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In this post, I express some thoughts that have been brewing for a few years now. We need health professionals to respond to feeding problems in an informed and supportive way.Read More
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I'm really thrilled to be publishing a guest post from registered nutritionist, Julie Clark. Julie is based in Kent in the UK, and she's a mine of information when it comes to feeding your family.
Julie is tackling the thorny question of how limited eating can impact children's health. She also has some tips for you, about how to address nutritional deficiencies in your child's diet.
One of the tasks that I always ask of my clients is to complete a food diary. This request must be so disheartening to do but it is vital for me to see exactly what nutrition is present in the diet.
The most common foods I see on the food diaries are:
Dry cereal – usually something loaded with sugar
Crackers – usually the least nutritious types such as cream crackers
Chocolate – it seems fussy eaters can eat their weight in chocolate
Custard – I can’t stand custard but this is a popular choice amongst the fussy ones
Sausages – usually a particular type and often the poorer quality brands
Bananas – at last something actually natural
Ella’s Kitchen Pouches – but only the one flavour, usually the sweetest one
Cheese – the more processed the better
Yoghurt – lots of it and the sweeter the better
Chips – frozen, oven ready ones not Mum’s homemade ones
Pizza – but only cheese and tomato sauce on base, nothing else
You get the picture, it’s a very beige looking meal plan.
The problem here is that most fussy eating has progressed from the usual picky stage (around 18 months old) and for whatever reason it had spiralled out of control to the point of very little variation in the diet.
This is where nutrition starts to play its role and you end up in a chicken and egg situation.
Constipation starts to become an issue due to the lack of fibre in the diet but constipation also effects appetite. If you can’t get stuff out you won’t want to put stuff in!
Sleep disturbances become a factor due to the imbalance of foods causing blood sugar issues. The trouble is, sleep disturbances, affect choice of food. The more tired you are the more you will crave carbs and sugar – the beige stuff!
Recurrent illness such as colds start to factor due to the lack of immune supporting nutrients. Being ill reduces your appetite and so you end up going around in circles.
And so it goes on…………..the chicken and the egg, day in and day out!
Having analysed a vast number of fussy eater’s food diaries over the years I have concluded the following with regards nutrition:
There is not always a reduction in calories, in fact most are meeting their calorific requirements by having a preference for high calorie foods, namely sugar and carbs.
There is a lower intake of fruit and vegetables. This results in a lack of broad spectrum vitamins and minerals, anti-oxidants and fibre. All of these are vital for the immune system.
There is a lower intake of wholegrain and fibre. This results in a lack of B-vitamins and magnesium. These nutrients are important to the nervous system.
Lower intake of meat and fish. This results in a lack of protein, iron, zinc and essential fats. These nutrients are key for the immune system, brain function, growth and development.
Diets are high in sugar and salt. This results in far too many problems to list here!
Having low levels of these nutrients is obviously not good. Poor nutrition will play a big part in behaviour and attention span as well as sleep quality, immunity, bowel function and growth.
Nutrients affecting appetite
There are two nutrients that are particularly relevant to helping a fussy eater. Please do not get over excited, this is NOT a magic wand. However, it can help to get things moving in the right direction and is usually the next step after looking at the psychological aspects and the child’s eating environment.
Zinc deficiency affects the appetite. I can usually tell if a child is low in zinc by just looking at them! They are often pale, have dark circles under their eye, are small for their age and look poorly. Zinc is vital for growth and the immune system.
Zinc is found in meat, fish, seafood, flaxseed, pumpkin seeds, spinach and cashew nuts.
It is possible to supplement with zinc but having too much is as bad as not having enough so getting help with this is advisable.
Finding ways to include foods high in zinc can help. I find that using ground seeds and nuts in baked foods can be a good way to increase levels.
Iron is one of the most common nutrient deficiencies found in young children. Low iron levels also affect appetite. Symptoms of iron deficiency in children can include tiredness, breathlessness, poor appetite, repeated infections, unexplained stomach pains and behavioural problems.
Iron is found in meat, seafood, dark leafy greens, dried apricots, black strap molasses, beans and peas. The biggest issue with iron is that it can be easily blocked by other foods and in drinks such as tea and cannot be properly absorbed without the presence of vitamin C (usually deficient in a fussy eater). Calcium also blocks iron absorption as you will see above many fussy eaters drink a lot of milk and eat a lot of yoghurt, custard & cheese!
Iron deficiency can be tested for by speaking to your GP.
I often find that using dried apricots blitzed in a flapjack type recipe with some black strap molasses really helps to improve a fussy eaters iron status.
For those children who avoid all meat and high protein foods it could be that they do not have sufficient stomach acid. Young children can associate the uncomfortable feeling of indigestion with high protein foods. There has been a huge increase in the use of drugs that lower stomach acid i.e. ranitidine and gaviscon. Whenever I see a fussy eater I always take a full history starting right from birth. If reflux was a factor before and during weaning, then I have to consider that the stomach acid may be too low. An early symptom for this may be unexplained stomach pains.
Your child’s craving or food preference can tell you a lot!
The body is very clever and it will often try to seek out and balance any nutrients deficiencies. Looking at the types of food your child prefers can give you a good indication.
Those who eat a lot of cheese & crisps could actually be low in essential fats.
The chocolate cravers are often low in magnesium.
Eating dirt can be sign of low iron.
Anyone with a fussy eater will know that nutrition is important and yet they are trapped by a child who completely refuses anything remotely healthy. I do not know a single parent who isn’t concerned about their child’s diet, especially since you are bombarded by the importance of it on an almost daily basis.
The biggest emotion I see in parents is complete failure.
It is not easy dealing with a fussy eater on a nutrition level.
It takes so much patience and persistence to tackle the initial emotional and psychological issue before moving on to look at specific nutrients and ways to improve the diet. It can be done though with some guidance from specialists like myself and Jo. Lucky for you we can see the wood for the trees.
If you feel you need some nutrition related help with your fussy eater a good place to start is my free Fussy Little Eater Facebook group. You can join by clicking here.
To find out more about Julie simply visit www.julieclarknutrition.co.uk
Having another baby?
How to avoid a fussy eater, free download with my top tips here
Parenting fashions come and go. We have moved from the authoritarian approach that many of my generation grew up with, to a gentler, perhaps more child-focused way of doing things. Reward charts are our go-to response to behaviour we don't want, and they are grounded in a behavioural approach to parenting that has been with us for some years now.
It goes like this: we reward the behaviours we want to see more of (maybe through praise, attention, reward charts or other incentives) and we do the opposite with behaviours we wish our kids would drop. By and large - at least in the short term - this works, although it has been criticised for moving children away from value-driven decision making, amongst other things.
You want your kids to tidy away their toys? You reward them with a sticker on their 'tidy chart'. You want them to get ready for school in the morning with speed an efficiency? You pop a marble in their jar. All of this is about EXTRINSIC not INTRINSIC motivation; it comes from the outside not the inside. And motivating kids to eat in this way, is a huge mistake.
This is because it comes from a misconception of what eating is. Eating is not a behaviour to be modified, it is (or should be) a fundamental response to our bodies' signals. I wrote recently about Ellyn Satter's Division of Responsibility model. This approach to feeding is based on a crucial understanding that we need to help children to self-regulate; to eat in response to their bodies, not because of the adults around them.
Every time we reward a child for eating, we are contributing to the following problems:
- We are increasing the potential for food to be used as a means of testing boundaries, because we are making it so clear that eating certain things is a behaviour we want from our children. If it is up to them what they eat (from within the context of the foods we make available) they are much less likely to engage in attention seeking behaviour, using food.
- We are piling on the pressure. There is a lot of research showing that applying pressure to a food-cautious child will make picky eating worse. It raises anxiety levels and that has a negative impact on eating. However gently we approach reward charts, at some level, the child will be experiencing this as pressure.
- We are interrupting their ability to self-regulate. We need to help children tune in to their body's signals (something many picky eaters struggle with) and listen to their appetite. Pushing them to eat because they will get a reward is not supportive of this at all.
- We are focusing heavily on their eating. It is pretty hard to have a meal that is both relaxed and heavily focused on a child's eating. Children do better when they feel that they are in control. They can calmly make decisions about what they will eat, when they are not in the spot-light. This empowers and relaxes them, which actually makes their eating better.
- We are maybe not even helping them learn to like new foods in the long term. While research points to short term success with reward systems, there is also evidence of things being made worse in the long term
For me, this last point gets to the crux of this question. In order to support psychologically healthy eating, we need to prioritise a positive relationship with food over the short term goal of what is consumed on any particular day or at any particular meal. It's better that your child misses that extra bite of cabbage that would have earned him a sticker, than feels pressured and eats it because he wants the sticker and he wants to please you.
I understand why reward charts seem like a good option - parenting a picky eater is really hard, and for many parents, it is extremely stressful and anxiety-provoking too. Anything that feels like it is giving you back a modicum of control reduces those difficult feelings. Take a step back though. Get your child's health, weight and growth checked to see if you need to be as worried as you are and learn as much as you can about how to support a child's long term positive relationship with food.
Ellyn Satter's Division of Responsibility model is a simple but powerful concept. However - who said simple meant easy?! In this post, I give an overview of DoR and share links to some great resources.Read More
Seeing tricky childhood behaviours as 'just a phase' can be really helpful. For example, one of the key differences for me, in my experience of parenting my first child and my experience of parenting her younger sisters, is that when I was struggling with something with my first born, (such as how hard she found it to share toys, or night-time waking) I felt like it was permanent. There were times when I thought I would have a thirteen year old who hid in a corner, clutching all her toys and screaming "mine" every time another child came over. As it turned out, she was through with this hyper-possessive phase by the age of two and a half, just a few months after it had started.
Research shows that picky eating is indeed a phase in most cases. Almost two thirds of children who become picky at an early age, are no longer picky in three years time. So for most children, picky eating has what scientists call a 'high level of remittance'. In simple language, most kids do grow out of it.
There are a couple of reasons why children who initially eat well, may begin to reject foods. The first is an evolutionary argument, based on the idea that back in our cave-dwelling days, once children became mobile after about 12 months of age, if they learnt not to toddle off and eat brightly coloured and unfamiliar items (think poisonous berries), this would increase their chances of survival.
The second argument is to do with a child's developmental trajectory. From about 18 months, children are all about boundary testing and striving for autonomy. They are learning about what they have control over and are experimenting with the power of the word "No!". It's very easy for these developmentally normal control battles and boundary challenges to take place at the dinner table.
So we know that picky eating is often a temporary behaviour, and it's pretty common too. But I don't think that it is helpful to frame it in this way. Here's three reasons why:
1) While two thirds of children soon grow out of picky eating, if you are the parent of a child in the other third, hearing that it's "just a phase" is infuriating, not only because it dismisses your concerns, but also because in your case, it is plain inaccurate. Picky eating is a very common phenomenon, so one third of picky eaters actually represents A LOT of kids.
2) To write picky eating off as "just a phase" belittles just how tough it can be for parents. 'JUST' = 'only' = 'stop complaining!' Research has shown that the negative impact of picky eating on parents is significant. We eat several times a day every single day - if there are problems in this area, this can really affect daily life, for the whole family.
3) If something is ''just a phase' the implication is that there is nothing we can do about it and we should just ride it out. Even if your child has started to become just a teeny tiny bit picky, there is still much you can do to improve things.
So if your child has suddenly started turning their nose up at the food you are serving, read up about picky eating (my guide to online feeding resources is a great starting point), maybe even go and see a professional (see this post about how to decide when it's time to seek specialist support). Because whether your child's eating issues are temporary or are more complex and longer term, the more you know about how to help them develop a positive relationship with food, the better.
This article is all about helping you recognise the small wins. Grab your free 'snap-shot' tool to give you a bit of perspective on your child's picky eating.Read More
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People pleasing starts young, and it flourishes at the dinner table. In this post, I share my thoughts on children's eating being driven by adult approval.Read More
As parents, we want to understand our children's behaviours in order to better support them. There are many, many causes of picky eating, but in this post I focus on one that is not often spoken of; temperament.Read More
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A British newspaper reported recently that "picky eating is down to genetics and not bad parenting, scientists conclude" but is this what the researchers were really saying?Read More
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Grazing, or offering children frequent (or constant) small eating opportunities, is an easy habit for parents of picky eaters to fall into. In this post, I talk you through why it is worth addressing.Read More
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As we navigate the start of a new school year here in the UK, I ask a teacher for some top tips for working with your child's school to support their eating.Read More