Picky Eaters Unpacked: Causes, Impacts, and Strategies for Management

OVERVIEW OF CONDITION

Fussy eating and picky eating are often interchanged and mean the same thing to some. There is also a category called sensory picky eating, which is possibly the most challenging of the eating categories to manage and treat. Whatever name we call it, if you have a fussy/picky or sensory picky eater you will know that it is a challenge and can cause an enormous amount of concern for most parents. 

CAUSES AND RISK FACTORS

Causes can be as simple as just a toddler or child pushing boundaries and finding their voice or it can be more severe:

Risk factors include but are not limited to: 

1. • Recent acute illness
   • Prematurity 
   • Severe reflux as a baby
   • Traumatic illness or hospitalization 
   • Repeated ear and throat infections
   • Allergies and food intolerances
   • Sensory conditions like autism spectrum disorder or sensory processing disorder

SIGNS AND SYMPTOMS

1. • Have a limited range of foods they will accept. 
   • Refuse to try anything new.
   • Thoroughly examine the food they are served.
   • Can’t handle the colour, textures or smells of certain foods
   • Show strong dislikes for specific foods. 
   • Prefer drinks to food 
   • Show little enjoyment of food
   • Eat very slowly
   • Happy to skip eating. 
   • Display some level of anxiety around eating. 
   • Range of accepted foods keeps narrowing. 
   • Engage in battles over foods with parents.  
   • Are not growing out of it. Parents realise that ‘your child will grow out of it’ advise is not accurate, nor is ‘ starve him and he will eat’.
   • Nutritional outcomes are a concern

DIAGNOSIS

Most children will go through a fussy/picky eating stage where they will limit their food repertoire based on preference or new taste experiences. However these children would generally eat at least one or two foods from each food group. 

A classic time for problems to arise is 18 months old. As a child is more aware of the world, her natural instincts make her more suspicious of new foods. This is actually nature’s way of protecting us from eating food that is potentially harmful. If you’re one of the lucky parents who sailed through weaning, a common time for problems to arise may be during the challenging twos.

Sensory picky eaters often will cut out a whole food group altogether. There is also a common element in their food choices eg all white foods or only soft foods, or only crunchy textures etc.

HOW THE CONDITION IMPACTS QUALITY OF LIFE

Picky/fussy or sensory picky eating can have a huge impact on the relationships within the family. Nutritional impact is also a big concern and can result in poor growth, faltering growth and weight gain as well as inability to regulate blood sugar leading to increased tantrums, meltdowns and poor concentration. 

Picky/fussy eating increases the risk of constipation.

Children who are fussy eaters, may also have poor oral motor skills.

Lastly fussy eating can impact a child’s ability to socialise and enjoy mealtimes. 

 It is important to know that as a parent, this is not your fault. It is much more complex that something you did or didn’t do.

TREATMENT

Try not to get frustrated

Whilst feeding your offspring might seem the most natural and basic duty of a parent, it can be a battle. As picky eating can cause so much emotional stress it’s really important to defuse the situation. patients always ask me. ‘How do I get my child to be healthy if they are not eating a healthy variety of foods’

We know that a well-nourished child wants to eat, so we need to find a way to break the cycle

We need to nourish the child through a process I call nutritional rehab and at the same time we need to take the pressure off feeding.

Set an example

Mealtimes are important for all the family as a focus for communication and bonding. Children mimic their parents so don’t pass on the vegetables unless you want your little one to do the same.

Have a routine

Schedule three meals and a few small snacks throughout the day and stick to it like clockwork. Allocate 30 minutes for meals and then lift the plate whether it’s finished or not, 

Keep trying

As we are hardwired to fear new foods, children like the foods that are most familiar to them. If at first you don’t succeed you may need to try 10-14 times before they will actually taste it.

Start small

Avoid offering large portions of food. Aim for small portions, which enable them to ask for more, 

Make it fun

Encourage your kids in the preparation of food and make it fun. Be adept at sneaking veg in, concealed in pasta tubes, grated, diced or pureed.

Beware the bribe

If you offer an alternative of chips or sweets, they are sure to perform at the next mealtime knowing you will cave in.

If you have a sensory picky eater the following will assist you: 

• • Address their fears, discuss them openly, and validate, validate, validate! Let them know you understand how hard it is for them to eat certain things and that’s OK
  • To combat these fears, you must go slowly!

Implementing a weekly goal chart system can work nicely for some kids.:

Monday: Smell the food

Tuesday: Kiss the food (or touch to lips)

Wednesday: Lick the food

Thursday: Hold a bite of food in their mouth

Friday: Chew a bite and swallow

Saturday: Reward, reward, reward! For my son, it was a little box car

PEDIASURE SOLUTION

Whole Nutritional supplements, like Pediasure are imperative when managing a picky eater with growth faltering or in a child that has a poor appetite or inconsistent eating..

Initially during a nutritional rehab, a supplement like PediaSure may need to make up around 80% of the required nutritional intake for the child. People are often concerned that giving such a large volume of a supplement may decrease appetite – quite the opposite is true. As the child becomes more nourished their appetite improves greatly. The importance of nutritional rehab is that it is a process where you eventually wean the child down from 80% of the nutritional support and then they start to replace with foods. This however needs to be done in the right way and at the appropriate time normally starting around 3 months post rehab to a few months down the line.

A feeding holiday is put in place to break the emotional cycle of picky eating. During a feeding holiday as a parent you need to take the focus off food in your home. You can offer three small meals and 2-3 small snacks a day and the rest of the time you focus on doing other things outside of feeding. During the feeding holiday the focus on mealtime is socialisation as opposed to feeding. Normally feeding holidays are done simultaneously with nutritional rehab and this gives you peace of mind that your child is getting in nutrition despite poor eating.

During this time also look at your expectations with regards to your child’s feeding behaviour – that is how much and what you are expecting them to eat. Look at voices that may be influencing you. Lastly during a feeding holiday, you must ensure that you offer the healthiest foods that your child will eat. Don’t focus on getting your child to eat and try new foods during this time.