this slows or stops the rebuilding of trust.
Negotiating, bribes and pressure increase anxiety. (“How many bites will I have to eat of X tonight?” or “Will I gag if they make me eat one bite of cherry tomato?”…) Anxiety decreases appetite, so creating a situation where the child feels comfortable and safe at the table goes a long way to improving a child’s ability to tune in to hunger signals and eat to fullness. If a child has butterflies in her stomach, there’s no room for food!
The first glimmer of progress parents need to look for is not how many bites or how much green smoothie a child sips, but the attitude around food. With progress, parents begin to trust their child around food. Parents notice less anxiety, more calm moments and smiles at the table, and a willingness to be around unfamiliar foods. Then the child expresses curiosity about foods, and later begins to engage with new foods, eventually asking to try some, or slipping it onto their plate. We’ve had children try new foods and discover hunger cues within a matter of days, while for others it may take a while— but the lifelong relationship they are building with food will pay off in the end. Attitude has to improve before the child feels safe to branch out.
Once you decide a course of action, how can you get other family members on board (spouses/ex-spouses, daycare/school staff and relatives)?
We often see one parent who believes in and wants to follow the STEPs+ approach, while the other is unsure or worried, or there are skeptical grandparents. Learn as much as you can and address fears. (Maybe your child is getting more than enough protein, or a supplement with snack can fill in a nutrition gap while you are waiting for eating to improve). Find support from other parents; Mealtime Hostage has a private forum on Facebook that is an excellent resource.
With that said, helping others come to the same understanding is difficult. It can help to ask them to “follow your lead”. Many families find that allowing one parent/caregiver to take the lead works well. Before you make big changes, review what you have tried so far and how things are now. (Our book includes several “food for thought” exercises to help with these discussions.) If nothing you have tried has helped and may have made matters worse, agreeing on the need for a new approach is a start.
Sharing objective information (articles, books, blog posts) helps explain what you are doing (and why) in a non-emotional way. Most importantly, sharing progress (no matter how insignificant it seems) helps everyone see how the new approach is helping.
- your son stayed calmly at the table while you sat next to him eating stew where a few weeks ago he would have cried and gagged
- he came happily to the table without complaint or anxiety about what he would eat
- he passed the beans without gagging or complaining
- he asked about a new food
- he sampled a new food at school
Keeping a journal is a great way to track progress. (Chapter 9 reviews what the stages of progress looks like and what to expect.)