Ask the Doc: Picky Eating

picky eating picky eating

Approved by the What’s Up Moms Medical Advisory Board

My child is such a picky eater. How can I get him to eat new/healthier foods?”

Although some parents get blessed with that miraculous child who devours whatever’s in their path (sushi! Brussels sprouts! foie gras!), most of us face this question at some point. In fact, the rejection of new/unfamiliar foods is a normal developmental stage, typically most intense between ages 2-6 (not all milestones can be as exciting as a child’s first steps!). While there’s no magic formula for turning children into adventurous and healthy eaters, there’s an emerging field of medical research that sheds some light onto what works well and what might not.

Some surprisingly unhelpful strategies:

  • Telling your child to eat – This one is counterintuitive, I know. But a recent study from Switzerland looked at 60 families with toddlers and video recorded multiple mealtime interactions looking for associations with picky eating. Turns out that more prompts to eat of any kind were associated with more food refusals.
  • Bargaining with dessert – “If you eat all your broccoli, then you get dessert.” This works in the short run, but can end up sending the message that healthy foods need to be suffered through while the sweet treats can be enjoyed. Ideally we want to help children enjoy a wide range of foods. While there’s some controversy about whether or not rewards should be offered at all for eating food, some studies indicate that offering rewards such as praise or stickers seems to work better long-term than offering “reward” foods.
  • Sticking with purees until a baby gets teeth and is “ready to chew” – Turns out babies can be developmentally ready to eat “real” food way before they have teeth. If you can mash up the food between your index finger and thumb, then babies can mash it up with their gums. And exposing them to a wide range of textures early on seems to be helpful for their future comfort with various foods. While the trend of Baby-Led Weaning fully embraces this concept and does away with purees entirely, parents who want to start solids in a more conventional way can still start out with purees but also offer more textured foods in addition.
  • Waiting longer to introduce high-allergy foods to help prevent allergies – There’s been a lot of awareness in the past few years about the changing food guidelines but I still see many parents waiting nervously to introduce peanuts, eggs, fish, etc. While you can’t entirely change one’s genetic susceptibility, the evidence is clear: early introduction (around 6 months, sometimes even earlier if there’s a family history of allergies) can help reduce the likelihood of food allergies down the road.

So what IS helpful?

  • Modeling healthy eating habits – This is probably the single most important thing you can do. In that same study with video monitoring of family mealtimes, the most immediate successful prompt was when parents actually ate the novel food themselves. There may not seem to be much payoff right away (like you may still see a ton of food get thrown onto the floor), but this usually leads to children making healthier food choices down the road.
  • Engaging in family meals – Family meals have been shown to correlate with multiple benefits: better mental health in children, better school performance, decreased risk-taking in adolescence, and healthier/less picky eating. Not to mention a chance to ‘model’ as mentioned above. If your family’s schedule doesn’t allow for regular family meals (or if you’re like me and crave the calmness of adult-only dinners later in the evening), get creative about scheduling regular brunches on the weekends, family breakfasts a few times per week, or even just making sure to sit down for a mini-meal with the kids and eating again later.
  • Having kids help with food prep – Some schools have started incorporating gardening into the curriculum because there’s great evidence that when kids are engaged in the growing process, they’re more curious and open about trying vegetables. But for those of you without a green thumb or garden space, it can be as simple as taking them grocery shopping or having them help you prepare meals in the kitchen.
  • Rinse and repeat – Familiarity breeds affection. The more kids are exposed to a food, the more likely they are to try it or suddenly start liking it. It often takes 10-15 exposures to a food before a child will feel comfortable trying it. (In the case of my son, it took about 40-50 episodes of flinging chicken onto the floor before one day he picked it up, ate it, and suddenly decided he loved it. I would never have had the stamina to prepare it so many times if it hadn’t been for the fact that his twin sister LOVED chicken so I always placed some on his plate as well.) So keep at it! You may feel like you’re getting nowhere but progress is happening!

Speaking of twins, it’s worth pointing out that genetics plays a significant role in determining a child’s baseline openness to novel foods. One study from UNC at Chapel Hill looked at 66 pairs of twins ages 4-7, and found that genes explain about 72 percent of the variation among children’s tolerance to new food. So for those of you coming up against some resistance, remember: most children’s pickiness improves as they get older, and practicing the tips above will help you shift their habits in the meantime.

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Dr. Hovav is a board-certified Pediatrician in CA and Fellow of the American Academy of Pediatrics. She lives in Sherman Oaks with her husband and three young children, boy/girl twins and their wanna-be-a-triplet little brother. She can be found caring for patients in Studio City at Beverly Hills Pediatrics -The Valley.